Physical therapists collect different outcome measures after total joint arthroplasty as compared to most orthopaedic surgeons: a New England study

Cut-off values of preoperative knee extensor strength and hip abductor strength for predicting good walking ability after total knee arthroplasty

INTRODUCTION

Total knee arthroplasty (TKA) reduces pain and improves physical function; however, not all patients have successful outcomes after surgery. To identify these patients would be critical information for improving rehabilitation programs. The purpose of this study was to clarify the cut-off values of lower extremity muscle strength for predicting postoperative good walking ability.

MATERIALS AND METHODS

Timed Up and Go test of 105 patients was measured at 6 months postoperatively, and participants were divided into good (< 9.1 s) and poor (≥ 9.1 s) walking ability. Both sides of knee extensor strength (KES) and hip abductor strength (HAS) were measured using hand-held dynamometer preoperatively. Receiver operating characteristic (ROC) curve analysis was used to identify cut-off values for classifying the participants into the two groups.

RESULTS

Of the 105 patients, 54 were allocated in the poor walking ability group, whereas 51 were allocated in the good walking ability group. KES and HAS were significantly greater in the good walking ability group than in the poor walking ability group. ROC curve analysis revealed that the cut-off value for KES was 0.79 Nm/kg (area under the curve (AUC) 0.68; sensitivity 64.7%; specificity 68.5%) on the involved side and 0.86 Nm/kg (AUC 0.73; sensitivity 84.6%; specificity 55.6%) on the uninvolved side, and for HAS was 0.57 Nm/kg (AUC 0.71; sensitivity 60.8%; specificity 71.7%) on the involved side and 0.61 Nm/kg (AUC 0.76; sensitivity 66.7%; specificity 77.4%) on the uninvolved side.

CONCLUSION

The cut-off values of preoperative KES and HAS for predicting good walking ability after TKA are 0.79 Nm/kg on the involved side and 0.86 Nm/kg on the uninvolved side, and 0.57 Nm/kg on the involved side and 0.61 Nm/kg on the uninvolved side, respectively. We should provide enhanced pre- and post-operative rehabilitation programs for patients with muscle strength lower than these values.

Patient-reported outcomes measurement information system physical function and knee injury and osteoarthritis outcome score relationship on performance measures in people undergoing total knee arthroplasty

PURPOSE

Primary purpose was to identify relationships between performance-based measures onto both computerized adaptive testing [Physical Function-Computer Adaptive Testing (PF-CAT)] and joint-specific legacy [Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living (KOOS-ADL)] instruments pre- and 12-month post-TKA.

METHODS

The PF-CAT and KOOS-ADL were identified as outcomes and performance on the 40-m fast-paced walking test, stair climb test and chair stand test were identified as predictors. Linear regression was used for all comparisons after adjusting for confounders.

RESULTS

Sixty-eight people with TKA (56.7% male) were tested. Better scores on the 40-m fast-paced walking (KOOS-ADL, p = 0.02), stair climb (KOOS-ADL, p = 0.05) and chair stand (KOOS-ADL, p < 0.01) associated with better self-reported scores pre-TKA. Better scores on the 40-m fast-paced walking (PF-CAT, p = 0.05; KOOS-ADL, p = 0.01), stair climb (KOOS-ADL, p < 0.01), chair stand (PF-CAT, p < 0.01) and range of motion (KOOS-ADL, p = 0.02) were associated with better self-reported scores 12-month post-TKA. Decrease knee range of motion related to poorer 40-m fast-paced walking (p = 0.01) and stair climb (p = 0.03) scores pre-TKA. Quadriceps weakness related to poorer 40-m fast-paced walking (p = 0.04) score pre-TKA.

CONCLUSION

Self-reported instruments are a moderate, but inconsistent surrogate to performance-based measures pre- and post-TKA. Our findings indicate that both self-reported and performance-based measures are necessary to fully characterize physical function and should be used jointly to aid in the recovery analysis of people undergoing TKA.Implications for RehabilitationMonitoring the trajectory of pre- to post-total knee arthroplasty (TKA) physical function is important as it directly relates to mortality, morbidity and poorer quality of life in older adults.Both self-reported and performance-based measures of physical function are used to determine progress in recovery for patients pre- and post- TKA.This study provides evidence that perceived physical function measures are a moderate, but an inconsistent, surrogate to objective physical function measures pre- and post-TKA.Joint specific deficits in knee range of motion and quadriceps strength were weakly associated with deficits in function measures pre-TKA, but no association was observed 12-month post-TKA.Our findings indicate that both self-reported and performance-based measures are necessary to fully characterize physical function and should be used jointly to aid in the complete recovery analysis of people undergoing TKA.

