Home » Patient Info » Patient Forms » Oxford Knee Score (OKS) Oxford Knee Score (OKS) Today's Date Clinician's name (or ref): Patient's name (or ref): Patient's Date of Birth : Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 On which side of your body is the affected joint: select one Right Left Both Problems With Your Knee Answer every question by ticking the appropriate box. If you are unsure about how to answer a question, please give the best answer you can. 1. During the past 4 weeks... How would you describe the pain you usually have from your knee? None Mild Moderate Severe Unbearable 2. During the past 4 weeks... Have you had any trouble with washing and drying yourself (all over) because of your knee? No trouble at all A little trouble Moderate trouble Extreme difficulty Impossible to do 3. During the past 4 weeks... Have you had any trouble getting in and out of a car or using public transport because of your knee?(whichever you would tend to use) No trouble at all A little bit of trouble Moderate trouble Extreme difficulty Impossible to do 4. During the past 4 weeks... 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 5. During the past 4 weeks... 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 6. During the past 4 weeks... 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 7. During the past 4 weeks... Could you kneel down and get up again afterwards? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 8. During the past 4 weeks... Have you been troubled by pain from your knee in bed at night? No nights Only 1 or 2 nights Some nights Most nights Every night 9. During the past 4 weeks... How much has pain from your knee interfered with your usual work (including housework)? Not at all A little bit Moderately Greatly Totally 10. During the past 4 weeks... 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 11. During the past 4 weeks... Could you do the household shopping on your own? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 12. During the past 4 weeks... Could you walk down one flight of stairs? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible To send this data to doctor please click submit
