Mapping EQ-5D-3L from the Knee Injury and Osteoarthritis Outcome Score (KOOS)

Research output: Contribution to journalArticle


PURPOSE: To develop a mapping model to estimate EQ-5D-3L from the Knee Injury and Osteoarthritis Outcome Score (KOOS).

METHODS: The responses to EQ-5D-3L and KOOS questionnaires (n = 40,459 observations) were obtained from the Swedish National anterior cruciate ligament (ACL) Register for patients ≥ 18 years with the knee ACL injury. We used linear regression (LR) and beta-mixture (BM) for direct mapping and the generalized ordered probit model for response mapping (RM). We compared the distribution of the original data to the distributions of the data generated using the estimated models.

RESULTS: Models with individual KOOS subscales performed better than those with the average of KOOS subscale scores (KOOS5, KOOS4). LR had the poorest performance overall and across the range of disease severity particularly at the extremes of the distribution of severity. Compared with the RM, the BM performed better across the entire range of disease severity except the most severe range (KOOS5 < 25). Moving from the most to the least disease severity was associated with 0.785 gain in the observed EQ-5D-3L. The corresponding value was 0.743, 0.772 and 0.782 for LR, BM and RM, respectively. LR generated simulated EQ-5D-3L values outside the feasible range. The distribution of simulated data generated from the BM model was almost identical to the original data.

CONCLUSIONS: We developed mapping models to estimate EQ-5D-3L from KOOS facilitating application of KOOS in cost-utility analyses. The BM showed superior performance for estimating EQ-5D-3L from KOOS. Further validation of the estimated models in different independent samples is warranted.


External organisations
  • University of Southern Denmark
  • Boston University
  • University of Sheffield
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Orthopedics
Original languageEnglish
Pages (from-to)265-274
Number of pages10
JournalQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Issue number1
Early online date2019 Sep 20
Publication statusPublished - 2020 Jan
Publication categoryResearch