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Wang QW, Man GCW, Choi BCY, Yeung YM, Qiu JH, Lu XM, Ong MTY, Yung PSH. The predictors to self-reported and performance-based physical function in knee osteoarthritis patients: a cross-sectional study. Front Cell Dev Biol 2024; 12:1406830. [PMID: 38946798 PMCID: PMC11214303 DOI: 10.3389/fcell.2024.1406830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Background Osteoarthritis (OA) knee patients have limited ability in physical function, or difficulties with physical tasks and activities may develop disability. This study aimed to observe the predictors of self-reported and performance-based physical function in patients with knee OA by analyzing the impacts of demographic, pathological, and muscle impairment factors. Methods 135 knee OA patients participated in this study to complete self-reported questionnaires using Knee Injury and Osteoarthritis Outcome Score (KOOS). When measuring performance-based physical function, a 6-meter gait speed (6MGS) test was measured to evaluate their mobility, and a 5-time Sit-to-Stand test (5STS) was assessed to evaluate their balance. Pain intensity, knee extensor and flexor muscle strength, age, body mass index (BMI), durations of symptoms, and radiographic severity were also collected. Spearman correlation and stepwise multiple linear regression were used to explore the association and predictors in self-reported and performance-based physical function. Results BMI and durations of symptoms did not indicate any significant correlation with either self-reported or performance-based physical function. Age is significantly negatively associated with 6MGS (r 2 = -0.383, p < 0.01), while knee extensor muscle strength has a moderate correlation with 5STS (r 2 = -0.528, p < 0.01). In the stepwise multiple linear regression models, pain intensity (β = 0.712, p < 0.001), knee flexor muscle strength (β = 0.112, p = 0.042) were significantly associated with self-reported physical function in daily activities and contributed to 55.0% of the variance in KOOS-PF score. Knee muscle strength, including knee extensor (5STS: β = -0.428, p < 0.001) and flexor muscle strength (6MGS: β = 0.367, p < 0.001), were the main predictors with performance-based physical function. Conclusion Pain intensity was the leading risk factor of self-reported physical function, and knee flexor muscle strength contributed as well. The severity of knee OA, durations of symptoms and BMI did not contribute to physical function. However, knee extensor and flexor muscle strength were the main predictors of performance-based performance. Our results show that strengthening of weak knee muscles in both quadriceps and hamstring muscle strength should be considered a priory consideration in knee OA no matter if people are in the early or end-stage of knee OA.
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Affiliation(s)
- Qian-wen Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Gene Chi-wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ben Chi-yin Choi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yi-man Yeung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ji-hong Qiu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xiao-min Lu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Michael Tim-yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Patrick Shu-hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Pua YH, Koh SSM, Terluin B, Woon EL, Chew ESX, Yeo SJ, Chen JY, Liow LMH, Clark R, Thumboo J. Effect of Context Specificity on Response to the Shortened WOMAC Function Scale in Patients Undergoing Total Knee Arthroplasty. Arch Phys Med Rehabil 2024:S0003-9993(24)00993-6. [PMID: 38723858 DOI: 10.1016/j.apmr.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western Ontario and McMaster Universities Osteoarthritis Index function (WOMAC-F) scale (ShortMAC-F) (1) enhanced the convergent validity of the ShortMAC-F with performance-based mobility measures (ii) affected mean scale score, structural validity, reliability, and interpretability. DESIGN Secondary analysis of randomized clinical trial data. SETTING A tertiary teaching hospital. PARTICIPANTS Patients undergoing TKA (N=114). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The ShortMAC-F was modified by specifying the "ascending stairs" and "rising from sitting" items to enquire about difficulty in performing the tasks without reliance on compensatory strategies, whereas the modified "level walking" item enquired about difficulty in walking 400 m. Before and 12 weeks after TKA, patients completed the WOMAC-F questionnaire, modified ShortMAC-F questionnaire, knee pain scale questionnaire, sit-to-stand test, fast gait speed test, and stair climb test. Interpretability was evaluated by calculating anchor-based substantial clinical benefit estimates. RESULTS The modified ShortMAC-F correlated significantly more strongly than ShortMAC-F or WOMAC-F with pooled performance measures (differences in correlation values, 0.12-0.14). Increasing item context specificity of the ShortMAC-F did not influence its psychometric properties of unidimensionality (comparative fit and Tucker-Lewis indices, >0.95; root mean square error of approximation, 0.05-0.08), reliability (Cronbach's α, 0.75-0.83), correlation with pain intensity (correlation values, 0.48-0.52), and substantial clinical benefit estimates (16 percentage points); however, it resulted in lower mean score (4.5-4.8 points lower). CONCLUSIONS The modified ShortMAC-F showed sufficient measurement properties for clinical application, and it seemed more adept than WOMAC-F at correlating with performance-based measures in TKA.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore.
