First local study validates new pictorial tool to better assess function in patients with knee osteoarthritis

MEDIA RELEASE

FIRST LOCAL STUDY VALIDATES NEW PICTORIAL TOOL TO BETTER ASSESS FUNCTION IN PATIENTS WITH KNEE OSTEOARTHRITIS

Researchers from SingHealth Polyclinics (SHP), in collaboration with the Singapore Institute of Technology (SIT), have developed and validated a new pictorial assessment tool that can effectively measure how knee osteoarthritis affects patients’ daily activities, particularly those who face language or literacy barriers.

The research is among the first to validate a pictorial functional outcome measure for knee osteoarthritis in a primary care population, aligning with global standards for patient-reported outcome measures.

The Functional Activity Scoring Tool (FAST) is a novel patient-reported outcome measure (PROM) that uses simple illustrations instead of text-heavy questionnaires. Developed and tested in Singapore’s primary care setting, FAST was found to be valid, reliable, responsive to change, and preferred by patients when compared with commonly used assessment tools.

Knee osteoarthritis is a common condition, particularly among older adults, often causing pain and difficulty with everyday tasks such as walking, climbing stairs or standing up from a chair. In clinical care, patient-reported outcome measures are widely used to understand how such conditions affect patients’ lives. However, many of these tools rely heavily on written language and numerical scales, which may pose challenges for patients with lower literacy levels or limited proficiency in English.

To address this gap, researchers developed the Functional Activity Scoring Tool (FAST) to address these challenges. Adapted from the widely recognised Wong-Baker FACES pain scale, the tool uses facial expressions and visual cues to help patients rate their ability to perform daily activities such as walking, standing, or climbing stairs.

The study involved 107 patients with clinically diagnosed knee osteoarthritis and was conducted across four public outpatient physiotherapy polyclinics under SingHealth Polyclinics, located at Bedok, Bukit Merah, Marine Parade and Tampines. Participants completed FAST alongside two established assessment tools - the Patient-Specific Functional Scale (PSFS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS), at the start of the study, and again after two to three weeks.

Researchers found that FAST closely matches the results of the PSFS and shows a good level of agreement with KOOS. This means FAST is a reliable tool for reflecting patients’ everyday functioning, matching PSFS results by about 90 per cent and KOOS areas by around 65 per cent. The tool also demonstrated moderate reliability, with consistent results

when repeated, and was able to detect meaningful changes in patients who reported improvement or deterioration in their condition.

Beyond the tool’s statistical performance, 69 per cent of participants preferred FAST over traditional questionnaires. Many cited its simplicity, ease of understanding and faster completion time. The use of pictures, in particular, made it easier for patients to express their difficulties accurately.

“I believe the FAST tool has strong potential to help seniors maintain their mobility and independence for longer, as it is simple and easy to use. Early screening for mobility issues is crucial, as it enables problems to be detected and addressed at an earlier stage. This can lead to better health outcomes for seniors, while also helping to reduce the long-term healthcare and caregiving burden on both seniors and their families,” said Foo May Chen, aged 60, a participant of the study.

“The findings suggest that FAST is a valid, reliable and responsive tool for assessing functional ability in patients with knee osteoarthritis, performing comparably to established questionnaires while being simpler and more accessible. This makes it particularly suitable for use in primary care and community settings, where it can be easily integrated into routine practice,” said Tang Zhi Yin, Senior Physiotherapist, SingHealth Polyclinics. Mr Tang is also the main author of the study.

Following the publication of the study, FAST has already been implemented in physiotherapy services across SingHealth Polyclinics, where it is now used routinely to assess and monitor patients’ functional progress.

“Building on these findings, a follow-up study is planned to explore the use of FAST in other common musculoskeletal conditions, including non-specific low back pain, neck pain and rotator cuff–related shoulder pain, within SingHealth Polyclinics’ physiotherapy services,” added Mr Tang.