ReGen Institute Of Orthopaedic
8110059999
riohospitalss@gmail.com
oxford knee score
oxford knee score
Name
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Last Name
Age
*
Phone
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R.I.O ID
*
Email
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How would you describe the pain you usually have from your knee?
None
Very mild
Mild
Moderate
Severe
Have you had any trouble with washing and drying yourself (all over) because of your knee?
No trouble at all
Very little trouble
Moderate trouble
Extreme difficulty
Impossible to do
Have you had any trouble getting in and out of a car or using public transport because of your knee? (which ever you would tend to use)
No trouble at all
Very little trouble
Moderate trouble
Extreme difficulty
Impossible to do
For how long have you been able to walk before pain from your knee becomes severe? (with or without a stick)
No pain/ more than 30 minutes
16 to 30 minutes
5 to 15 minutes
Around the house only
Not at all pain severe when walking
After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your knee?
Not at all painful
Slightly painful
Moderately painful
Very painful
Unbearable
Have you been limping when walking because of your knee?
Rarely/ Never
Sometimes or just at first
Often, not just at first
Most of the time
All of the time
Could you kneel down and get up afterwards?
Yes, Easily
With little difficulty
With moderate difficulty
With extreme difficulty
No Impossible
Have you been troubled by pain from your knee in bed at night?
No nights
Only 1 nights
Some nights
Most nights
Every nights
How much has pain from your knee interfered with your usual work? (including housework)
Not at all
A little bit
Moderately
Greatly
Total
Have you felt that your knee might suddenly “give way” or let you down?
Rarely/ Never
Sometimes or just at first
Often, not just at first
Most of the time
All of the time
Could you do the household shopping on your own?
Yes, Easily
With little difficulty
With moderate difficulty
With extreme difficulty
No Impossible
Could you walk down one flight of stairs?
Yes, Easily
With little difficulty
With moderate difficulty
With extreme difficulty
No Impossible
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