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Kobayashi T, Igusa T, Uchida H, Tsuchiya K, Akiba T, Takahashi T, Taguchi M, Okada C, Yabuki H, Kanazawa Y, Kikuchi S, Hirao K. Reliability of the Two-dimensional Mood Scale for self-reported mood assessment by older adults with dementia. Geriatr Nurs 2024; 58:459-465. [PMID: 38941790 DOI: 10.1016/j.gerinurse.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
The purpose of this study was to evaluate the reliability of the Two-dimensional Mood Scale (TDMS) for mood assessment among older adults with dementia. The study included 100 elderly patients with dementia admitted to two hospitals. For each mood state measured by the TDMS, the intraclass correlation coefficient of agreement (ICCagreement) was calculated to evaluate test-retest reliability. Scores corresponding to the minimal detectable change (MDC) in each mood state at the individual level (MDCind) was also calculated to evaluate measurement error, while McDonald's omega was calculated to evaluate internal consistency. The TDMS ICC was 0.54 for vitality, 0.74 for stability, 0.70 for pleasure, and 0.55 for arousal. The MDCind was 6.89 for vitality, 5.88 for stability, 9.96 for pleasure, and 4.11 for arousal. McDonald's omega ranged from 0.60 to 0.84. The TDMS has generally acceptable reliability for the self-assessment of mood states by older adults with dementia.
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Affiliation(s)
- Takuya Kobayashi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Takumi Igusa
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Hiroyuki Uchida
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Takanari Akiba
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Tsuyoshi Takahashi
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Maya Taguchi
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Chihiro Okada
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Hasumi Yabuki
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Yukina Kanazawa
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Senichiro Kikuchi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan.
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Kubo Y, Fujita D, Sugiyama S, Takachu R, Sugiura T, Sawada M, Yamashita K, Kobori K, Kobori M. Safety and Effects of a Four-Week Preoperative Low-Load Resistance Training With Blood Flow Restriction on Pre- and Postoperative Quadriceps Strength in Patients Undergoing Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial. Cureus 2024; 16:e64466. [PMID: 39156304 PMCID: PMC11328827 DOI: 10.7759/cureus.64466] [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] [Accepted: 07/13/2024] [Indexed: 08/20/2024] Open
Abstract
Background/Objectives Enhancing preoperative quadriceps strength and mitigating quadriceps strength loss due to total knee arthroplasty (TKA) is crucial for post-TKA recovery. This study compared the safety and effect of a four-week preoperative regimen of low-load resistance training with blood flow restriction (LLRT-BFR) with those of low-intensity resistance training with slow movement and tonic force generation (LST) on the pre- and postoperative quadriceps strength in patients undergoing TKA. Methods In this randomized controlled trial, 22 patients were assigned to either the LLRT-BFR (n=11) or LST (n=11) group. Primary outcomes included changes in quadriceps strength before and after the intervention and surgery. To assess safety, we monitored D-dimer and high-sensitivity C-reactive protein levels pre- and post-intervention. Statistical analysis involved independent samples t-tests and Mann-Whitney U tests for group comparisons of quadriceps strength changes. Additionally, a two-way repeated-measures analysis of variance was used to assess safety parameters. Results No significant differences were observed between the BFR and LST groups in terms of the rate of increase in quadriceps strength pre- and post-intervention (BFR: median 12.1%, interquartile range -0.8% to 19.5%; LST: median 6.2%, interquartile range 2.7% to 14.7%; p>0.99) or in the rate of reduction in quadriceps strength pre- and post-surgery (BFR: mean -72.4%, standard deviation ±11.2%; LST: mean -75.3%, standard deviation ±12.2%; p=0.57). Safety assessments showed no significant main effects of time, group, or interaction on the safety parameters (all p>0.05). Conclusions LLRT-BFR and LST demonstrated comparable effects on quadriceps strength before and after intervention and surgery in patients undergoing TKA. The lack of significant changes in the safety parameters supports the safety profile of both interventions, indicating their suitability for preoperative conditioning in patients scheduled for TKA.
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Affiliation(s)
- Yusuke Kubo
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
| | - Daisuke Fujita
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Shuhei Sugiyama
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
| | - Rie Takachu
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
| | - Takeshi Sugiura
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
| | - Masahiro Sawada
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
| | - Kohtaro Yamashita
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
| | - Kaori Kobori
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
| | - Makoto Kobori
- Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN
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Waddell LM, Musbahi O, Collins JE, Jones MH, Selzer F, Losina E, Katz JN. Responsiveness of Subjective and Objective Measures of Pain and Function Following Operative Interventions for Musculoskeletal Conditions: A Narrative Review. Arthritis Care Res (Hoboken) 2024; 76:882-888. [PMID: 38221714 PMCID: PMC11132946 DOI: 10.1002/acr.25298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/16/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Musculoskeletal (MSK) disorders affect ~50% of US adults and 75% of those over the age of 65, representing a sizable economic and disability burden. Outcome measures, both objective and subjective, help clinicians and investigators determine whether interventions to treat MSK conditions are effective. This narrative review qualitatively compared the responsiveness of different types of outcome measures, a key measurement characteristic that assesses an outcome measure's ability to detect change in patient status. METHODS We evaluated elective orthopedic interventions as a model for assessing responsiveness because the great majority of patients improves following surgery. We searched for articles reporting responsiveness (quantified as effect size [ES]) of subjective and objective outcome measures after orthopedic surgery and included 16 articles reporting 17 interventions in this review. RESULTS In 14 of 17 interventions, subjective function measures had an ES 10% greater than that of objective function measures. Two reported a difference in ES of <10%. The sole intervention that demonstrated higher ES of objective function used a composite measure. Sixteen interventions reported measures of subjective pain and/or mixed measures and subjective function. In nine interventions, subjective pain had a higher ES than subjective function by >10%, in three, subjective function had a higher ES than subjective pain by >10%, and in the remaining four, the difference between pain and function was <10%. CONCLUSION These findings reinforce the clinical observation that subjective pain generally changes more than function following elective orthopedic surgery. They also suggest that subjective function measures are more responsive than objective function measures, and composite scores may be more responsive than individual performance tests.
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Affiliation(s)
- Lily M. Waddell
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital
- Department of Orthopedic Surgery, Brigham and Women’s Hospital
| | - Omar Musbahi
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital
- MSk Lab, Imperial College London, London
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital
- Harvard Medical School
- Department of Orthopedic Surgery, Brigham and Women’s Hospital
| | - Morgan H. Jones
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital
- Harvard Medical School
- Department of Orthopedic Surgery, Brigham and Women’s Hospital
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital
- Harvard Medical School
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital
- Harvard Medical School
- Department of Orthopedic Surgery, Brigham and Women’s Hospital
- Department of Biostatistics, Boston University School of Public Health
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital
- Harvard Medical School
- Department of Orthopedic Surgery, Brigham and Women’s Hospital
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Hong QM, Wang HN, Liu XH, Zhou WQ, Luo XB. Intermittent blood flow restriction with low-load resistance training for older adults with knee osteoarthritis: a randomized, controlled, non-inferiority trial protocol. Trials 2024; 25:352. [PMID: 38822360 PMCID: PMC11140873 DOI: 10.1186/s13063-024-08203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a chronic musculoskeletal disorder characterized by pain and functional impairment. Blood flow restriction (BFR) with low-load resistance training (LLRT) demonstrates a similar improvement in clinical outcomes to high-load resistance training (HLRT) in treating KOA. It has not been established whether intermittent blood flow restriction (iBFR) with LLRT can lead to clinical outcomes that are comparable to those produced by continuous blood flow restriction (cBFR) with LLRT and HLRT. The aim of the proposed study is to evaluate the efficacy of iBFR with LLRT on pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), muscle strength, muscle mass, physical function, perceptions of discomfort and effort, and adherence in KOA patients. METHODS This is a three-arm, non-inferiority, randomized controlled trial utilizing blinded assessors. Two hundred thirteen participants will be randomly allocated to one of the following three groups: iBFR group-receiving 4 months of LLRT with iBFR, twice weekly (n = 71); cBFR group-receiving 4 months of LLRT with cBFR, twice weekly (n = 71); or HLRT group-receiving 4 months of HLRT without BFR, twice weekly (n = 71). The primary outcome is pain. The secondary outcomes include the WOMAC, muscle strength, muscle mass, physical function, perceptions of discomfort and effort, and adherence. Pain and WOMAC will be measured at the baseline and 4 and 12 months after randomizations. Muscle strength, muscle mass, and physical function will be measured at the baseline and 4 months after randomizations. The perceptions of discomfort and effort will be measured during the first and final sessions. DISCUSSION BFR with LLRT has a similar improvement in clinical outcomes as HLRT. However, cBFR may cause elevated ratings of perceived exertion and local discomfort, compromising patient tolerability and treatment adherence. If iBFR with LLRT could produce improvement in clinical outcomes analogous to those of HLRT and iBFR with LLRT, it could be considered an alternative approach for treating patients with KOA. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300072820. Registered on June 26, 2023.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, 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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Pua YH, Yeo SJ, Clark RA, Tan BY, Haines T, Bettger JP, Woon EL, Tan HH, Tan JWM, Low J, Chew E, Thumboo J. Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial. Osteoarthritis Cartilage 2024; 32:601-611. [PMID: 38049030 DOI: 10.1016/j.joca.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). DESIGN In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n = 58) or TR (n = 56). HBR comprised at least five physical therapy sessions over 10 weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12 weeks, with a non-inferiority margin of 0.10 m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). RESULTS In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02 m/s; 95%CrI, -0.05 to 0.10 m/s; week-24 difference, 0.01 m/s; 95%CrI, -0.07 to 0.10 m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24 weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. CONCLUSIONS In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Ross Allan Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia.
| | - Bryan Yijia Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore.