| | | | - Berend Terluin
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | | | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | | - Ross Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore
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Tolk JJ, Janssen RPA, Prinsen C(SAC, van der Steen M(MC, Bierma Zeinstra SMA, Reijman M. Measurement properties of the OARSI core set of performance-based measures for hip osteoarthritis: a prospective cohort study on reliability, construct validity and responsiveness in 90 hip osteo-arthritis patients. Acta Orthop 2019; 90:15-20. [PMID: 30451049 PMCID: PMC6366472 DOI: 10.1080/17453674.2018.1539567] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Improvement of physical function is one of the main treatment goals in severe hip osteoarthritis (OA) patients. The Osteoarthritis Research Society International (OARSI) has identified a core set of performance-based tests to assess the construct physical function: 30-s chair stand test (30-s CST), 4x10-meter fast-paced walk test (40 m FPWT), and a stair-climb test. Despite this recommendation, available evidence on the measurement properties is limited. We evaluated the reliability, validity, and responsiveness of these performance-based measures in patients with hip OA scheduled for total hip arthroplasty (THA). Patients and methods - Baseline and 12-month follow-up measurements were prospectively obtained in 90 end-stage hip OA patients who underwent THA. As there is no gold standard for comparison, the hypothesis testing method was used for construct validity and responsiveness analysis. A test can be assumed valid if ≥75% of predefined hypotheses are confirmed. A subgroup (n = 30) underwent test-retest measurements for reliability analysis. The Oxford Hip Score, Hip injury and Osteoarthritis Outcome Score-Physical Function Short Form, pain during activity score, and muscle strength were used as comparator instruments. Results - Test-retest reliability was appropriate; intraclass correlation coefficient values exceeded 0.70 for all 3 tests. None of the performance-based measures reached 75% hypothesis confirmation for the construct validity or responsiveness analysis. Interpretation - The performance-based tests have good reliability in the assessment of physical function. Construct validity and responsiveness, using patient-reported measures and muscle strength as comparator instruments, could not be confirmed. Therefore, our findings do not justify their use for clinical practice.
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Affiliation(s)
- Jaap J Tolk
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven;; ,Correspondence:
| | - Rob P A Janssen
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven;;
| | - C (Sanna) A C Prinsen
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health (APH) Research Institute, Amsterdam;
| | | | - Sita M A Bierma Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam;; ,Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven;; ,Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Bobić Lucić L, Grazio S. Impact of Balance Confidence on Daily Living Activities of Older People with Knee Osteoarthritis with Regard to Balance, Physical Function, Pain, and Quality of Life - A Preliminary Report. Clin Gerontol 2018; 41:357-365. [PMID: 29617207 DOI: 10.1080/07317115.2018.1453907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The objective of this study was to explore the impact of balance confidence on different activities of daily living (ADL) in older people with knee osteoarthritis (OA). METHODS Forty-seven consecutive participants with knee OA were included in this cross-sectional study. They were divided according to the results of the Activities-specific Balance Confidence (ABC) Scale into a group with a low level of confidence in physical functioning (ABC < 50, n = 22) and a group with moderate and high levels of confidence (ABC ≥ 50, n = 25). RESULTS In the ABC < 50 group, the effect of pain on ADL, the physician's global assessment of the disease, and the Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly higher, while quality of life (Short form-36) was lower compared to the ABC ≥ 50 group. No significant difference was found between the two groups regarding the static and dynamic balance measurements. CONCLUSIONS Older people with knee OA who were less confident in their daily physical activities had more physical difficulties and a greater effect of pain on ADL, lower quality of life, and a higher physician's global assessment, but no differences were obtained in balance tests. CLINICAL IMPLICATIONS In people with knee OA, decreased balance confidence is associated with more physical difficulties, an increased effect of pain on ADL, and lower quality of life. An improved awareness of decreased balance confidence may lead to more effective management of older people with knee OA by improving their mobility and QOL through rehabilitation. Furthermore, future research in that direction is warranted.
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Affiliation(s)
- Lana Bobić Lucić
- a Clinic Department of Rheumatology, Physical Medicine and Rehabilitation , Special Hospital for Medical Rehabilitation Lipik , Lipik , Croatia
| | - Simeon Grazio
- b Clinical Hospital Center Sisters of Mercy , Zagreb , Croatia
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Abdelaleem EA, Rizk YM. Health-related quality of life in Egyptian patients with knee osteoarthritis: correlation with performance-related measures. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/1110-161x.237048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Baldwin JN, McKay MJ, Hiller CE, Moloney N, Nightingale EJ, Burns J. Relationship between physical performance and self-reported function in healthy individuals across the lifespan. Musculoskelet Sci Pract 2017; 30:10-17. [PMID: 28494261 DOI: 10.1016/j.msksp.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Functional outcome measures in clinical trials of musculoskeletal conditions need to be meaningful to individuals. OBJECTIVES To investigate the relationship between physical performance and self/proxy-reported function in 1000 healthy children and adults. DESIGN Cross-sectional observational study (1000 Norms Project). METHODS One thousand males and females aged 3-101 years, healthy by self-report and without major physical disability, were recruited. Twelve performance-based tests were analysed: vertical and long jump, two hand dexterity tests, four balance tests, stepping reaction time, 30-second chair stand, timed up-and-down stairs, and six-minute walk. Self/proxy-reported function was assessed using the Infant-Toddler Quality of Life questionnaire, Child Health Questionnaire, Assessment of Quality of Life (AQoL)-6D Adolescent, AQoL-8D, International Physical Activity Questionnaire and work ability question. Bivariate and multivariate correlational analyses were constructed for infants (3-4y), children (5-10y), adolescents (11-17y), adults (18-59y) and older adults (60+). RESULTS/FINDINGS Socio-demographic characteristics were similar to the Australian population. Among infants/children, greater jump and sit-to-stand performance correlated with higher proxy-reported function (p < 0.05). There were no significant relationships observed for adolescents (p > 0.05). Greater jump, dexterity, balance, reaction time, sit-to-stand, stair-climbing and six-minute walk performance correlated with higher self-reported function in adults (r = -0.097 to.231; p < 0.05) and older adults (r = -0.135 to 0.625; p < 0.05). Multivariate regression modelling revealed a collection of independent performance measures explaining up to 46% of the variance in self/proxy-reported function. CONCLUSIONS Many performance-based tests were significantly associated with self/proxy-reported function. We have identified a set of physical measures which could form the basis of age-appropriate functional scales for clinical trials of musculoskeletal conditions.
