2015 ISAKOS Biennial Congress ePoster #1105

Validation of Electronic Administration of Knee Specific Patient Reported Outcomes

Stephen L. Lyman, PhD, New York, NY UNITED STATES
Joseph T. Nguyen, MPH, New York, NY UNITED STATES
Chisa Hidaka, MD, New York, NY UNITED STATES
Robert G. Marx, MD, MSc, FRCSC, New York, NY UNITED STATES

Hospital for Special Surgery, New York, NY, USA

FDA Status Not Applicable

Summary: The IKDC, Marx Activity Rating Scale, Tegner, and Lysholm, previously developed for paper administration, are now valid for electronic administration.




Knee-specific patient reported outcome measures (PROMs) are vital tools in the evaluation of injuries and sports medicine intervention effectiveness. The PROMs were originally developed and validated for paper administration. While electronic data capture has been widely adopted, this technology has not yet been adequately validated. With the advancement of touchscreen technology use in clinical settings, electronic data capture has itself evolved. Studies of human-computer interactions suggest survey responses may vary due to capture method. The purpose of this study was to evaluate the validity of touchscreen versus paper administration of several common knee-specific surveys.


Test-retest reliability of paper and touchscreen tablet survey administration was conducted in a cohort of 60 patients who underwent ACL reconstruction at a single, tertiary orthopaedic institution from February 2011 to August 2013. Surveys were given at pre-operative assessment and again between 1 and 7 days later. Weighted kappa statistic (?) and intraclass correlation coefficients (ICC) were calculated to test the reliability of the two modalities in several commonly used knee-specific surveys (IKDC Subjective Knee Form, Marx Activity Scale, Tegner Activity Level Scale, Lysholm Knee Scale). Error assessment was performed for the paper surveys by an independent observer to evaluate the incidence of responses that may have been misinterpreted during the data entry process.


Data completeness and patient retention was excellent with a 98% response rate. Mean age of patients was 28.1±11.6 years (range: 13 to 55 years). Females made up 46% of the study population. There was substantial or better agreement in all PROMs collected. Test-retest reliability for the knee-specific outcomes were the following: IKDC Subjective (ICC: 0.788); Marx (ICC: 0.700); Lysholm (ICC: 0.653); and Tegner (?=0.672). Nearly a third of the paper surveys (19 of 60) had errors that included marking multiple responses for a single question, marking in between options, or omitting questions all together.


Paper data collection forms are an increasingly outdated method of capturing responses. Paper surveys are susceptible to errors that are non-existent in the tablet surveys and highlight the amount of error that may be introduced during the data entry process. Our results demonstrate that touchscreen-based administration of PROMs are a valid capture method and provide reliable results relative to traditional paper survey administration. Future studies should investigate the reliability of this technology in an older patient population. Touchscreen administration of PROMs could have a significant impact on sports medicine practice and research with improved efficiency, more accurate data collection, and enhanced patient engagement.