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IKDC Subjective Knee Evaluation Form

1 forms  
General information
Description

General information

Alias
UMLS CUI-1
C1508263
Patient name
Description

Patient name

Data type

text

Alias
UMLS CUI-1
C1299487
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI-1
C0421451
Clinician diagnosis
Description

Clinician diagnosis

Data type

text

Alias
UMLS CUI-1
C0011900
Type of surgery
Description

Type of surgery

Data type

text

Alias
UMLS CUI-1
C0543467
Surgery date
Description

Surgery date

Data type

date

Alias
UMLS CUI-1
C1628561
Symptoms
Description

Symptoms

Alias
UMLS CUI-1
C1457887
What is the highest level of activity that you can perform without significant knee pain? (last week)
Description

What is the highest level of activity that you can perform without significant knee pain? (last week)

Data type

integer

During the past 4 weeks, or since your injury, how often have you had pain?
Description

During the past 4 weeks, or since your injury, how often have you had pain?

Data type

integer

If you have pain, how severe is it?
Description

If you have pain, how severe is it?

Data type

integer

Alias
UMLS CUI-1
C1507013
During the past 4 weeks, or since your injury, how stiff or swollen was your knee?
Description

During the past 4 weeks, or since your injury, how stiff or swollen was your knee?

Data type

integer

Alias
UMLS CUI-1
C0576086
What is the highest level of activity you can perform without significant swelling in your knee?
Description

What is the highest level of activity you can perform without significant swelling in your knee?

Data type

integer

During the past 4 weeks, or since your injury, did your knee lock or catch?
Description

During the past 4 weeks, or since your injury, did your knee lock or catch?

Data type

boolean

Alias
UMLS CUI-1
C0231753
What is the highest level of activity you can perform without significant giving way in your knee?
Description

What is the highest level of activity you can perform without significant giving way in your knee?

Data type

integer

Sports activities
Description

Sports activities

Alias
UMLS CUI-1
C0038039
What is the highest level of activity you can participate in on a regular basis?
Description

What is the highest level of activity you can participate in on a regular basis?

Data type

integer

Alias
UMLS CUI-1
C3694575
How does your knee affect your ability to go up stairs?
Description

How does your knee affect your ability to go up stairs?

Data type

integer

How does your knee affect your ability to go down stairs?
Description

How does your knee affect your ability to go down stairs?

Data type

integer

How does your knee affect your ability to kneel on the front of your knee?
Description

How does your knee affect your ability to kneel on the front of your knee?

Data type

integer

How does your knee affect your ability to squat?
Description

How does your knee affect your ability to squat?

Data type

integer

Alias
UMLS CUI-1
C0560874
How does your knee affect your ability to sit with your knee bent?
Description

How does your knee affect your ability to sit with your knee bent?

Data type

integer

How does your knee affect your ability to rise from a chair?
Description

How does your knee affect your ability to rise from a chair?

Data type

integer

How does your knee affect your ability to run straight ahead?
Description

How does your knee affect your ability to run straight ahead?

Data type

integer

How does your knee affect your ability to jump and land on your involved leg?
Description

How does your knee affect your ability to jump and land on your involved leg?

Data type

integer

How does your knee affect your ability to stop and start quickly?
Description

How does your knee affect your ability to stop and start quickly?

Data type

integer

Function, and activity of daily living
Description

Function, and activity of daily living

Alias
UMLS CUI-1
C0001288
Function prior to knee injury?
Description

Function prior to knee injury: How would you rate the function of your knee on a scale of 0 to 10 with 10 being normal, excellent function and 0 being the inability to perform any of your usual daily activities which may include sports?

Data type

integer

Current function of your knee?
Description

Current function of your knee (last week): How would you rate the function of your knee on a scale of 0 to 10 with 10 being normal, excellent function and 0 being the inability to perform any of your usual daily activities which may include sports?