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Affiliation(s)
- Jennifer N Baldwin
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia.
| | - Marnee J McKay
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Claire E Hiller
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Niamh Moloney
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia; Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Australia
| | - Elizabeth J Nightingale
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Joshua Burns
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), Australia
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Konan S, Hossain F, Patel S, Haddad FS. Measuring function after hip and knee surgery: the evidence to support performance-based functional outcome tasks. Bone Joint J 2015; 96-B:1431-5. [PMID: 25371452 DOI: 10.1302/0301-620x.96b11.33773] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Accurate, reproducible outcome measures are essential for the evaluation of any orthopaedic procedure, in both clinical practice and research. Commonly used patient-reported outcome measures (PROMs) have drawbacks such as 'floor' and 'ceiling' effects, limitations of worldwide adaptability and an inability to distinguish pain from function. They are also unable to measure the true outcome of an intervention rather than a patient's perception of that outcome. Performance-based functional outcome tools may address these problems. It is important that both clinicians and researchers are aware of these measures when dealing with high-demand patients, using a new intervention or implant, or testing a new rehabilitation protocol. This article provides an overview of some of the clinically-validated performance-based functional outcome tools used in the assessment of patients undergoing hip and knee surgery.
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Affiliation(s)
- S Konan
- NE (UCH) London Orthopaedic Training Rotation, 235 Euston Road, London, NW1 2BU, UK
| | - F Hossain
- Leeds General Infirmary, Great George St, Leeds LS1 3EX, UK
| | - S Patel
- NE (UCH) London Orthopaedic Training Rotation, 235 Euston Road, London, NW1 2BU, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
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Peter WF, Loos M, de Vet HCW, Boers M, Harlaar J, Roorda LD, Poolman RW, Scholtes VAB, Boogaard J, Buitelaar H, Steultjens M, Roos EM, Guillemin F, Rat AC, Benedetti MG, Escobar A, Østerås N, Terwee CB. Development and Preliminary Testing of a Computerized Animated Activity Questionnaire in Patients With Hip and Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2014; 67:32-9. [DOI: 10.1002/acr.22386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/17/2014] [Indexed: 12/27/2022]
Affiliation(s)
- W. F. Peter
- EMGO Institute for Health and Care Research, VU University Medical Center, and Amsterdam Rehabilitation Research Center/Reade; Amsterdam The Netherlands
| | - M. Loos
- EMGO Institute for Health and Care Research, VU University Medical Center; Amsterdam The Netherlands
| | - H. C. W. de Vet
- EMGO Institute for Health and Care Research, VU University Medical Center; Amsterdam The Netherlands
| | - M. Boers
- VU University Medical Center; Amsterdam The Netherlands
| | - J. Harlaar
- MOVE Research Institute and VU University Medical Center; Amsterdam The Netherlands
| | - L. D. Roorda
- Amsterdam Rehabilitation Research Center/Reade; Amsterdam The Netherlands
| | - R. W. Poolman
- Onze Lieve Vrouwe Gasthuis; Amsterdam The Netherlands
| | | | | | | | - M. Steultjens
- Glasgow Caledonian University, School of Health and Life Sciences; Glasgow UK
| | - E. M. Roos
- Institute of Sports Science and Clinical Biomechanics; Odense Denmark
| | - F. Guillemin
- University of Lorraine, University Paris Descartes, EA 4360 APEMAC; Nancy France
| | - A. C. Rat
- University of Lorraine, University Paris Descartes, EA 4360 APEMAC; Nancy France
| | | | - A. Escobar
- Basurto University Hospital and Health Service Research Network on Chronic Diseases; Bizkaia Spain
| | | | - C. B. Terwee
- EMGO Institute for Health and Care Research, VU University Medical Center; Amsterdam The Netherlands
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Development and validation of the computer-administered animated activity questionnaire to measure physical functioning of patients with hip or knee osteoarthritis. Phys Ther 2014; 94:251-61. [PMID: 24029297 DOI: 10.2522/ptj.20120472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical functioning of patients with hip or knee osteoarthritis is measured by self-report questionnaires and performance-based tests. However, performance-based tests often are not feasible. OBJECTIVE The aim of this study was to develop a computer-administered questionnaire (ie, the Animated Activity Questionnaire [AAQ]) to measure physical functioning in patients with hip or knee OA. By showing animations of activities, the influence of the patient's own reference frame is minimized. The AAQ measures the same aspects of physical functioning as performance-based tests do. DESIGN This was a development and preliminary validation (cross-sectional) study. METHODS A pilot version of the AAQ was developed using motion capture to analyze the movement of a person performing 7 daily activities. Different animations of the same activity were made with 2 to 5 levels of difficulty. For each activity, participants were asked to choose one animation that best corresponds to their own way of performing the activity. A preliminary validation study was performed to compare the AAQ with validated self-report questionnaires (Knee Injury and Osteoarthritis Outcome Score, Hip Disability and Osteoarthritis Outcome Score, and questionnaires on walking, stair climbing, and rising and sitting down) and performance-based tests (walking, Timed "Up & Go" Test, Timed Stair Test) in 33 patients with hip or knee osteoarthritis. RESULTS As expected, the AAQ showed a correlation above .70 (.79, 95% confidence interval=.61-.89) with the total score of the performance-based tests. On the subscore level, the results were partly as expected. Fifty-eight percent of the participants preferred the AAQ over self-report questionnaires and performance-based tests. LIMITATIONS The findings need to be replicated in larger samples of patients because the sample size of the study was rather small. CONCLUSION The AAQ might be a good alternative for measuring physical functioning of patients with hip or knee osteoarthritis. The AAQ can easily be adapted for use in other patient populations. However, further development and validation are needed.