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Janet Prvu Bettger
- Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Hong Han Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - John Wei-Ming Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Juanita Low
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Eleanor Chew
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore; Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
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Mostafaee N, Rashidi F, Negahban H, Ebrahimzadeh MH. Responsiveness and minimal important changes of the OARSI core set of performance-based measures in patients with knee osteoarthritis following physiotherapy intervention. Physiother Theory Pract 2024; 40:1028-1039. [PMID: 36346362 DOI: 10.1080/09593985.2022.2143253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The Osteoarthritis Research Society International has recommended a core set of performance-based tests of physical function for use in knee osteoarthritis (OA) patients. The core set includes 30-second chair stand test (30-s CST), 4 × 10 m fast-paced walk test (40-m FPWT), and a stair climb test. This study aimed to evaluate responsiveness and minimal important changes (MICs) of these performance-based measures in knee OA patients following physiotherapy. METHODS Sixty patients with knee OA, undergoing 4-week physiotherapy performed 30-s CST, 40-m FPWT, and 4-step stair climb test (4-step SCT) at pre- and post-intervention. Patients also completed the 7-point global rating scale as an external anchor at post-intervention. Responsiveness was evaluated using receiver operating characteristics curve and correlation analysis. RESULTS All three performance-based measures of physical function showed area under the curve > 0.70. Correlation analysis showed relationship of 30-s CST, 40-m FPWT, and 4-Step SCT with the external anchor fell within moderate to good range (Spearman = 0.43-0.63). Furthermore, MIC values reflecting improvement for 30-s CST, 40-m FPWT, and 4-Step SCT were 2.5, 0.21, and 3.21, respectively. CONCLUSION Our findings demonstrated all three performance-based measures have good responsiveness to measure improvement in physical functions of knee OA patients following physiotherapy. The MIC reflecting improvement can help clinicians and researchers to make a decision based on the clinical significance of improvements in patients' functional status.
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Affiliation(s)
- Neda Mostafaee
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Rashidi
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmad-Abad Street,Mashhad, 91799-9199 Iran
| | - Mohammad Hosein Ebrahimzadeh
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmad-Abad Street,Mashhad, 91799-9199 Iran
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Labie C, Runge N, Mairesse O, Nijs J, Malfliet A, Verschueren S, Van Assche D, de Vlam K, Luyten F, Bilterys T, Cools W, De Pourcq V, Delwiche B, Huysmans E, De Baets L. Integration of Cognitive Behavioral Therapy for Insomnia in Best-Practice Care for Patients With Knee Osteoarthritis and Insomnia: A Randomized Controlled Trial Protocol. Phys Ther 2024; 104:pzad181. [PMID: 38157312 DOI: 10.1093/ptj/pzad181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Knee osteoarthritis (KOA) is a common musculoskeletal problem worldwide and its key symptom is pain. Guidelines recommend incorporating comorbidity-specific therapies into patient-centered care. Patients diagnosed with KOA frequently have insomnia, which is associated with higher-pain severity. For this reason, this study protocol outlines the methodology of a randomized controlled trial (RCT) investigating the effectiveness of cognitive behavioral therapy for insomnia (CBTi) combined with best-practice KOA care (BPC) compared to best-practice KOA care and lifestyle education. METHODS A 2-arm RCT in patients with KOA and insomnia is conducted, in which a total of 128 patients are randomly allocated to an intervention or control group. The experimental intervention consists of 12 sessions of physical therapist-led BPC with an additional 6 sessions of CBTi. The control intervention also receives BPC, which is supplemented with 6 general lifestyle information sessions. The primary outcome is the between-group difference in change in pain severity at 6 months after intervention. Secondary outcomes are pain-related outcomes, sleep-related outcomes, symptoms of anxiety and depression, level of physical activity and function, perceived global improvement, biomarkers of inflammation, and health-related quality of life. Assessments are conducted at baseline, immediately after intervention, and 3, 6, and 12 months after intervention. Furthermore, a cost-utility analysis for the proposed intervention will be performed alongside the RCT. IMPACT This is the first RCT investigating the clinical and cost-effectiveness of a physical therapist-led intervention integrating CBTi into BPC in patients with KOA and insomnia. The results of this trial will add to the growing body of evidence on the effectiveness of individualized and comorbidity-specific KOA care, which can inform clinical decision-making and assist policymakers and other relevant stakeholders in optimizing the care pathway for patients with KOA.
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Affiliation(s)
- Céline Labie
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nils Runge
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Mairesse
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Laboratoire de Psychologie Médicale et d'Addictologie (ULB312), Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles (ULB) and Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Dieter Van Assche
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Frank Luyten
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | - Wilfried Cools
- Core facility - Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Veerle De Pourcq
- ReumaNet vzw, Flemish Patient Organization for Rheumatological Conditions, Zaventem, Belgium
| | - Bérénice Delwiche
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Sleep Unit, University Hospital Brussels, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
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9
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Mostafaee N, Pashaei-Marandi M, Negahban H, Pirayeh N, Saki Malehi A, Ebrahimzadeh MH. Examining the diagnostic accuracy of common physical examination and functional tests in the diagnosis of patellofemoral pain syndrome among patients with anterior knee pain. Physiother Theory Pract 2024; 40:843-855. [PMID: 36537113 DOI: 10.1080/09593985.2022.2158053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE The aims of this study were to evaluate the diagnostic accuracy of common physical examination and functional evaluation tests, and to determine a set of tests with the highest diagnostic accuracy for diagnosing patellofemoral pain syndrome (PFPS) in patients with anterior knee pain. METHODS Based on careful evaluation of clinical findings and imaging methods by orthopedic physicians, 162 patients with anterior knee pain were classified into two groups of PFPS and non-PFPS. The physical examination and functional tests were performed by two physiotherapists. The accuracy of these measures was determined by calculating sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC), likelihood ratio (LR), and predictive value (PV). RESULTS Our results showed the most sensitive tests in identifying patients with PFPS were as follows: eccentric step test [0.82 (95%CI: 0.72-0.89)]; palpation test [0.81(95%CI: 0.70-0.88)]; and prolonged sitting [0.73 (95%CI: 0.62-0.82)]. The palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending tests had an acceptable accuracy (AUC ≥ 70). The strongest combination of the physical examination and functional tests included pain severity between 3 and 10 during stair descending test and pain severity between 6 and 10 during prolonged sitting test. This combination showed a positive LR of 19.47 (95% CI: 6.36-59.65) and a posttest probability of 95%. CONCLUSION Our findings provide evidence for the good accuracy of the palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending and prolonged sitting tests for diagnosing PFPS. Also, the combination of stair descending test and prolonged sitting test could be very useful for ruling in PFPS patients.