Relationship Between Self-Reported Function, Functional Tests and Biomechanical Parameters in Patients 12 Months After Total Hip Arthroplasty: A Preliminary Cross-Sectional Study

Background/Purpose

Several methods are used to evaluate the outcome of total hip arthroplasty (THA), however, their relationship at different time points after surgery is unclear. The purpose of this exploratory study was to investigate correlations between self-report function, performance-based tests (PBTs) and biomechanical parameters in patients 12 months after THA.

Methods

Eleven patients were included in this preliminary cross-sectional study. Hip disability and Osteoarthritis Outcome Score (HOOS) was completed for self-reported function. As PBTs, the Timed-up-and-Go test (TUG) and 30-Second-Chair-Stand test (30CST) were used. Biomechanical parameters were derived from analyses of hip strength, gait and balance. Potential correlations were calculated using Spearman correlation coefficient r.

Results

HOOS scores and parameters of PBTs showed moderate to strong correlations (0.3 < r < 0.7). Correlation analysis between HOOS scores and biomechanical parameters revealed moderate to strong correlations for hip strength whereas correlations with gait parameters and balance were rather weak (r < 0.3). Moderate to strong correlations were also found between parameters of hip strength and 30CST.

Conclusion

For THA outcome assessment 12 months after surgery, our first results indicate that self-report measures or PBTs could be used. Analysis of hip strength also appears to be reflected in HOOS and PBT parameters and may be considered as an adjunct. Given the weak correlations with gait and balance parameters, we suggest that gait analysis and balance testing should be performed in addition to PROMs and PBTs as they may provide supplementary information, especially for THA patients that are at risk for falls.

Validity and reliability of performance tests as balance measures in patients with total knee arthroplasty

PURPOSE

This study aimed to investigate validity and reliability of the Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT), Single Leg Stance Test (SLST), 2 Minute Walk Test (2MWT), and Five Times Sit-to-Stand Test (5xSST) for evaluating balance in patients with total knee arthroplasty (TKA).

MATERIALS AND METHODS

This cross-sectional study included 41 participants who had undergone TKA 6 months before the study due to osteoarthritis. Participants performed the TUG, 10MWT, SLST, 5xSST, and 2MWT. Each of the tests was performed twice, with a 1-day interval between tests. Intraclass correlation coefficient (ICC) models were used to determine the test-retest reliability. The level of correlations between performance tests and Berg Balance Scale and Fall Efficacy Scale-International were used to establish concurrent and convergent validity of the performance tests, respectively.

RESULTS

The mean age of the subjects was 64.07 ± 10.57 years. All tests showed excellent reliability (ICC > 0.94), excluding SLST that demonstrated good test-retest reliability (ICC = 0.72). All of the tests (SLST, 10MWT, 5xSST, 2MWT, TUG) were found to have good validity (rho > 0.704).

CONCLUSIONS

According to these results, TUG, 10MWT, SLST, 5xSST, and 2MWT are reliable and valid outcome measures in patients with TKA, and could be used to assess balance after TKA surgery.

Patient, physiotherapist and surgeon endorsement of the core domain set for total hip and total knee replacement in Germany: a study protocol for an OMERACT initiative

INTRODUCTION

There is a lack of harmonising measures for clinical trials on total joint replacement (TJR) that would allow for results from TJR studies to be compared or pooled. The Outcome Measures in Rheumatology (OMERACT) TJR core domain set is already endorsed among patients and physicians in the USA and Australia. Physiotherapists use different types of measurements compared to orthopaedic surgeons while both make substantial contributions to research in the field of TJR. To achieve consensus on core measurements sets, patients, physiotherapists and orthopaedic surgeons need to achieve consensus on the core domains for TJR trials.