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Correlation of Self-Reported Questionnaire (KOOS) with Some Objective Measures in Primary OA Knee Patients. ISRN RHEUMATOLOGY 2014; 2014:301485. [PMID: 24527222 PMCID: PMC3914450 DOI: 10.1155/2014/301485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022]
Abstract
Purpose. Objective of the present study was to see the correlation of subjectively measured KOOS questionnaire with objectively measured 6-minute walk test (6-MWT), age, height, weight, and BMI. Participants. 251 subjects with OA knee based on American College of Rheumatology criteria. Methods. After passing inclusion and exclusion criteria, the following parameters were recorded: age, height, weight, and BMI. Then subjects were asked to fill KOOS questionnaire; then all subjects were asked to do self-paced walk for 6 minutes. Analysis. Spearman rank test was done to see the correlation. Significant level was set at P < 0.05. Results. 6-MWT had a weak correlation with KOOS-ADL (rho 0.461) and strong correlation with KOOS-symptom, KOOS-pain, and KOOS-sports and very strong correlation with KOOS-QOL. BMI had a strong correlation with KOOS-pain, KOOS-symptom, KOOS-ADL, and KOOS-sports and very strong correlation with KOOS-QOL. Weight had a weak correlation with KOOS-symptom, KOOS-ADL, and KOOS-sports and strong correlation with KOOS-pain and KOOS-QOL. All the above values were significant with P < 0.001. Conclusion. KOOS is strongly positively correlated with 6-MWT and negatively correlated with BMI. Its correlation strength has decreased with weight.
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Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL. Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2012; 20:1548-62. [PMID: 22944525 DOI: 10.1016/j.joca.2012.08.015] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/05/2012] [Accepted: 08/22/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To systematically review the measurement properties of performance-based measures to assess physical function in people with hip and/or knee osteoarthritis (OA). METHODS Electronic searches were performed in MEDLINE, CINAHL, Embase, and PsycINFO up to the end of June 2012. Two reviewers independently rated measurement properties using the consensus-based standards for the selection of health status measurement instrument (COSMIN). "Best evidence synthesis" was made using COSMIN outcomes and the quality of findings. RESULTS Twenty-four out of 1792 publications were eligible for inclusion. Twenty-one performance-based measures were evaluated including 15 single-activity measures and six multi-activity measures. Measurement properties evaluated included internal consistency (three measures), reliability (16 measures), measurement error (14 measures), validity (nine measures), responsiveness (12 measures) and interpretability (three measures). A positive rating was given to only 16% of possible measurement ratings. Evidence for the majority of measurement properties of tests reported in the review has yet to be determined. On balance of the limited evidence, the 40 m self-paced test was the best rated walk test, the 30 s-chair stand test and timed up and go test were the best rated sit to stand tests, and the Stratford battery, Physical Activity Restrictions and Functional Assessment System were the best rated multi-activity measures. CONCLUSION Further good quality research investigating measurement properties of performance measures, including responsiveness and interpretability in people with hip and/or knee OA, is needed. Consensus on which combination of measures will best assess physical function in people with hip/and or knee OA is urgently required.
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Affiliation(s)
- F Dobson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
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Sabirli F, Paker N, Bugdayci D. The relationship between Knee Injury and Osteoarthritis Outcome Score (KOOS) and Timed Up and Go test in patients with symptomatic knee osteoarthritis. Rheumatol Int 2012; 33:2691-4. [PMID: 22955800 DOI: 10.1007/s00296-012-2512-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 08/23/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Feride Sabirli
- Physical Medicine and Rehabilitation Clinic, Istanbul PMR Training Hospital, Istanbul, Turkey,
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Bennell K, Dobson F, Hinman R. Measures of physical performance assessments: Self-Paced Walk Test (SPWT), Stair Climb Test (SCT), Six-Minute Walk Test (6MWT), Chair Stand Test (CST), Timed Up & Go (TUG), Sock Test, Lift and Carry Test (LCT), and Car Task. Arthritis Care Res (Hoboken) 2011; 63 Suppl 11:S350-70. [DOI: 10.1002/acr.20538] [Citation(s) in RCA: 275] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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van Ittersum MW, Bieleman HJ, Reneman MF, Oosterveld FGJ, Groothoff JW, van der Schans CP. Functional capacity evaluation in subjects with early osteoarthritis of hip and/or knee; is two-day testing needed? JOURNAL OF OCCUPATIONAL REHABILITATION 2009; 19:238-44. [PMID: 19444597 DOI: 10.1007/s10926-009-9179-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 04/13/2009] [Indexed: 05/24/2023]
Abstract
INTRODUCTION The Work Well Functional Capacity Evaluation (WW FCE) is a two-day performance based test consisting of several work-related activities. Three lifting and carrying test items may be performed on both days. The objective of this study was to assess the need for repeated testing of these items in subjects with early osteoarthritis of the hip and/or the knee and to analyze sources of variation between the 2 days of measurement. METHODS A standardized WW FCE protocol was applied, including repeated testing of lifting low, lifting overhead and carrying. Differences and associations between the 2 days were calculated using paired samples t-tests, intraclass correlation coefficients (ICC) and limits of agreement (LoA). Possible sources of individual variation between the 2 days were identified by Wilcoxon signed ranks tests. Pearson correlation coefficients were calculated for differences in performances between days and differences in possible sources of variation between days. RESULTS Seventy-nine subjects participated in this study, their mean (SD) age was 56.6 (4.8) years, median (min-max) WOMAC (Western Ontario and McMaster Universities) index scores for pain, stiffness and physical function were 5 (0-17), 3 (0-7) and 14 (0-49), respectively. Median (min-max) SF36 physical function was 75 (5-95), and SF36 pain score was 67 (12-76). Mean performance differences ranged from -0.2 to -0.8 kg (P > 0.05). ICC's ranged from 0.75 (lifting overhead) to 0.88 (lifting low). LoA were: lifting low 8.0 kg; lifting overhead 6.5 kg; carrying 9.0 kg. Pearson's correlations were low and non-significant. CONCLUSIONS All three tests show acceptable two-day consistency. WW FCE testing on two consecutive days is not necessary for groups of subjects with early osteoarthritis. Individual sources of variation could not be identified.
