Children and adolescents with anterior knee pain can show construct validity and reliability with anterior knee pain scale, lower extremity functional scale and visual analogue scale

  1. Sarah Hofmeister
  2. Linda Camilleri
  3. Stacey Llewellyn
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Abstract

Background

To investigate validity and reliability of the Anterior Knee Pain Scale, Lower Extremity Functional Scale and the Visual Analogue Scale Usual and Worst in 8-16-year-old children and adolescents with symptoms of ‘Anterior knee pain’ commonly present to emergency and orthopaedic outpatients departments at Australian public tertiary/quaternary hospitals

Method

50 participants aged 8-16 years with anterior knee pain participated in this prospective pre- and post-test methodological study. Measures employed included the Anterior Knee Pain Scale (AKPS), the Lower Extremity Functional Scale (LEFS), Visual Analogue Scale Usual (VAS-U) and Visual Analogue Scale Worst (VAS-W). Correlations between these outcome measures and the participant-perceived Global Rating of Change (GRC) categories (incomplete improvement, complete improvement) were determined.

Results

Test-retest reliability

Intraclass Coefficient (ICC) values indicated good to excellent reliability in VAS-U (0.86), VAS-W (0.70), AKPS (0.98) and LEFS (0.98).

Validity

All measures showed convergent validity in comparison to the combined GRC assessment of complete score. The adjusted mean change scores had moderate evidence of a difference in AKPS (p=0.015) and LEFS (0.050); and very strong evidence for difference in VAS-U (p=0.006) and VAS-W (p<0.001) in the improvement groups, with a larger mean change exhibited in the complete improvement group.

Responsiveness

ANCOVA results indicated all the outcomes had larger adjusted mean scores in the complete group compared to the incomplete improvement group, suggesting these measures are responsive to measure change.

Conclusion

Anterior Knee pain is a common knee condition from child to adults. Just like in adults, questionnaires AKPS, LEFS, VAS-U, and VAS-W are valid, reliable and responsive measures in child and adolescent populations aged 8 - 16 years with anterior knee pain. These PROMs (Patient Reported Outcome Measures) can now be used in anterior knee pain conditions 8 years and above.

Level of Evidence

II Prospective pre- and post-test methodological study

Contributions of the paper

  • The PROMs-AKP, LEFS, VAS-U and VAS-W can be used from 8 years old to adulthood in anterior knee pain.

  • This study provides evidence showing the above PROMs are valid and reliable in the child and adolescent population with anterior knee pain.

  • These PROMs now have the potential to measure and monitor performance in children with anterior knee pain as has been done in adults.

Article activity feed

  1. Version published to 10.1101/2025.07.20.25331597 on medRxiv