Relationships between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and smartphone ecological momentary assessment outcomes in people with knee osteoarthritis

Overton, M; Dunn, J; Snell, D; Mani, R

Relationships between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and smartphone ecological momentary assessment outcomes in people with knee osteoarthritis

Overton, M

Dunn, J Snell, D Mani, R

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Osteoarthritis and Cartilage Open, 2026, 8, (2), pp. 100809
Issue Date:: 2026-05-01

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Field	Value	Language
dc.contributor.author	Overton, M https://orcid.org/0000-0001-9314-9696
dc.contributor.author	Dunn, J
dc.contributor.author	Snell, D
dc.contributor.author	Mani, R
dc.date.accessioned	2026-05-12T05:31:15Z
dc.date.available	2026-05-12T05:31:15Z
dc.date.issued	2026-05-01
dc.identifier.citation	Osteoarthritis and Cartilage Open, 2026, 8, (2), pp. 100809
dc.identifier.issn	2665-9131
dc.identifier.uri	http://hdl.handle.net/10453/194941
dc.description.abstract	Introduction The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a recommended recall-based self-report questionnaire assessing pain and function in people with knee osteoarthritis (OA). Smartphone Ecological Momentary Assessment (EMA) could be a more accurate method to assess current symptoms during everyday life. Whether outcomes collected via smartphone EMA align with recall-based patient-reported outcome measures (PROMs), such as the KOOS, is yet to be explored. Therefore, this study aims to explore relationships between outcomes collected via smartphone EMA and the KOOS in people with knee OA. Secondary aims include exploring whether relationships are maintained after adjusting for demographic and clinical factors influencing knee OA outcomes. Methods A smartphone EMA survey was developed, piloted and then administered to people with knee OA. Participants were asked to rate current symptoms (i.e. pain intensity, pain interference, pain bothersomeness and stiffness) three times daily at random times during the morning, afternoon and evening for two weeks. Following this, participants completed a KOOS to collect pain, symptoms, function (daily living, sport and recreation) and quality of life outcomes. Bivariate correlations were performed to explore relationships between outcomes collected via smartphone EMA and the KOOS. Partial correlations were then performed to control for age, sex, body mass index (BMI) and baseline pain intensity. Results Eighty-six people with knee OA completed both smartphone EMA and the KOOS. There was no loss to follow-up. Statistically significant inverse relationships (ranging in strength from weak to strong) were demonstrated between pain intensity (r = -0.69, p = <0.01), interference (r = -0.62, p = <0.01), bothersomeness (r = 0.78, p = <0.01) and knee stiffness (r = 0.61, p = <0.01) measured via the two methods. After controlling for established covariates, statistically significant inverse relationships were maintained although the strength of these relationships reduced overall, ranging from weak to moderate. Discussion and conclusion Smartphone EMA appears to be valid when compared with recommended recall-based PROMs assessing pain and function in people with knee OA, even after controlling for knee OA prognostic factors. Collecting pain and function outcomes in a momentary manner could offer greater ecological validity to living with knee OA. Additionally, EMA could help to improve our understanding of concurrent psychosocial and lifestyle factors in shaping pain and functional outcomes in people with knee OA.
dc.language	en
dc.publisher	Elsevier BV
dc.relation.ispartof	Osteoarthritis and Cartilage Open
dc.relation.isbasedon	10.1016/j.ocarto.2026.100809
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	3202 Clinical sciences
dc.title	Relationships between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and smartphone ecological momentary assessment outcomes in people with knee osteoarthritis
dc.type	Journal Article
utslib.citation.volume	8
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Graduate School of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Graduate School of Health/Physiotherapy
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/INSIGHT: Institute for Innovative Solutions for Wellbeing and Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2026-05-12T05:31:13Z
pubs.issue	2
pubs.publication-status	Accepted
pubs.volume	8
utslib.citation.issue	2

Abstract:

Introduction The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a recommended recall-based self-report questionnaire assessing pain and function in people with knee osteoarthritis (OA). Smartphone Ecological Momentary Assessment (EMA) could be a more accurate method to assess current symptoms during everyday life. Whether outcomes collected via smartphone EMA align with recall-based patient-reported outcome measures (PROMs), such as the KOOS, is yet to be explored. Therefore, this study aims to explore relationships between outcomes collected via smartphone EMA and the KOOS in people with knee OA. Secondary aims include exploring whether relationships are maintained after adjusting for demographic and clinical factors influencing knee OA outcomes. Methods A smartphone EMA survey was developed, piloted and then administered to people with knee OA. Participants were asked to rate current symptoms (i.e. pain intensity, pain interference, pain bothersomeness and stiffness) three times daily at random times during the morning, afternoon and evening for two weeks. Following this, participants completed a KOOS to collect pain, symptoms, function (daily living, sport and recreation) and quality of life outcomes. Bivariate correlations were performed to explore relationships between outcomes collected via smartphone EMA and the KOOS. Partial correlations were then performed to control for age, sex, body mass index (BMI) and baseline pain intensity. Results Eighty-six people with knee OA completed both smartphone EMA and the KOOS. There was no loss to follow-up. Statistically significant inverse relationships (ranging in strength from weak to strong) were demonstrated between pain intensity (r = -0.69, p = <0.01), interference (r = -0.62, p = <0.01), bothersomeness (r = 0.78, p = <0.01) and knee stiffness (r = 0.61, p = <0.01) measured via the two methods. After controlling for established covariates, statistically significant inverse relationships were maintained although the strength of these relationships reduced overall, ranging from weak to moderate. Discussion and conclusion Smartphone EMA appears to be valid when compared with recommended recall-based PROMs assessing pain and function in people with knee OA, even after controlling for knee OA prognostic factors. Collecting pain and function outcomes in a momentary manner could offer greater ecological validity to living with knee OA. Additionally, EMA could help to improve our understanding of concurrent psychosocial and lifestyle factors in shaping pain and functional outcomes in people with knee OA.

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http://hdl.handle.net/10453/194941