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Affiliation(s)
- M W van Ittersum
- Research and Innovation Group in Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, P.O. Box 3109, 9701 DC, Groningen, The Netherlands.
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van Weely SFE, van Denderen CJ, van der Horst-Bruinsma IE, Nurmohamed MT, Dijkmans BAC, Dekker J, Steultjens MPM. Reproducibility of performance measures of physical function based on the BASFI, in ankylosing spondylitis. Rheumatology (Oxford) 2009; 48:1254-60. [DOI: 10.1093/rheumatology/kep190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
BACKGROUND AND PURPOSE Self-report and performance-based measures of physical functioning in people before and after total hip arthroplasty seem to present different information. The relationship between these different measures is not well understood, and little information is available about changes in this relationship over time. The aims of this study were: (1) to determine the relationship between self-report and performance-based measures of physical functioning before and after total hip arthroplasty, (2) to assess the influence of pain on the relationship, and (3) to determine whether the relationship changes over time. SUBJECTS AND METHODS Seventy-five subjects admitted for total hip arthroplasty were included and examined before and 6 and 26 weeks after surgery. The relationships between the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical functioning subscale and walking speed and gait variability were examined by use of generalized estimating equations, which included interactions with time and the WOMAC pain subscale. RESULTS The relationship between self-report and performance-based measures of physical functioning was poor. Pain appeared to have a considerable influence on self-reported physical functioning. The relationship did not appear to change over time. DISCUSSION AND CONCLUSION The influence of pain on self-reported physical functioning serves as an explanation for the poor relationship between self-reported and performance-based physical functioning. When using a self-report measure such as the WOMAC, one should realize that it does not seem to assess the separate constructs--physical functioning and pain--that are claimed to be measured.
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de Groot IB, Bussmann JB, Stam HJ, Verhaar JAN. Actual everyday physical activity in patients with end-stage hip or knee osteoarthritis compared with healthy controls. Osteoarthritis Cartilage 2008; 16:436-42. [PMID: 17900934 DOI: 10.1016/j.joca.2007.08.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 08/13/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Few data are available on the level of actual physical activity in patients with osteoarthritis (OA) of the hip and knee. The aim of this study was to measure the level of actual physical activity of patients with end-stage OA of the hip and the knee, to compare this with that of matched healthy controls, and to analyze the data in order to ascertain the factors of influence. METHOD The actual physical activity was measured with an activity monitor (AM) in 40 hip and 44 knee OA patients, and compared with measurements obtained from healthy controls. Data were also collected on pain and psychological aspects as anxiety, depression and mental functioning. The primary outcome parameter of the actual physical activity was the percentage of movement-related activity. RESULTS The percentage of movement-related activity did not differ between the two OA groups. It was 8.8 (4.2)% for the hip and 8.1 (3.8)% for the knee OA patients. The matched controls were significantly higher movement-related active than OA patients (about 11.0 (2.9)%). Increasing age and body mass index were negatively associated with the percentage of movement-related activity (beta=-0.29 and beta=-0.25, respectively), whereas mental functioning was positively related (beta=0.30). CONCLUSION The impact of end-stage OA on the level of actual physical activity is equal for hip and knee OA patients. The actual physical activity for both of the OA groups was significantly and clinically relevantly lower compared to controls. However, this difference was smaller than expected and less dominant than patients' perception of limitations in daily life. Clinicians must be aware that the patients' perception of physical functioning in daily life does not always correspond to the actual physical activity.