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Affiliation(s)
- Neda Mostafaee
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Khorasan Razavi, Mashhad, Iran
| | - Melika Pashaei-Marandi
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Khorasan Razavi, Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Khorasan Razavi, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Ghaem Hospital, Ahmad Abad St., Khorasan Razavi, Mashhad, Iran
| | - Nahid Pirayeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amal Saki Malehi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hosein Ebrahimzadeh
- Orthopedic Research Center, Mashhad University of Medical Sciences, Ghaem Hospital, Ahmad Abad St., Khorasan Razavi, Mashhad, Iran
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Karsdal MA, Tambiah J, Felson D, Ladel C, Nikolov NP, Hodgins D, Bihlet AR, Neogi T, Baatenburg de Jong C, Bay-Jensen AC, Baron R, Laslop A, Mobasheri A, Kraus VB. Reflections from the OARSI 2022 clinical trials symposium: The pain of OA-Deconstruction of pain and patient-reported outcome measures for the benefit of patients and clinical trial design. Osteoarthritis Cartilage 2023; 31:1293-1302. [PMID: 37380011 PMCID: PMC11184959 DOI: 10.1016/j.joca.2023.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) drug development is hampered by a number of challenges. One of the main challenges is the apparent discordance between pain and structure, which has had a significant impact on drug development programs and has led to hesitance among stakeholders. Since 2017, the Clinical Trials Symposium (CTS) has been hosted under the Osteoarthritis Research Society International (OARSI) leadership. OARSI and the CTS steering committee yearly invite and encourage discussions on selected special subject matter between regulators, drug developers, clinicians, clinical researchers, biomarker specialists, and basic scientists to progress drug development in the OA field. METHOD The main topic for the 2022 OARSI CTS was to elucidate the many facets of pain in OA and to enable a discussion between regulators (Food and Drug Administration (FDA) and the European Medicines Agency (EMA)) and drug developers to clarify outcomes and study designs for OA drug development. RESULTS Signs or symptoms indicative of nociceptive pain occur in 50-70% of OA patients, neuropathic-like pain in 15-30% of patients, and nociplastic pain in 15-50% of patients. Weight-bearing knee pain is associated with bone marrow lesions and effusions. There are currently no simple objective functional tests whose improvements correlate with patient perceptions. CONCLUSIONS The CTS participants, in collaboration with the FDA and EMA, raised several suggestions that they consider key to future clinical trials in OA including the need for more precise differentiation of pain symptoms and mechanisms, and methods to reduce placebo responses in OA trials.
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Affiliation(s)
- M A Karsdal
- Nordic Bioscience, Herlev, Denmark; Southern Danish University, Odense, Denmark.
| | - J Tambiah
- Biosplice Therapeutics, San Diego, USA
| | - D Felson
- Boston University School of Medicine, Boston, MA, USA
| | - C Ladel
- CHL4special Consultancy, Darmstadt, Germany
| | - N P Nikolov
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - D Hodgins
- Dynamic Metrics Limited, Codicote, UK
| | | | - T Neogi
- Boston University School of Medicine, Boston, MA, USA
| | | | | | - R Baron
- University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - A Laslop
- Committee for Medicinal Products for Human Use (CHMP), European Medicines Agency, Amsterdam, the Netherlands; Bundesamt für Sicherheit im Gesundheitswesen (BASG), Vienna, Austria
| | - A Mobasheri
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Université de Liège, Liege, Belgium
| | - V B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
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11
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Adriani M, Becker R, Milano G, Lachowski K, Prill R. High variation among clinical studies in the assessment of physical function after knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:3854-3860. [PMID: 36907938 PMCID: PMC10435639 DOI: 10.1007/s00167-023-07375-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE The purpose of this study was to summarise the current use of outcome measures for the assessment of physical function after knee joint replacement. METHODS A systematic approach following the PRISMA guidelines was used. Literature search was performed on MEDLINE database via PubMed and on Epistemonikos. Clinical trials (level of evidence I-II) on knee joint replacement reporting data on the 'physical function' domain published between January 2017 and June 2022 were included. Descriptive statistics were used to summarise the evidence. RESULTS In the 181 articles that met the inclusion criteria, 49 different outcome measurements were used to evaluate clinical outcomes after knee joint replacement. The most frequently adopted patient-reported outcome measures (PROMs) were the Knee Society Score (KSS) (78 studies; 43.1%), the Western Ontario and McMaster Universities (WOMAC) Arthritis Index (62 studies; 34.3%), the Oxford Knee Score (OKS) (51 studies; 28.2%) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) (36 studies; 20%). The most frequently used performance-based outcome measures (PBOMs) were the Timed-Up-and-Go (TUG) test (30 studies; 16.6%) and the 6-min-walk test (6MWT) (21 studies; 11.6%). Among impairment-based outcome measures (IBOMs), range of motion (ROM) was the most used (74 studies; 40.9%). CONCLUSION There is considerable variation among clinical studies regarding the assessment of the physical function of patients after knee joint replacement. PROMs were found to be the most commonly adopted outcome measures; however, no single PROM was used in more than half of the papers analysed. LEVEL OF EVIDENCE Level II, systematic review of level I-II studies.
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Affiliation(s)
- Marco Adriani
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Krzysztof Lachowski
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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12
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Onitsuka K, Kubota K, Yokoyama M, Miyazawa T, Hamaguchi T, Taniguchi H, Usuki N, Miyamoto S, Okazaki K, Murata K, Kanemura N. Clinical utility of markerless motion capture for kinematic evaluation of sit-to-stand during 30 s-CST at one year post total knee arthroplasty: a retrospective study. BMC Musculoskelet Disord 2023; 24:254. [PMID: 37005665 PMCID: PMC10067213 DOI: 10.1186/s12891-023-06364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/24/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Although the importance of kinematic evaluation of the sit-to-stand (STS) test of total knee arthroplasty (TKA) patients is clear, there have been no reports analyzing STS during the 30-s chair sit-up test (30 s-CST) with a focus on kinematic characteristics. This study aimed to demonstrate the clinical utility of kinematic analysis of STS during the 30 s-CST by classifying STS into subgroups based on kinematic parameters, and to determine whether differences in movement strategies are expressed as differences in clinical outcomes. METHODS The subjects were all patients who underwent unilateral TKA due to osteoarthritis of the knee and were followed up for one year postoperatively. Forty-eight kinematic parameters were calculated using markerless motion capture by cutting STS in the 30 s-CST. The principal components of the kinematic parameters were extracted and grouped by kinematic characteristics based on the principal component scores. Clinical significance was examined by testing whether differences in patient-reported outcome measures (PROMs) were observed. RESULTS Five principal components were extracted from the 48 kinematic parameters of STS and classified into three subgroups (SGs) according to their kinematic characteristics. It was suggested that SG2, using a kinematic strategy similar to the momentum transfer strategy shown in previous studies, performed better in PROMs and, in particular, may be associated with achieving a "forgotten joint", which is considered the ultimate goal after TKA. CONCLUSIONS Clinical outcomes differed according to kinematic strategies used STS, suggesting that kinematic analysis of STS in 30 s-CST may be useful in clinical practice. TRIAL REGISTRATION This study was approved by the Medical Ethical Committee of the Tokyo Women's Medical University (approval number: 5628 on May 21, 2021).
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Affiliation(s)
- Katsuya Onitsuka
- Department of Rehabilitation, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Keisuke Kubota
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, 343-8540, Saitama, Japan
| | - Moeka Yokoyama
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taku Miyazawa
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Toyohiro Hamaguchi
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, 343-8540, Saitama, Japan
| | - Hiroto Taniguchi
- Department of Orthopaedic Surgery, Ushiku Aiwa General Hospital, Ibaraki, Japan
| | - Naohiro Usuki
- Department of Rehabilitation, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Satoshi Miyamoto
- Department of Orthopaedic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, 343-8540, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, 343-8540, Saitama, Japan.
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13
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Lee SH, Kao CC, Liang HW, Wu HT. Validity of the Osteoarthritis Research Society International (OARSI) recommended performance-based tests of physical function in individuals with symptomatic Kellgren and Lawrence grade 0-2 knee osteoarthritis. BMC Musculoskelet Disord 2022; 23:1040. [PMID: 36451167 PMCID: PMC9714223 DOI: 10.1186/s12891-022-06012-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Performance-based physical tests have been widely used as objective assessments for individuals with knee osteoarthritis (KOA), and the core set of tests recommended by the Osteoarthritis Research Society International (OARSI) aims to provide reliable, valid, feasible and standardized measures for clinical application. However, few studies have documented their validity in roentgenographically mild KOA. Our goal was to test the validity of five performance-based tests in symptomatic KOA patients with X-ray findings of Kellgren and Lawrence (K-L) grade 0-2. METHODS We recruited a convenience sample of thirty KOA patients from outpatient clinics and 30 age- and sex-matched asymptomatic controls from the community. They performed five OARSI-recommended physical tests and the KOA group answered the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. The tests included the 9-step stair-climbing test (9 s-SCT), timed up and go (TUG) test, 30-second chair-stand test (30sCST), 40-m fast walking-test (40MFPW) and 6-minute walking test (6MWT). The discriminant validity of these physical tests were assessed by comparisons between the KOA and control groups, receiver operating curve and multivariate logistic regression analysis. The convergent/divergent validity was assessed by correlation between the physical tests results and the three subscale scores of the WOMAC in the KOA group. RESULTS The KOA group had significantly worse performance than the control group. The percentage of difference was the largest in the 9 s-SCT (57.2%) and TUG tests (38.4%). Meanwhile, Cohen's d was above 1.2 for the TUG test and 6MWT (1.2 ~ 2.0), and between 0.8 and 1.2 for the other tests. The areas under the curve to discriminate the two groups were mostly excellent to outstanding, except for the 30sCST. Convergent validity was documented with a moderate correlation between the 9 s-SCT and the physical function (WOMAC-PF) subscale scores (Spearman's ρ = 0.60). CONCLUSIONS The OARSI recommended core set was generally highly discriminative between people with K-L grade 0-2 KOA and their controls, but convergent/divergent validity was observed only in the 9 s-SCT. Further studies are required to evaluate the responsiveness of these tests and understand the discordance of physical performance and self-reported measures.