Data type

integer

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Similar models

IKDC Subjective Knee Evaluation Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General information
C1508263 (UMLS CUI-1)
Patient name
Item
Patient name
text
C1299487 (UMLS CUI-1)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI-1)
Clinician diagnosis
Item
Clinician diagnosis
text
C0011900 (UMLS CUI-1)
Type of surgery
Item
Type of surgery
text
C0543467 (UMLS CUI-1)
Surgery date
Item
Surgery date
date
C1628561 (UMLS CUI-1)
Item Group
Symptoms
C1457887 (UMLS CUI-1)
Item
What is the highest level of activity that you can perform without significant knee pain? (last week)
integer
Activity level without pain
Code List
What is the highest level of activity that you can perform without significant knee pain? (last week)
CL Item
Unable to perform any of the above activities due to knee pain (0)
CL Item
Very strenuous activities like jumping or pivoting as in basketball or soccer (4)
CL Item
Strenuous activities like heavy physical work, skiing or tennis (3)
CL Item
Moderate activities like moderate physical work, running or jogging (2)
CL Item
Light activities like walking, housework or yard work (1)
Item
During the past 4 weeks, or since your injury, how often have you had pain?
integer
pain during past 4 weeks
Code List
During the past 4 weeks, or since your injury, how often have you had pain?
CL Item
Never (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
Constant (10)
Item
If you have pain, how severe is it?
integer
C1507013 (UMLS CUI-1)
Pain severity
Code List
If you have pain, how severe is it?
CL Item
No Pain (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
Worst Pain (10)
Item
During the past 4 weeks, or since your injury, how stiff or swollen was your knee?
integer
C0576086 (UMLS CUI-1)
Swelling of knee joint
Code List
During the past 4 weeks, or since your injury, how stiff or swollen was your knee?
CL Item
Not at all (0)
CL Item
Mildly (1)
CL Item
Moderately (2)
CL Item
Very (3)
CL Item
Extremely (4)
Item
What is the highest level of activity you can perform without significant swelling in your knee?
integer
Activity level without swelling
Code List
What is the highest level of activity you can perform without significant swelling in your knee?
CL Item
Very strenuous activities like jumping or pivoting as in basketball or soccer (4)
CL Item
Strenuous activities like heavy physical work, skiing or tennis (3)
CL Item
Moderate activities like moderate physical work, running or jogging (2)
CL Item
Light activities like walking, housework, or yard work (1)
CL Item
Unable to perform any of the above activities due to knee swelling (0)
Knee locking
Item
During the past 4 weeks, or since your injury, did your knee lock or catch?
boolean
C0231753 (UMLS CUI-1)
Item
What is the highest level of activity you can perform without significant giving way in your knee?
integer
Activity level without giving way in knee
Code List
What is the highest level of activity you can perform without significant giving way in your knee?
CL Item
Very strenuous activities like jumping or pivoting as in basketball or soccer (4)
CL Item
Strenuous activities like heavy physical work, skiing or tennis (3)
CL Item
Moderate activities like moderate physical work, running or jogging (2)
CL Item
Light activities like walking, housework or yard work (1)
CL Item
Unable to perform any of the above activities due to giving way of the knee (0)
Item Group
Sports activities
C0038039 (UMLS CUI-1)
Item
What is the highest level of activity you can participate in on a regular basis?
integer
C3694575 (UMLS CUI-1)
Physical activity level
Code List
What is the highest level of activity you can participate in on a regular basis?
CL Item
Very strenuous activities like jumping or pivoting as in basketball or soccer (4)
CL Item
Strenuous activities like heavy physical work, skiing or tennis (3)
CL Item
Moderate activities like moderate physical work, running or jogging (2)
CL Item
Light activities like walking, housework or yard work (1)
CL Item
Unable to perform any of the above activities due to giving way of the knee (0)
Item
How does your knee affect your ability to go up stairs?
integer
Go up stairs
Code List
How does your knee affect your ability to go up stairs?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to go down stairs?
integer
Go down stairs
Code List
How does your knee affect your ability to go down stairs?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to kneel on the front of your knee?
integer
Kneel on the front of your knee
Code List
How does your knee affect your ability to kneel on the front of your knee?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to squat?
integer
C0560874 (UMLS CUI-1)
Ability to squat
Code List
How does your knee affect your ability to squat?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to sit with your knee bent?
integer
Sit with knee bent
Code List
How does your knee affect your ability to sit with your knee bent?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to rise from a chair?
integer
Rise from a chair
Code List
How does your knee affect your ability to rise from a chair?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to run straight ahead?
integer
Run straight ahead
Code List
How does your knee affect your ability to run straight ahead?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to jump and land on your involved leg?
integer
Jump and land on your involved leg
Code List
How does your knee affect your ability to jump and land on your involved leg?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item
How does your knee affect your ability to stop and start quickly?
integer
Stop and start quickly
Code List
How does your knee affect your ability to stop and start quickly?
CL Item
No difficulty  (4)
CL Item
Minimal difficulty (3)
CL Item
Moderate difficulty (2)
CL Item
Extreme difficulty (1)
CL Item
Unable to do (0)
Item Group
Function, and activity of daily living
C0001288 (UMLS CUI-1)
Item
Function prior to knee injury?
integer
Function prior to knee injury
Code List
Function prior to knee injury?
CL Item
Can not perform ADL (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
No limitation of ADL (10)
Item
Current function of your knee?
integer
Current function of your knee
Code List
Current function of your knee?
CL Item
Can not perform ADL (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
No limitation of ADL (10)
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