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Affiliation(s)
- I B de Groot
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Terwee CB, van der Slikke RMA, van Lummel RC, Benink RJ, Meijers WGH, de Vet HCW. Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. J Clin Epidemiol 2006; 59:724-31. [PMID: 16765276 DOI: 10.1016/j.jclinepi.2005.11.019] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 08/24/2005] [Accepted: 11/11/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES To test the hypothesis that self-reported physical functioning is more influenced by pain than performance-based physical functioning. METHODS 163 knee-osteoarthritis patients completed the performance-based DynaPort KneeTest (DPKT), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and SF-36 (self-report measures of pain and physical functioning) before, 3, 6, and 12 months after knee replacement. RESULTS Correlations between (two) self-reported measures of functioning and (two) pain measures were higher (0.57-0.74) than correlations between the performance-based measure of functioning and the two pain measures (0.20 and 0.26). In factor analysis, WOMAC and SF-36 pain and physical functioning subscores loaded on the first factor (eigenvalue 3.2), while DPKT KneeScore2 loaded on the second factor (eigenvalue 0.92). Before surgery, correlations between performance-based and self-reported physical functioning were higher in patients with less pain (0.43) compared to patients with more pain (0.17), for the WOMAC (as expected), but not for the SF-36. After surgery, when the pain had diminished, the correlations between performance-based and self-reported physical functioning were higher, especially for the WOMAC. CONCLUSIONS Our hypothesis was convincingly supported by the results of the WOMAC, and somewhat less by the results of the SF-36. We consider this as evidence for a lack of content validity of the WOMAC.
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Affiliation(s)
- Caroline B Terwee
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands.
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Veenhof C, Bijlsma JWJ, van den Ende CHM, van Dijk GM, Pisters MF, Dekker J. Psychometric evaluation of osteoarthritis questionnaires: a systematic review of the literature. ACTA ACUST UNITED AC 2006; 55:480-92. [PMID: 16739188 DOI: 10.1002/art.22001] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Cindy Veenhof
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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Terwee CB, Mokkink LB, Steultjens MPM, Dekker J. Performance-based methods for measuring the physical function of patients with osteoarthritis of the hip or knee: a systematic review of measurement properties. Rheumatology (Oxford) 2006; 45:890-902. [PMID: 16461441 DOI: 10.1093/rheumatology/kei267] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To systematically review the measurement properties (i.e. internal consistency, reproducibility, validity, responsiveness and interpretability) of all performance-based methods which have been used to measure the physical function of patients with osteoarthritis of the hip or knee. METHODS A systematic search was conducted in Medline, CINAHL, PsychINFO and Embase. Standardized criteria were applied to assess the quality of the clinimetric studies and the measurement properties. RESULTS Twenty-six performance-based methods were included: 13 walking tests, two stair-climb tests, one chair test and ten multi-item tests. Three out of seven multi-activity tests were tested for internal consistency and two were rated positively. Fourteen tests were tested for reliability and five were rated positively. The absolute measurement error (agreement) was assessed for 10 tests. Only one test received a positive rating. Fourteen tests were tested for construct validity. Only two tests received positive ratings. Responsiveness was assessed for 12 tests, but none of them received a positive rating. A lot of indeterminate ratings were given, mostly for small studies or non-optimal analyses. CONCLUSION Many more well-designed studies are needed to assess the measurement properties of performance-based methods. More importantly, however, before one can make a justified choice of a particular performance-based method, consensus is needed on what activities should be included in a performance-based test for patients with hip or knee osteoarthritis and which aspects of function should be measured.
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Affiliation(s)
- C B Terwee
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Hoeksma HL, van den Ende CHM, Breedveld FC, Ronday HK, Dekker J. A comparison of the OARSI response criteria with patient's global assessment in patients with osteoarthritis of the hip treated with a non-pharmacological intervention. Osteoarthritis Cartilage 2006; 14:77-81. [PMID: 16214379 DOI: 10.1016/j.joca.2005.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Accepted: 07/27/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the Osteoarthritis Research Society International (OARSI) response criteria for clinical trials with patient's global assessment in patients with osteoarthritis (OA) of the hip receiving a non-pharmacological intervention, i.e., manual therapy or exercise therapy. METHODS Data of a randomized clinical trial on manual therapy and exercise therapy in patients with OA of the hip (n = 109) were used. Change scores of measures of hip function, range of joint motion and pain were compared between patients who were differently classified by the OARSI response criteria and the patient's global assessment (using a t test, 95% CI). Furthermore, risk ratios (with 95% CI) were calculated for the contrast between treatment outcome, using the OARSI criteria or patient's global assessment. RESULTS Few patients were classified as improved (i.e., responders) with the OARSI response criteria as compared to patient's global assessment. Significantly worse outcome for hip function and pain was observed in patients who were classified as non-responders (OARSI criteria), but who considered themselves as improved (patient's global assessment). Risk ratios for the contrast between the two treatment programs (manual therapy vs exercise therapy) were similar, when using the OARSI criteria or patient's global assessment. CONCLUSION The validity of the OARSI response criteria has been previously demonstrated in OA patients treated with pharmacological interventions. The present study demonstrates the validity of the OARSI response criteria in OA patients treated with a non-pharmacological intervention, i.e., manual therapy and exercise therapy.
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Affiliation(s)
- Hugo L Hoeksma
- Department of Physical Therapy, Leyenburg Hospital, The Hague, The Netherlands.