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Affiliation(s)
- Si-Huei Lee
- grid.278247.c0000 0004 0604 5314Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China ,grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Chi-Chun Kao
- grid.278247.c0000 0004 0604 5314Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China ,grid.260539.b0000 0001 2059 7017Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Huey-Wen Liang
- grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, No 7, Chong-Shan South Road, Taipei, 100 Taiwan, Republic of China ,grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Shin-Chu branch, Shin-Chu, Taiwan, Republic of China
| | - Hung-Ta Wu
- grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China ,grid.278247.c0000 0004 0604 5314Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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14
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KORBEE S, VAN KEMPEN R, VAN WENSEN R, VAN DER STEEN M, LIU WY. Measurement properties of the HOOS-PS in revision total hip arthroplasty: a validation study on validity, interpretability, and responsiveness in 136 revision hip arthroplasty patients. Acta Orthop 2022; 93:742-749. [PMID: 36121126 PMCID: PMC9484076 DOI: 10.2340/17453674.2022.4572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE To determine whether the Hip disability and Osteoarthritis Outcome Score-Physical function Short-form (HOOS-PS) is able to appropriately evaluate physical function in revision hip arthroplasty patients, this study assesses psychometric properties of the Dutch HOOS-PS in this patient population. PATIENTS AND METHODS We assessed psychometric properties of the HOOS-PS following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. Content validity, including comprehensibility, comprehensiveness, and relevance of the items, was assessed using cognitive debriefing interviews in hip revision patients (n = 8) and orthopedic surgeons specialized in revision surgery (n = 7). Construct validity, responsiveness, and interpretability (floor/ceiling effects) were assessed in revision hip arthroplasty patients (baseline n = 136, follow-up n = 67). We formulated hypotheses a priori to assess construct validity and responsiveness using the EuroQol 5-Dimensions Health Questionnaire, Numeric Rating scale for pain, and Oxford Hip Score as comparators. All questionnaires were measured at baseline and 1 year postoperatively. RESULTS We found insufficient content validity of the HOOS-PS, as relevance and comprehensibility of the items scored < 85% on the COSMIN criteria for revision hip arthroplasty patients. Construct validity was sufficient as all hypotheses were confirmed (≥ 75% COSMIN criteria). Interpretability was sufficient (< 15% COSMIN criteria) and responsiveness was insufficient (< 75% COSMIN criteria). INTERPRETATION The Dutch HOOS-PS is not able to sufficiently evaluate physical function in revision hip arthroplasty patients. Minor changes in the items are needed for the HOOS-PS to become sufficiently content valid, because the HOOS-PS lacks relevant items and comprehensiveness.
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Affiliation(s)
- Sanne KORBEE
- Department of Orthopedic Surgery & Trauma, Catharina Hospital, Eindhoven
| | - Robin VAN KEMPEN
- Department of Orthopedic Surgery & Trauma, Catharina Hospital, Eindhoven
| | - Remco VAN WENSEN
- Department of Orthopedic Surgery & Trauma, Catharina Hospital, Eindhoven
| | - Marieke VAN DER STEEN
- Department of Orthopedic Surgery & Trauma, Catharina Hospital, Eindhoven,Department of Orthopedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands
| | - Wai-Yan LIU
- Department of Orthopedic Surgery & Trauma, Catharina Hospital, Eindhoven,Department of Orthopedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands
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15
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Jyothikiran J, Rajan A, Leo Aseer PA, N V, K S. Influence of pain quality on physical performance in subjects with osteoarthritis of knee. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2043697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jambala Jyothikiran
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, India
| | - Angeline Rajan
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, India
| | - P Antony Leo Aseer
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, India
| | - Venkatesh N
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, India
| | - Soundararajan K
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, India
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16
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Chen H, Wang C, Wu J, Wang M, Wang S, Wang X, Wang J, Yu H, Hu Y, Shang S. Measurement properties of performance-based measures to assess physical function in knee osteoarthritis: A systematic review. Clin Rehabil 2022; 36:1489-1511. [PMID: 35702008 DOI: 10.1177/02692155221107731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review the measurement properties of performance-based measures to assess physical function in people with knee osteoarthritis. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CINAHL, and PsycINFO were searched in May 2022. METHODS This study was conducted in accordance with the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Clinical trials on the psychometric properties of performance-based tools for measuring physical function in people with knee osteoarthritis were included. Two reviewers independently rated measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). "Best evidence synthesis" was made using COnsensus-based Standards for the selection of health Measurement INstruments outcomes and the quality of findings. RESULTS Thirty-six out of 3425 publications were eligible for inclusion. Thirty-two performance-based measures were evaluated including 26 single-activity measures and 6 multi-activity measures. Measurement properties evaluated included internal consistency (2 measures), reliability (23 measures), measurement error (20 measures), hypotheses testing for construct validity (22 measures), and responsiveness (23 measures). On balance of the limited evidence, the walk 40 m fast-paced test and 6-minute walking test were the best rated walking tests. The 30-second chair stand test and timed up and go test were the best rated sit-to-stand tests. The Performance Tests Measures and Physical Activity Restrictions may be the suitable multi-activity measures for knee osteoarthritis. CONCLUSIONS Further good quality research investigating the measurement properties, and in particular, the measurement error of performance-based measures in patients with knee osteoarthritis is needed.
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Affiliation(s)
- Hongbo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China.,School of Nursing, 12465Peking University, China, Beijing, China
| | - Cui Wang
- School of Nursing, 12465Peking University, China, Beijing, China
| | - Junhui Wu
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China.,School of Nursing, 12465Peking University, China, Beijing, China
| | - Mengying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China
| | - Siyue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China
| | - Jiating Wang
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China
| | - Huan Yu
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, 12465Peking University, Beijing, China.,Medical Informatics Center, 12465Peking University, Beijing, China
| | - Shaomei Shang
- School of Nursing, 12465Peking University, China, Beijing, China
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17
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Gill S, Hely R, Page RS, Hely A, Harrison B, Landers S. Thirty second chair stand test: Test-retest reliability, agreement and minimum detectable change in people with early-stage knee osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1957. [PMID: 35592902 PMCID: PMC9539496 DOI: 10.1002/pri.1957] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/16/2022] [Accepted: 05/07/2022] [Indexed: 11/11/2022]
Abstract
Background and Purpose To determine intra‐session test‐retest reliability, agreement and minimum detectable change (MDC) of the 30 CST across three tests in people with knee osteoarthritis (OA). Methods A test–retest reliability study was performed with 93 people with mild radiological knee OA. Participants were asked to complete three attempts of the 30 CST 1–2 min apart according to a standardised protocol. Participants completed three attempts on two occasions: baseline and 6 months later. Change between tests within each session was assessed with ANOVA's and post‐hoc t‐tests. Reliability was assessed with intra‐class correlation coefficients (ICC[2,1]). Measurement error was expressed as MDC for an individual (MDCind) and a group (MDCgroup). Floor effects were considered present if more than 15% of participants scored zero for a test. Results Scores increased by 0.5 and 0.8 stands between the first and second test (p < 0.05) at the baseline and 6‐month assessments respectively, and then stabilised between the second the third tests at the baseline assessment (p > 0.05) or decreased (0.3 stands) at the 6‐month assessment (p < 0.05). Scores demonstrated excellent reliability (ICCs >0.9). MDCind was approximately 2.5 stands and MDCgroup was 0.3–0.4 stands. No floor effects were apparent. Discussion The 30CST demonstrated a practice effect between the first and second tests, which was no longer apparent by the third test. Despite this, scores demonstrated excellent intra‐session reliability. MDC estimates provide clinicians and researchers with the smallest change that can be detected by the instrument beyond measurement error for individuals and groups in community‐dwelling adults with knee OA.