METHODS AND ANALYSIS

For this multistage study, first, the OMERACT TJR core domain set survey will be translated to German and validated according to WHO guidelines. Next, the TJR core domain set will be considered for endorsement in different German stakeholder groups including patients, physiotherapists and orthopaedic surgeons.

ETHICS AND DISSEMINATION

Ethical approval for this protocol was given by the ethics committee of the Brandenburg University of Technology Cottbus-Senftenberg (BTU-CS, EK 2019-2). This article is based on the protocol version 2.5 from 6 May 2020. Anonymous data will be presented only. We will publish the results in peer-reviewed publications and at international conferences.

TRIAL REGISTRATION NUMBER

German Clinical Trials Registry (DRKS00016015).

Effects of total hip arthroplasty for primary hip osteoarthritis on postural balance: A systematic review

BACKGROUND

Hip osteoarthritis is one of the major causes of disability worldwide, and although total hip arthroplasty is considered effective in the management of this condition, its effects on postural balance remain unclear.

RESEARCH QUESTION

What are the effects of total hip arthroplasty for primary hip osteoarthritis on the postural balance compared to preoperative status and/or to healthy controls?.

METHOD

A systematic review was conducted, and the Embase, Latin American and Caribbean Health Sciences (LILACS), PubMed, Scopus, The Cochrane Library, and Web of Science databases were searched. Randomized and non-randomized studies were considered eligible for inclusion. The risk of bias of included studies was assessed using the Joanna Briggs Institute critical appraisal tools.

RESULTS

Among the 41 potentially eligible studies, 13 studies were included for qualitative synthesis-8 studies had low risk of bias and 5 had moderate risk of bias. Ten studies compared the effects of total hip arthroplasty on the postural balance in healthy controls. Meanwhile, the remaining 3 studies compared such effects to the preoperative status only. Comparable results on the postural balance between the intervention and control groups were observed in 5 studies, whereas 3 studies showed better scores among healthy controls. The other 2 studies reported that postural balance could still be impaired at 6 months to 3 years postoperatively. All 3 studies with no healthy controls reported an improvement in the postural balance compared to the preoperative status.

CONCLUSIONS

Major post-surgical improvements were consistently observed compared to preoperative status, although postural balance impairment was still noted compared to healthy controls.

SIGNIFICANCE

The results of this study might be a useful guide for clinicians on the extent of the therapeutic effects of hip arthroplasty on postural balance. Furthermore, the standardization of balance assessment tools could strengthen the certainty of cumulative evidence in future studies.

Timed Up and Go test is predictive of Patient-Reported Outcomes Measurement Information System physical function in patients awaiting total knee arthroplasty

Background

The Patient Reported Outcomes Measurement Information System (PROMIS) Computerized Adaptive Test (CAT) physical function rapidly assesses self-reported function capability. The Timed Up and Go (TUG) test is often used in clinical practice, but administration may be impeded by space and patient limitations. PROMIS CAT can potentially address these limitations, but we lack evidence if TUG and health indicators are predictors of PROMIS CAT. This study assessed whether TUG, body mass index (BMI), numeric pain rating scale (NPRS), and smoking status were predictors of PROMIS CAT in total knee arthroplasty (TKA) candidates.

Methods

Sixty-five TKA candidates completed the PROMIS CAT physical function test using an iPad application. TUG, NPRS, BMI, and smoking status were obtained at the clinic visit or from medical records. Univariate and multiple regression analyses identified the strongest predictors of PROMIS CAT.

Results

TUG was the best predictor of PROMIS CAT physical function based on simple regression (r = −0.43, 95% CI = −0.62 to −0.20) or multiple regression (βˆ = −0.45, 95% CI = −0.73 to −0.17) analyses. BMI and NPRS did not incrementally help predict the PROMIS score beyond TUG. Smoking status did not contribute to the prediction of the PROMIS CAT score.

Conclusions

The findings suggest that the PROMIS CAT physical function is not a surrogate for the TUG performance-based measure in candidates for TKA. However, TUG was the best predictor of PROMIS physical function compared with BMI, NPRS, and smoking status. Clinicians should consider both patient-reported and performance-based measures when evaluating function for TKA outcomes.