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Stratford PW, Kennedy DM. Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol 2005; 59:160-7. [PMID: 16426951 DOI: 10.1016/j.jclinepi.2005.07.012] [Citation(s) in RCA: 219] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 06/27/2005] [Accepted: 07/03/2005] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Self-report questionnaires and performance measures represent two methods for assessing physical function. A recurring theme is that self-report measures are superior to performance measures. This study investigated the association between three performance test outcomes of four activities (pain, exertion, and time or distance; for self-paced walk, stair test, timed up-and-go, 6-minute walk) with self-reports of physical function (WOMAC Physical Function subscale and LEFS) and the association between the change scores of the performance tests and those of the self-report measures. STUDY DESIGN AND SETTING Performance and self-report measures were administered three times (presurgery and at approximately 1 week and approximately 8 weeks post arthroplasty) to 85 patients who underwent total hip or knee arthroplasty. Components of the performance tests were pooled within each domain across the four measures. Multiple regression analyses were applied. Independent variables were performance tests components; dependent variables were self-report measures. Standardized regression coefficients described the cross-sectional and longitudinal associations. RESULTS Pain was the principal determinant of WOMAC Physical Function subscale scores. Pain, exertion, and time or distance were strongly associated with the LEFS at the first, second, and third assessments, respectively. Change in pain was most strongly associated with change in self-reported physical function. CONCLUSION Our findings caution against the isolated use of self-report assessments of physical function.
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Affiliation(s)
- Paul W Stratford
- Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, IAHS School of Rehabilitation Science, McMaster University, Hamilton, Ontario L8N 1C7, Canada.
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Roorda LD, Roebroeck ME, van Tilburg T, Molenaar IW, Lankhorst GJ, Bouter LM, Boonstra AM, de Laat FA, Caron JJ, Burger BJ, Heyligers IC, Nollet F, Stover-Van Herk IE, Perez RS, Meijer JW, Rijken PM. Measuring Activity Limitations in Walking: Development of a Hierarchical Scale for Patients With Lower-Extremity Disorders Who Live at Home. Arch Phys Med Rehabil 2005; 86:2277-83. [PMID: 16344023 DOI: 10.1016/j.apmr.2005.06.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 06/02/2005] [Accepted: 06/14/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To develop a hierarchical scale that measures activity limitations in walking in patients with lower-extremity disorders who live at home. DESIGN Cross-sectional study. SETTING Orthopedic workshops and outpatient clinics of secondary and tertiary care centers. PARTICIPANTS Patients (N=981; mean age +/- standard deviation, 58.6+/-15.4 y; 46% men) living at home, with different lower-extremity disorders: stroke, poliomyelitis, osteoarthritis, amputation, complex regional pain syndrome type I, and diabetic and degenerative foot disorders. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES (1) Fit of the monotone homogeneity model, indicating whether items can be used for measuring patients; (2) fit of the double monotonicity model, indicating invariant (hierarchical) item ordering; (3) intratest reliability, indicating repeatability of the sum score; (4) robustness, addressing the clinimetric properties within subgroups of patients; and (5) differential item functioning, addressing the validity of comparisons between subgroups of patients. RESULTS Thirty-five of 41 dichotomous items had (1) good fit of the monotone homogeneity model (coefficient H=.50), (2) good fit of the double monotonicity model (coefficient H(T)=.33), (3) good intratest reliability (coefficient rho=.95), (4) satisfactory robustness (within subgroups of patients defined by age, sex, and diagnosis), and (5) some differential item functioning (6 items in amputees compared with nonamputees). CONCLUSIONS A hierarchical scale, with excellent scaling characteristics, was developed to measure activity limitations in walking in patients with lower-extremity disorders who live at home. The measurements should be interpreted cautiously when making comparisons between amputees and nonamputees.
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Affiliation(s)
- Leo D Roorda
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Mokkink LB, Terwee CB, van der Slikke RMA, van Lummel RC, Benink RJ, Bouter LM, de Vet HCW. Reproducibility and validity of the DynaPort KneeTest. ACTA ACUST UNITED AC 2005; 53:357-63. [PMID: 15934012 DOI: 10.1002/art.21167] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the reproducibility and validity of the DynaPort KneeTest, a performance-based test that measures quality of movement of patients undergoing total knee replacement (TKR). METHODS A total of 92 patients with osteoarthritis (OA) of the knee performed the KneeTest twice on the same day; 94 healthy controls performed the KneeTest once. During the test, 29 activities were performed with accelerometers attached to the body. Relevant functional parameters were extracted from the accelerometers. A selection of parameters was used to calculate activity scores, based on the ability of parameters to discriminate between patients and controls (regression analyses). Based on internal consistency analyses (Cronbach's alpha), redundant activities were removed. Four cluster scores and a total KneeScore were calculated from the remaining activity scores. Reproducibility and validity of the cluster scores and the total KneeScore 2 were assessed. RESULTS Based on internal consistency analyses, the test was reduced to 23 activities. Inter- and intraobserver reliability using intraclass correlation coefficients were 0.90 (0.83-0.94) and 0.95 (0.83-0.98), respectively. Limits of inter- and intraobserver agreement were -8.3 to 11.3 and -4.2 to 9.0. Construct validity was confirmed by expected correlations with the Western Ontario and McMaster University Osteoarthritis Index physical functioning (0.55), Medical Outcomes Study Short Form-36 Health Survey physical functioning (0.62), and Knee Society Score function (0.64). CONCLUSION The KneeTest is a useful performance-based measure for research in patients with knee OA undergoing TKR, with good reliability and validity. Further research is required to improve its usefulness for clinical practice.