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Affiliation(s)
- Stephen Gill
- Barwon Medical Imaging, Barwon Health, Geelong, Australia.,GIRADI Research Institute, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia.,Barwon Centre for Orthopaedic Research & Education (B-CORE), St John of God Hospital, Geelong, Australia
| | - Rachael Hely
- Barwon Medical Imaging, Barwon Health, Geelong, Australia.,GIRADI Research Institute, Geelong, Australia
| | - Richard S Page
- Barwon Medical Imaging, Barwon Health, Geelong, Australia.,GIRADI Research Institute, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia.,Barwon Centre for Orthopaedic Research & Education (B-CORE), St John of God Hospital, Geelong, Australia
| | - Andrew Hely
- Barwon Medical Imaging, Barwon Health, Geelong, Australia.,GIRADI Research Institute, Geelong, Australia
| | - Benjamin Harrison
- Barwon Medical Imaging, Barwon Health, Geelong, Australia.,GIRADI Research Institute, Geelong, Australia
| | - Steve Landers
- Barwon Medical Imaging, Barwon Health, Geelong, Australia.,GIRADI Research Institute, Geelong, Australia
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Effectiveness of Ultrasound-Guided Canal Adductor Blockade for Chronic Pain and Functioning in Knee Osteoarthritis: A Prospective Longitudinal Observational Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5270662. [PMID: 35103237 PMCID: PMC8800601 DOI: 10.1155/2022/5270662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
Methods Seventy-seven patients with chronic knee osteoarthritis pain received ultrasound-guided ACB with 14 ml 0.25% levobupivacaine and 100 mcg clonidine. At baseline and 1 month after the blockade, we assessed maximal and minimal pain intensity in the knee using a numeric rating scale (NRS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). The range of motion in extension and flexion (ROMext and ROMflex) and quadriceps muscle strength of both knees (QS), Timed Up and Go Test (TUG), and 30-Second Chair Stand Test (30CST) results were determined at baseline, 1 hour, 1 week, and 1 month after the blockade. Results ACB with levobupivacaine and clonidine appeared to decrease pain severity (NRSmax 8.13 to 4.2, p < 0.001 and NRSmin 3.32 to 1.40, p < 0.001). Similarly, knee ROMext decreased from 3.90 preintervention to 2.89 postintervention at 1 month, p < 0.001; ROMflex decreased from 5.70 to 3.29, p < 0.001; TUG time decreased from 3.22 to 2.93, <0.001; QS increased from 18.43 to 22.77, p < 0.001; CST increased from 8.23 to 10.74, p < 0.001. The KOOS for pain (36.40 to 58.34), symptoms (52.55 to 64.32), activities of daily living functions (ADLs, 36.36 to 60.77), and quality of life (QoL, 17.87 to 30.97) also increased, all p < 0.001. Conclusion ACB appeared to decrease pain and increase ambulation. If our preliminary results are reproducible in a planned randomized controlled trial, ACB could be a useful adjunctive pain therapy in patients with disabling pain due to knee OA.
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Almeida GPL, Monteiro IO, Dantas RGDO, Tavares MLA, Lima PODP. Reliability, validity and responsiveness of the Step Up and Down (StUD) test for individuals with symptomatic knee osteoarthritis. Musculoskelet Sci Pract 2021; 56:102454. [PMID: 34482195 DOI: 10.1016/j.msksp.2021.102454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/19/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stair climbing test (SCT) has been suggested as the first task affected in individuals with symptomatic knee osteoarthritis (KOA). However, there are environmental barriers for the execution of the 9- to 12-step SCT. Thus, we developed a feasible one-step SCT that could be completed in 15s. OBJECTIVE To check the clinimetric properties of the 15s Step Up and Down (StUD) test in individuals with KOA. DESIGN Prospective validity study. METHOD Eighty-two individuals with KOA participated in this study. The test-retest reliability of the StUD test was measured with a 1-week interval. The construct validity and responsiveness were assessed by testing predefined hypotheses. For this, the 30s Chair Stand Test (30CS), Timed Up and Go Test (TUG), quadriceps strength, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lequesne Algofunctional Index were used as comparator instruments. RESULTS The StUD test presented good test-retest reliability (ICC = 0.87; 95% CI = 0.79-0.91) and showed a moderate to good correlation with the 30CS (r = 0.65), TUG (r = -0.56), and quadriceps strength (r = 0.41). We found a higher correlation between the StUD test and the performance-based tests than the patient-reported outcome measures. The StUD test was responsive, with five out of the six (83.3%) hypotheses confirmed. CONCLUSION StUD test showed good reliability, adequate validity and responsiveness. Our findings suggest that StUD is a useful performance-based test for individuals with KOA.
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Affiliation(s)
- Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Isabel Oliveira Monteiro
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | | | - Maria Larissa Azevedo Tavares
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
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20
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Does muscle stiffness predict early-onset knee osteoarthritis? JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.1014433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Fernandes L, Holm CE, Villadsen A, Sørensen MS, Zebis MK, Petersen MM. Clinically Important Reductions in Physical Function and Quality of Life in Adults with Tumor Prostheses in the Hip and Knee: A Cross-sectional Study. Clin Orthop Relat Res 2021; 479:2306-2319. [PMID: 33974591 PMCID: PMC8445557 DOI: 10.1097/corr.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with a bone sarcoma who undergo limb-sparing surgery and reconstruction with a tumor prosthesis in the lower extremity have been shown to have reduced self-reported physical function and quality of life (QoL). To provide patients facing these operations with better expectations of future physical function and to better evaluate and improve upon postoperative interventions, data from objectively measured physical function have been suggested. QUESTIONS/PURPOSES We sought to explore different aspects of physical function, using the International Classification of Functioning, Disability, and Health (ICF) as a framework, by asking: (1) What are the differences between patients 2 to 12 years after a bone resection and reconstruction surgery of the hip and knee following resection of a bone sarcoma or giant cell tumor of bone and age-matched controls without walking limitations in ICF body functions (ROM, muscle strength, pain), ICF activity and participation (walking, getting up from a chair, daily tasks), and QoL? (2) Within the patient group, do ICF body functions and ICF activity and participation outcome scores correlate with QoL? METHODS Between 2006 and 2016, we treated 72 patients for bone sarcoma or giant cell tumor of bone resulting in bone resection and reconstruction with a tumor prosthesis of the hip or knee. At the timepoint for inclusion, 47 patients were alive. Of those, 6% (3 of 47) had undergone amputation in the lower limb and were excluded. A further 32% (14 of 44) were excluded because of being younger than 18 years of age, pregnant, having long transportation, palliative care, or declining participation, leaving 68% (30 of 44) for analysis. Thus, 30 patients and 30 controls with a mean age of 51 ± 18 years and 52 ± 17 years, respectively, were included in this cross-sectional study. Included patients had been treated with either a proximal femoral (40% [12 of 30]), distal femoral (47% [14 of 30]), or proximal tibia (13% [4 of 30]) reconstruction. The patients were assessed 2 to 12 years (mean 7 ± 3 years) after the resection-reconstruction. The controls were matched on gender and age (± 4 years) and included if they considered their walking capacity to be normal and had no pain in the lower extremity. Included outcome measures were: passive ROM of hip flexion, extension, and abduction and knee flexion and extension; isometric muscle strength of knee flexion, knee extension and hip abduction using a hand-held dynamometer; pain intensity (numeric rating scale; NRS) and distribution (pain drawing); the 6-minute walk test (6MWT); the 30-second chair-stand test (CST); the Toronto Extremity Salvage Score (TESS), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The TESS and the EORTC QLQ-C30 were normalized to 0 to 100 points. Higher scoring represents better status for TESS and EORTC global health and physical functioning scales. Minimum clinically important difference for muscle strength is 20% to 25%, NRS 2 points, 6MWT 14 to 31 meters, CST 2 repetitions, TESS 12 to 15 points, and EORTC QLQ-C30 5 to 20 points. RESULTS Compared with controls, the patients had less knee extension and hip abduction strength in both the surgical and nonsurgical limbs and regardless of reconstruction site. Mean knee extension strength in patients versus controls were: surgical limb 0.9 ± 0.5 Nm/kg versus 2.1 ± 0.6 Nm/kg (mean difference -1.3 Nm/kg [95% CI -1.5 to -1.0]; p < 0.001) and nonsurgical limb 1.7 ± 0.6 Nm/kg versus 2.2 ± 0.6 Nm/kg (mean difference -0.5 Nm/kg [95% CI -0.8 to -0.2]; p = 0.003). Mean hip abduction strength in patients versus controls were: surgical limb 1.1 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (mean difference -0.7 Nm/kg [95% CI -1.0 to -0.5]; p < 0.001) and nonsurgical limb 1.5 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (-0.4 Nm/kg [95% CI -0.6 to -0.2]; p = 0.001). Mean hip flexion ROM in patients with proximal femoral reconstructions was 113° ± 18° compared with controls 130° ± 11° (mean difference -17°; p = 0.006). Mean knee flexion ROM in patients with distal femoral reconstructions was 113° ± 29° compared with patients in the control group 146° ± 9° (mean difference -34°; p = 0.002). Eighty-seven percent (26 of 30) of the patients reported pain, predominantly in the knee, anterior