Knee Replacement Post-Op QPROM

Thank you for having your knee replacement at Kinvara Private Hospital. Please complete this short questionnaire (known as a Quality Patient-Reported Outcome Measure – QPROM).

The questionnaire should only be completed by patients that have had knee replacement and will only take a few minutes.

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Name
Date of birth
When did your knee surgery take place?
1. Is anyone helping you fill in this questionnaire?
2. Which statement best describes your living arrangements?
3. Did you experience any of the following problems after your operation?
4. Have you been readmitted to hospital since your knee operation?
5. Have you had another operation on your knee since your knee replacement surgery?
6. In general, how would you rate your general health?
7. Overall, how are your problems now in the knee on which you had surgery, compared to before your operation?

During the past 4 weeks...

9. How would you describe the pain you usually have from your knee?
10. Have you had any trouble with washing and dressing yourself (all over) because of your knee?
11. Have you had any trouble getting in and out of a car or using public transport because of your knee?
12. For how long have you been able to walk before pain from your knee becomes severe?
13. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your knee?
14. Have you been limping when walking, because of the knee?
13. Could you do the household shopping on your own?
14. Could you kneel and get up again afterwards?
15. Have you been troubled by pain from your knee in bed at night?
16. How much has the pain from your knee interfered with your usual work (including housework)?
17. Have you felt that your knee might suddenly give way or let you down?
18. Could you do the household shopping on your own?
19. Could you walk down one flight of stairs?

By placing a tick in one box in each group below, please indicate which statements best describe your own health state today.

21. Mobility
22. Self-care
23. Usual activities (e.g. work, study, housework, family)
24. Pain / discomfort
25. Anxiety / depression
26. How many times have you seen a physiotherapist since you left hospital?
27. Do you consider yourself to have a disability?
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Name
Date of birth
1. Is anyone helping you fill in this questionnaire?
2. Are you?
3. Which statement best describes your living arrangements?
4. For how long have you had problems with the hip on which you are about to have surgery?

During the past 4 weeks;

5. How would you describe the pain you usually had from your hip?
6. Have you had any trouble with washing and dressing yourself (all over) because of your hip?
7. Have you had any trouble getting in and out of a car or using public transport because of your hip?
8. Have you been able to put on a pair of socks, stocking or tights?
9. Could you do the household shopping on your own?
10. For how long have you been able to walk before pain from your hip becomes severe?
11. Have you been able to climb a flight of stairs?
12. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip?
13. Have you been limping when walking, because of the hip?
14. Have you had any sudden, severe pain, shooting, stabbing or spasms from the affected hip?
15. How much has the pain from your hip interfered with your usual work (including housework)?
16. Have you been troubled by pain from your hip in bed at night?

By placing a tick in one box in each group below, please indicate which statements best describe your own health state today.

17. Mobility
18. Self-care
19. Usual activities (e.g. work, study, housework, family)
20. Pain/discomfort
21. Anxiety/ Depression
22. In general, how would you rate your general health?
23. Have you been told by a doctor that you have any of the following? (Check all that apply)
24. Do you consider yourself to have a disability?