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Affiliation(s)
- Lidwine B Mokkink
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
To determine the influence of body mass index (BMI) on perioperative morbidity, functional recovery, and hospital use, the records of 207 patients who underwent primary total hip arthroplasty were reviewed and patients were grouped according to BMI. Transfusion requirements, operative complications, functional recovery, and assistance needed for transfers from supine to sit, sit to stand, and bed to chair positions were analyzed at the first physical therapy. Compared with others, morbidly obese patients (BMI > or = 40 kg/m2) had significantly longer mean operative time and higher mean intraoperative blood loss (P<.05), a trend toward more complications, but no significant difference in functional recovery and hospital use.
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Affiliation(s)
- Stefan R Jibodh
- Department of Orthopedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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Hoeksma HL, Van Den Ende CHM, Ronday HK, Heering A, Breedveld FC. Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip. Ann Rheum Dis 2003; 62:935-8. [PMID: 12972470 PMCID: PMC1754316 DOI: 10.1136/ard.62.10.935] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare responsiveness of the Harris Hip Score with generic measures (that is, the Short Form-36 (SF-36), and a test of walking speed and pain during walking) in patients with osteoarthritis (OA) of the hip. METHOD The first 75 cases within the population of a randomised clinical trial on manual therapy and exercise therapy were selected for secondary analysis. Experienced (self reported) recovery by the patients after treatment (five weeks) was used as an external criterion for clinically relevant improvement. Responsiveness was evaluated by comparing responsiveness ratios and receiver operating characteristic curves. RESULTS The responsiveness ratio for the Harris Hip Score was high (1.70) compared with walking speed (0.45), pain during walking (0.66), and the subscales of the SF-36-"bodily pain" (0.42) and "physical functioning" (0.36). The area under the curve also was highest for the Harris Hip Score (0.92) compared with walking speed (0.71), pain during walking (0.73), and the SF-36 subscales-bodily pain and physical functioning (both 0.66). CONCLUSION The Harris Hip Score is more responsive than the test of walking speed, pain, and subscales for function of the SF-36 in patients with OA of the hip. The Harris Hip Score seems to be a suitable instrument to evaluate change in hip function in patients with OA of the hip.
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Affiliation(s)
- H L Hoeksma
- Leyenburg Hospital, The Hague, The Netherlands.
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Stratford PW, Kennedy D, Pagura SMC, Gollish JD. The relationship between self-report and performance-related measures: questioning the content validity of timed tests. ARTHRITIS AND RHEUMATISM 2003; 49:535-40. [PMID: 12910560 DOI: 10.1002/art.11196] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the determinants of the modest correlation between self-report and performance-related measures in patients with osteoarthritis of the hip or knee. METHODS Measures included the Lower Extremity Functional Scale (LEFS), the self paced walk, timed up-and-go, and stair test. Each performance measure consisted of 3 domains: time, pain (visual analog scale), and exertion (Borg scale). Activity specificity was assessed by examining correlations between the LEFS with single activity and multiple activity time scores. Domain specificity was examined by comparing correlations between the LEFS and single and multiple domain scores. The impact of measurement error was considered. RESULTS Increasing the number of activity time scores had no effect. Forming a composite performance score based on time, pain, and exertion substantially increased the correlation from 0.44 (composite timed score) to 0.59 (pooled domain and activity score) (P = 0.009). CONCLUSION Performance scores based on time alone appear to inadequately represent the breadth of health concepts associated with functional status.
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Lan TY, Deeg DJH, Guralnik JM, Melzer D. Responsiveness of the index of mobility limitation: comparison with gait speed alone in the longitudinal aging study amsterdam. J Gerontol A Biol Sci Med Sci 2003; 58:721-7. [PMID: 12902530 DOI: 10.1093/gerona/58.8.m721] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Interpreting self-reported disability differences between diverse older populations is complicated by differences in attitudes and environment. We have previously reported on the index of mobility-related limitation tests (MOBLI), and shown that it predicts mortality over 4 years. In this article, we examine whether the index is responsive to changes in self-reported mobility disability. METHODS Data on gait speed, time to complete 5 chair stands, and peak expiratory flow rate, with self-reported difficulty walking for 5 minutes, were available from the baseline and two 3-year follow-ups in the Longitudinal Aging Study Amsterdam. Analysis used data on changes in the index (or walking speed alone) and corresponding change over 3 years in self-reported difficulty or inability with a medium-distance walk. RESULTS During all follow-ups, groups reporting deterioration in functioning had relatively larger changes in gait speed and MOBLI score than did the "no deterioration" groups. In comparative analyses of responsiveness, the MOBLI score had a larger responsiveness index, higher odds ratios, and larger receiving operating characteristic area than gait speed alone. CONCLUSIONS The MOBLI index of mobility-related physical limitation tests is responsive to changes in self-reported mobility disability over two 3-year periods, and performs better than gait speed alone. This property is strongly supportive of its validity for epidemiological comparison of older populations across countries or over longer periods of time.
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Affiliation(s)
- Tzuo-Yun Lan
- Department of Public Health & Primary Care, University of Cambridge, UK
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Wenz JF, Gurkan I, Jibodh SR. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics 2002; 25:1031-43. [PMID: 12401009 DOI: 10.3928/0147-7447-20021001-14] [Citation(s) in RCA: 192] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Compared with patients with total hip arthroplasty (THA) via a direct lateral approach, patients treated with THA via a mini-incision approach had significantly earlier ambulation, less transfer assistance, and more favorable discharge dispositions; they also had decreased transfusion requirements and better functional recovery with early physical therapy. This procedure achieved accurate and reproducible implantation, regardless of patient habitus.
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Affiliation(s)
- James F Wenz
- Department of Orthopedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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