thigh, and gluteal area. The patients showed poorer walking and chair-stand capacity and had lower TESS scores than patients in the control group. Mean 6MWT was 499 ± 100 meters versus 607 ± 68 meters (mean difference -108 meters; p < 0.001), mean CST was 12 ± 5 repetitions versus 18 ± 5 repetitions (mean difference -7 repetitions; p < 0.001), and median (interquartile range) TESS score was 78 (21) points versus 100 (10) points (p < 0.001) in patients and controls, respectively. Higher pain scores correlated to lower physical functioning of the EORTC QLQ-C30 (Rho -0.40 to -0.54; all p values < 0.05). Less muscle strength in knee extension, knee flexion, and hip abduction correlated to lower physical functioning of the EORTC QLQ-C30 (Rho 0.40 to 0.51; all p values < 0.05). CONCLUSION This patient group demonstrated clinically important muscle weaknesses not only in resected muscles but also in the contralateral limb. Many patients reported pain, and they showed reductions in walking and chair-stand capacity comparable to elderly people. The results are relevant for information before surgery, and assessments of objective physical function are advisable in postoperative monitoring. Prospective studies evaluating the course of physical function and which include assessments of objectively measured physical function are warranted. Studies following this patient group with repetitive measures over about 5 years could provide information about the course of physical function, enable comparisons with population norms, and lead to better-designed, targeted, and timely postoperative interventions. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Linda Fernandes
- Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Christina Enciso Holm
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Allan Villadsen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Michala Skovlund Sørensen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mette Kreutzfeldt Zebis
- Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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22
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Holm PM, Nyberg M, Wernbom M, Schrøder HM, Skou ST. Intrarater Reliability and Agreement of Recommended Performance-Based Tests and Common Muscle Function Tests in Knee Osteoarthritis. J Geriatr Phys Ther 2021; 44:144-152. [PMID: 32304510 DOI: 10.1519/jpt.0000000000000266] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Some uncertainty persists regarding the reproducibility of the recommended core set of performance-based tests, as well as common muscle function tests, when applied in individuals with knee osteoarthritis (KOA). The purpose of this study was to investigate the intrarater reliability and agreement of the recommended core set of performance-based tests and common muscle function tests in KOA. METHODS Participants (N=40) with radiographic and/or symptomatic KOA were evaluated twice with a 3-day interval between test sessions using the following tests: Leg extensor (LE) maximal muscle power measured in a Nottingham Power Rig; knee extensor (KE) peak isometric strength measured with a handheld dynamometer; 40-m walk test; 30-second chair-stand test; and 9-step stair climb test. Reliability was assessed using a 2-way, mixed-effects, single-measures model (3,1), absolute agreement-type intraclass correlation coefficient (ICC). Agreement was assessed using 95% limits of agreement (LOA) and LOA relative to the mean score from test and retest (LOA-%). RESULTS Reliability for all tests was very high (ICC ≥ 0.97). LOA (LOA-%) was ±32.3 watt (W) (±22%) for LE power; ±22.7 N·m (±24%) for KE strength; ±0.2 m/s (±10%) for 40-m walk test; ±2.4 repetitions (±14%) for 30-second chair-stand test; and ±2 second (±20%) for stair climb test. A potential participant learning effect was found for all 3 performance-based tests, indicated by the significantly better scores at retest. DISCUSSION The very high reliability found for the performance-based tests supports findings from previous studies and confirms discriminate reliability of these tests on a group level. Also, very high reliability estimates were demonstrated for both muscle function tests. This study also provided estimates of agreement for both performance-based and muscle function tests, which are important to consider when using these tests on an individual level in clinical practice. CONCLUSION When using these tests to monitor changes over time in the clinic, depending on the test, improvements of less than 10% to 24% could be a result of measurement error alone and therefore may not be considered an actual improvement after treatment.
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Affiliation(s)
- Pætur Mikal Holm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Mette Nyberg
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mathias Wernbom
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Søren Thorgaard Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
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23
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Tolk JJ, Janssen RPA, Haanstra TM, van der Steen MC, Bierma-Zeinstra SMA, Reijman M. The influence of expectation modification in knee arthroplasty on satisfaction of patients: a randomized controlled trial. Bone Joint J 2021; 103-B:619-626. [PMID: 33789470 DOI: 10.1302/0301-620x.103b4.bjj-2020-0629.r3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment. METHODS In total, 204 primary TKA patients with osteoarthritis were enrolled in this randomized controlled trial (RCT). Patients were allocated to either usual preoperative education (control group) or usual education plus an additional module on realistic expectations (intervention group). Primary outcome was being very satisfied (numerical rating scale for satisfaction ≥ 8) with the treatment result at 12 months' follow-up. Other outcomes were change in preoperative expectations and postoperative expectation fulfilment. RESULTS A total of 187 patients (91.7%) were available for analysis at follow-up. In the intention-to-treat analysis, 58.5% (55/94) of patients were very satisfied with the treatment result in the control group, and 69.9% (65/93) of patients in the intervention group (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 0.90 to 3.29). A per-protocol analysis for patients who attended the education session (92.0%, n = 172) showed that 56.9% (49/86) of patients were very satisfied in the control group and 74.4% (61/86) in the intervention group (AOR 2.44, 95% CI 1.21 to 4.91). After preoperative education, the expectation scores in the intervention group were significantly lower (mean difference -6.9 (95% CI -10.2 to -3.6)) and did not alter in the control group (mean difference 0.5 (95% CI -2.9 to 3.9)). Overall, fulfilment of expectations at 12 months was significantly higher in the intervention group (mean difference 11.4% (95% CI 2.3 to 20.5)). CONCLUSION Improved preoperative patient education can modify patient expectations, resulting in higher postoperative fulfilment of expectation and higher satisfaction in the group that attended the preoperative education. This is the first RCT to confirm the potential of improved expectation management on satisfaction after TKA. Cite this article: Bone Joint J 2021;103-B(4):619-626.
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Affiliation(s)
- Jaap J Tolk
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Eindhoven, The Netherlands
| | - Rob P A Janssen
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Eindhoven, The Netherlands.,Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven.,Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Tsjitske M Haanstra
- Department of Orthopaedic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Eindhoven, The Netherlands.,Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Coleman G, Dobson F, Hinman RS, Bennell K, White DK. Measures of Physical Performance. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:452-485. [PMID: 33091270 DOI: 10.1002/acr.24373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Fiona Dobson
- University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Bennell
- University of Melbourne, Melbourne, Victoria, Australia
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25
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Master H, Coleman G, Dobson F, Bennell K, Hinman RS, Jakiela JT, White DK. A Narrative Review on Measurement Properties of Fixed-distance Walk Tests Up to 40 Meters for Adults With Knee Osteoarthritis. J Rheumatol 2020; 48:638-647. [PMID: 33060316 DOI: 10.3899/jrheum.200771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
Knee osteoarthritis (OA) is a serious disease and has no cure to date. Knee OA is a leading cause of functional limitation (e.g., difficulty walking). Walking speed is 1 method of quantifying difficulty with walking and should be assessed in clinical practice for adults with knee OA because it has prognostic value and is modifiable. Specifically, slow walking speed is associated with increased risk of adverse health outcomes, including all-cause mortality in adults with knee OA and can be modified by engaging in physical activity or exercise. However, at present, there is little consensus on the distance and instructions used to conduct the walk test. Distance is often selected based on space availability, and instruction varies, from asking the participants to walk at a comfortable pace versus as fast as possible. Therefore, the purpose of this narrative review is to summarize the measurement properties, strengths, and limitations of a fixed-distance walk test ≤ 40 meters in adults with knee OA. Good measurement properties in terms of reliability and validity were observed across the different testing protocols for fixed-distance walk test (i.e., any distance ≤ 40 m and fast- or self-paced). Therefore, clinicians and researchers can select a testing protocol that can safely and consistently be performed over time, as well as provide a practice trial to acclimatize the patients to the fixed-distance walk test.
