2000IKDC Score膝关节功能主观评定.pdfVIP

2000 IKDC KNEE FORMS INTRODUCTION The entire IKDC form, which includes a demographic form, current health assessment form, subjective knee evaluation form, knee history form, surgical documentation form, and knee examination form, may be used as separate forms. The knee history form and surgical documentation form are provided for convenience. All researchers are required to complete the subjective knee evaluation and knee examination form. Instructions for scoring the subjective knee evaluation form and the knee examination form are provided on the back of the forms. TABLE OF CONTENTS 1. Demographic Form 2. Current Health Assessment Form 3. Subjective Knee Evaluation Form 4. Knee History Form 5. Surgical Documentation Form 6. Knee Examination Form IKDC DEMOGRAPHIC FORM Your Full Name ______________________________________________________ Your Date of Birth _________/___________/___________ Day Month Year Your Social Security Number ____-___-_____ Your Gender: q Male q Female Occupation __________________________________________________________ Today’s Date _____________/___________/___________ Day Month Year The following is a list of common health problems. Please indicate “Yes” or “No” in the first column, and then skip to the next item. If you do have the problem, please indicate in the second column if you receive medications or some other type of treatment for the problem. In the last column, indicate if the problem limits any of your activities. Do you have Do you