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Affiliation(s)
- Hiral Master
- H. Master, PT, PhD, MPH, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Grace Coleman
- G. Coleman, BS, SPT, Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Fiona Dobson
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Kim Bennell
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Jason T Jakiela
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
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26
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Holm PM, Kemnitz J, Bandholm T, Wernbom M, Schrøder HM, Skou ST. Muscle Function Tests as Supportive Outcome Measures for Performance-Based and Self-Reported Physical Function in Patients With Knee Osteoarthritis: Exploratory Analysis of Baseline Data From a Randomized Trial. J Strength Cond Res 2020; 36:2635-2642. [PMID: 33021580 DOI: 10.1519/jsc.0000000000003840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Holm, PM, Kemnitz, J, Bandholm, T, Wernbom, M, Schrøder, HM, and Skou, ST. Muscle function tests as supportive outcome measures for performance-based and self-reported physical function in patients with knee osteoarthritis: Exploratory analysis of baseline data from a randomized trial. J Strength Cond Res XX(X): 000-000, 2020-Uncertainty on the role of muscle function in relation to physical function in knee osteoarthritis (KOA) persists. This study aimed to assess the associations between muscle function and performance-based and self-reported physical function in patients with KOA. Physical function in 80 subjects with symptomatic and radiographic KOA was assessed using 40-m fast-paced walk, 30-second chair stand, 9-step stair climb tests, and the subscale activities of daily living from the Knee injury and Osteoarthritis Outcome Score (KOOS-ADL). Measurements of muscle function included leg extension (LE) power, knee extension (KE) torque, and estimated leg press one repetition maximum (LP RM). Associations were investigated using multivariable hierarchical linear regressions adjusted for age, sex, body mass index, self-reported physical activity, and thigh muscle lean area. Leg extension power was significantly associated with 40-m walk, stair climb, and 30-second chair stand, explaining 18, 8, and 3% of additional variance, respectively. Knee extension torque explained 13, 7, 17, and 7% of additional variance in the 40-m walk, stair climb, 30-second chair stand, and KOOS-ADL, respectively. Leg press one repetition maximum explained 11% of additional variance in the 30-second chair stand. In conclusion, LE power was the best explanatory variable for performance on the 40-m walk and stair climb tests, whereas KE torque best explained chair stand performance. Only KE torque was associated with KOOS-ADL. Our results highlight the importance of selecting supportive muscle function tests based on the specific physical function and suggest that other factors may be more important for certain physical function outcomes. Level of significance p < 0.05. Trial identifier: NCT03215602.
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Affiliation(s)
- Pætur Mikal Holm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Jana Kemnitz
- Institute of Anatomy & Department of Imaging and Functional Musculoskeletal Research, Paracelsus Medical University Salzburg, Salzburg, Austria.,Chondrometrics GmbH Ainring, Ainring, Germany.,Department of Computer Science, University of Vienna, Vienna, Austria
| | - Thomas Bandholm
- Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research, Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.,Clinical Research Center, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Mathias Wernbom
- Department of Food and Nutrition and Sport Science, Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Søren Thorgaard Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
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Psychometric properties of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS-12) Spanish version for people with knee osteoarthritis. Clin Rheumatol 2020; 40:1547-1558. [PMID: 32948971 DOI: 10.1007/s10067-020-05403-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
To evaluate the validity, reliability, and responsiveness to change of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS) Spanish version questionnaire. This study was based on a questionnaire validation design. A cross-sectional survey of 199 patients with knee osteoarthritis (KOA) and ten healthy controls was studied to evaluate the validity and reliability of KOOS-12. One hundred and sixteen patients were assessed for test-retest reliability, and 38 patients were included for a responsiveness assessment. Structural validity was assessed by the confirmatory factor analysis (CFA). Item response theory-based methods were used to determine the performance of the items. Internal consistency reliability was appropriate for all scales (Cronbach's alpha = 0.85-0.94). The intra-class correlation coefficient of KOOS-12 scales ranged from 0.60 to 0.71. The CFA and generalized partial credit model showed that KOOS-12 scales presented a good overall model fit. No differential item functioning was found. Convergent validity was demonstrated by strong correlations (Spearman's rho ≥ 0.70) with KOOS, International Knee Documentation Committee subjective knee evaluation form (IKDC), and Knee Intermittent and Constant Osteoarthritis Pain (ICOAP). Known-groups validity showed that KOOS-12 well discriminated subgroups of patients (radiographic severity and nutritional status). Standardized response means for KOOS-12 scales were ≥ 0.75. Changes in KOOS-12 scales had a moderate to strong correlation (Pearson's r ≥ 0.40) with the changes in the KOOS, ICOAP, and IKDC scales. The KOOS-12 Spanish version is a valid, reliable, and responsiveness to change questionnaire to measure patients' opinions about their knee and associated problems in Mexican subjects with KOA. Key Points • KOOS-12 is a short self-reported measure that assesses patient's opinions about the difficulties they experience due to problems with their knee and also covers aspects of pain, functional limitations, and knee-related quality of life. • The Spanish version of KOOS-12 questionnaire is a valid instrument for measuring the patients' opinions about their knee and associated problems, and is both reliable and responsiveness to change.
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Kaiser U, Liedgens H, Meissner W, Weinmann C, Zahn P, Pogatzki-Zahn E. Developing consensus on core outcome domains and measurement instruments for assessing effectiveness in perioperative pain management after sternotomy, breast cancer surgery, total knee arthroplasty, and surgery related to endometriosis : The IMI-PainCare PROMPT protocol for achieving a consensus on core outcome domains. Trials 2020; 21:773. [PMID: 32912288 PMCID: PMC7488037 DOI: 10.1186/s13063-020-04665-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/09/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Evidence synthesis of clinical trials requires consistent outcome assessment. For pain management after surgery, inconsistency of effectiveness assessment is still observed. A subproject of IMI-PainCare (Innovative Medicine Initiatives, www.imi-paincare.eu ) aims for identifying core outcome domains and measurement instruments for postoperative pain in four surgical fields (sternotomy, breast cancer surgery, total knee arthroplasty, and surgery related to endometriosis) in order to harmonize outcome assessment for perioperative pain management. METHODS A multifaceted process will be performed according to existing guidelines (Core Outcome Measures in Effectiveness Trials (COMET), COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)). In a first step, outcome domains will be identified via systematic literature review and consented on during a 1-day consensus meeting by 10 stakeholder groups, including patient representatives, forming an IMI PROMPT consensus panel. In a second step, outcome measurement instruments regarding the beforehand consented core outcome domains and their psychometric properties will be searched for via systematic literature review and approved by COSMIN checklist for study quality and scale quality separately. In a three-step online survey, the IMI PROMPT consensus panel will vote for most suitable measurement instruments. The process is planned to be conducted between 11/2017 (systematic literature review on common outcome domains) and 3/2022 (final voting on core outcome measurement).
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Affiliation(s)
- Ulrike Kaiser
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Claudia Weinmann
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Peter Zahn
- Department of Anaesthesiology and Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
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Suwit A, Rungtiwa K, Nipaporn T. Reliability and Validity of the Osteoarthritis Research Society International Minimal Core Set of Recommended Performance-Based Tests of Physical Function in Knee Osteoarthritis in Community-Dwelling Adults. Malays J Med Sci 2020; 27:77-89. [PMID: 32788844 PMCID: PMC7409575 DOI: 10.21315/mjms2020.27.2.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background The proper reliability analysis for specific type of data and limit study of various types of construct validity are crucial for performance-based tests for the knee osteoarthritis (OA) population. The purpose of this study was to evaluate relative and absolute reliability and construct validity of the Osteoarthritis Research Society International (OARSI) recommended minimal core set of performance-based tests in knee OA in community-dwelling adults. Methods Fifty-five primary knee OA (median age 69.0, interquartile range [IQR] 11.0) participated in the cross-sectional study. Three performance-based tests were performed in two sessions with a 1-week interval; 30-s chair stand test, 40-m fast-paced walk test and 9-step stair climb test. Relative reliability included intra-class correlation and Spearman’s correlation coefficient (SPC). Absolute reliability included standard error of measurement, minimum detectable change, coefficient of variance, limit of agreement (LOA) and ratio LOA. Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), knee extensor strength and pain scale were analysed for convergent validity using Pearson’s correlation coefficient and SPC. Analysis of Covariance was utilised for known-groups validity. Results Relative and absolute reliability were all acceptable. LOA showed small systematic bias. Acceptable construct validity was only found with knee extensor strength. All tests demonstrated known-groups validity with medium to large effect size. Conclusion The OARSI minimum core set of performance-based tests demonstrated acceptable relative and absolute reliability and good known-groups validity but poor convergent validity.
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Affiliation(s)
- Ariyachaikul Suwit
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Kanthain Rungtiwa
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Thonglorm Nipaporn
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
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Reynaud V, Verdilos A, Pereira B, Boisgard S, Costes F, Coudeyre E. Core Outcome Measurement Instruments for Clinical Trials of Total Knee Arthroplasty: A Systematic Review. J Clin Med 2020; 9:jcm9082439. [PMID: 32751523 PMCID: PMC7463550 DOI: 10.3390/jcm9082439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
(1) Background: We have updated knowledge of the psychometric qualities of patient-reported outcome measures and, for the first time, systematically reviewed and compared the psychometric qualities of physical tests for patients with knee osteoarthritis who are undergoing total knee arthroplasty. This work was conducted to facilitate the choice of the most appropriate instruments to use in studies and clinical practice. (2) Methods: A search of medical databases up to December 2019 identified the studies and thus the instruments used. The quality of the measurement properties was assessed by the Bot et al. criteria. (3) Results: We identified 20 studies involving 25 instruments. Half of the instruments were questionnaires (n = 13). Among the condition-specific instruments, the Oxford knee score, Knee injury and Osteoarthritis Outcomes Score, and the Western Ontario and McMaster Universities Osteoarthritis index had the highest overall scores. Concerning generic tools, the Medical Outcomes Study Short-Form 36 (SF-36) or SF-12 obtained the highest overall score. For patient-specific tools, the Hospital Anxiety and Depression Scale ranked the highest. Some physical tests seemed robust in psychometric properties: 6-min Walk Test, five times Sit-To-Stand test, Timed Up and Go test strength testing of knee flexor/extensor by isometric or isokinetic dynamometer and Pressure Pain Threshold. (4) Conclusion: To make stronger recommendations, key areas such as reproducibility, responsiveness to clinical change, and minimal important change still need more rigorous evaluations. Some promising physical tests (e.g., actimetry) lack validation and require rigorous studies to be used as a core set of outcomes in future studies.
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Affiliation(s)
- Vivien Reynaud
- Plateforme d’Exploration de la Mobilité, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
- Correspondence: ; Tel.: +33-47375-0900
| | - Anargyros Verdilos
- Plateforme d’Exploration de la Mobilité, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Bruno Pereira
- Unité de Biostatistique, CHU Clermont-Ferrand, Direction Recherche Clinique et Innovation, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Stéphane Boisgard
- Service d’Orthopédie Traumatologie, CNRS, SIGMA Clermont, CHU Clermont-Ferrand, Université Clermont Auvergne, ICCF, F-63000 Clermont–Ferrand, France;
| | - Frédéric Costes
- Plateforme d’Exploration de la Mobilité, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
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Alnahdi AH. Measurement properties of the 15-item Arabic lower extremity functional scale. Disabil Rehabil 2020; 43:3839-3844. [DOI: 10.1080/09638288.2020.1754927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ali H. Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Hoglund LT, Folkins E, Pontiggia L, Knapp MW. The Validity, Reliability, Measurement Error, and Minimum Detectable Change of the 30-Second Fast-Paced Walk Test in Persons with Knee Osteoarthritis: A Novel Test of Short-Distance Walking Ability. ACR Open Rheumatol 2019; 1:279-286. [PMID: 31777804 PMCID: PMC6858032 DOI: 10.1002/acr2.1040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To develop and establish the reliability, validity, measurement error, and minimum detectable change of a novel 30‐second fast‐paced walk test (30SFW) in persons with knee osteoarthritis (OA) that is easy to administer and can quantify walking performance in persons of all abilities. Methods Twenty females with symptomatic knee OA (mean age [SD] 58.30 [8.05] years) and 20 age‐ and sex‐matched asymptomatic controls (57.25 [8.71] years) participated in the study. Participants completed questionnaires of demographic and clinical data, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36‐item Short Form Health Survey (SF‐36) followed by 30SFW performance. Participants returned 2‐7 days later and performed the 30SFW again. Results The knee OA group reported function that was worse than controls (all KOOS subscales; P < 0.0001). The 30SFW intrarater and interrater reliability were excellent [ICC(2,1) = 0.95‐0.99]. Knee OA participants walked a shorter distance in the 30SFW than controls (mean [SD]: OA 44.4 m [9.5 m]; control 58.1 m [7.8 m]; P < 0.0001). Positive strong correlations were found between the 30SFW and the KOOS–Activity of Daily Living, SF‐36‐Physical Functioning, and SF‐36‐Physical Health Composite scores (P < 0.0001). A nonsignificant, weak correlation between 30SFW and SF‐36‐Mental Health scores was present (r = 0.32, P = 0.05). Conclusion The 30SFW has excellent intrarater and interrater reliability. The 30SFW demonstrated excellent known groups, convergent, and discriminant validity as a measure of short‐distance walking ability in persons with knee OA. Clinicians and researchers should consider using the 30SFW to quantify walking ability in persons with knee OA and assess walking ability change.
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Affiliation(s)
| | - Eric Folkins
- University of the Sciences in Philadelphia Philadelphia Pennsylvania
| | - Laura Pontiggia
- University of the Sciences in Philadelphia Philadelphia Pennsylvania
| | - Michael W Knapp
- University of the Sciences in Philadelphia Philadelphia Pennsylvania
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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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Tolk JJ, Janssen RPA, Haanstra TM, Bierma-Zeinstra SMA, Reijman M. The EKSPECT study: the influence of Expectation modification in Knee arthroplasty on Satisfaction of PatiEnts: study protocol for a randomized Controlled Trial. Trials 2018; 19:437. [PMID: 30107814 PMCID: PMC6092877 DOI: 10.1186/s13063-018-2821-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/26/2018] [Indexed: 12/18/2022] Open
Abstract
Background One out of five patients is unsatisfied to some extent after total knee arthroplasty (TKA). Unmet expectations are the main driver of post-operative dissatisfaction. Improved pre-operative education on realistic expectations for long-term outcome after TKA potentially leads to higher post-operative satisfaction. The effect of expectation modification on post-operative satisfaction in TKA patients has not yet been studied. The primary objective of the presented study is to examine whether an educational module on long-term recovery after TKA will improve patient satisfaction compared to usual pre-operative education. Methods The EKSPECT study is a randomized controlled trial. Patients with symptomatic and radiographic knee osteoarthritis who are indicated for a primary TKA will be randomized to the usual pre-operative education (control group) or usual education plus an additional module on realistic expectations for long-term recovery (intervention group). Patients will be naïve to study objective and difference between study groups. Outcome expectations will be measured blinded for group allocation using the HSS Knee Replacement Expectations Survey at baseline (before the intervention), pre-operatively (after the intervention) and fulfillment of expectations at 12-month follow-up. Baseline physical function, quality of life and psychological factors are measured using self-reported questionnaires. The primary outcome measure is satisfaction with treatment result at the 12-month follow-up. Discussion The EKSPECT study should provide evidence on the effectiveness of an education module on long-term recovery after TKA to improve treatment satisfaction. If beneficial, the education module is a simple intervention with a low burden for patients, which can easily be implemented in clinical practice. Trial registration Dutch Trial Registry registration number: NTR5779. Registered on 17 March 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2821-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaap J Tolk
- Máxima Medical Center, Department of Orthopedic Surgery and Trauma, PO Box 90052, 5600 PD, Eindhoven, The Netherlands
| | - Rob P A Janssen
- Máxima Medical Center, Department of Orthopedic Surgery and Trauma, PO Box 90052, 5600 PD, Eindhoven, The Netherlands
| | - Tsjitske M Haanstra
- Department of Orthopedic Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Max Reijman
- Máxima Medical Center, Department of Orthopedic Surgery and Trauma, PO Box 90052, 5600 PD, Eindhoven, The Netherlands. .,Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Liao CD, Xie GM, Tsauo JY, Chen HC, Liou TH. Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2018; 19:278. [PMID: 30068324 PMCID: PMC6090995 DOI: 10.1186/s12891-018-2204-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/20/2018] [Indexed: 12/26/2022] Open
Abstract
Background Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations. Methods We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM). Results We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84–6.12, P < 0.0001), pain reduction (SMD: − 1.49, 95% CI: − 2.11 to − 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43–2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being − 3.13 (95% CI: − 5.70 to − 0.56; P = 0.02) and − 1.80 (95% CI: − 2.52 to − 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT. Conclusions The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12891-018-2204-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chun-De Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Guo-Min Xie
- Department of Neurology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University, Zhejiang, China
| | - Jau-Yih Tsauo
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan. .,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan.
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