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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; 105:1725-1732. [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] [MESH Headings] [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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Zhao R, Wei X, Hu S, Zhang Y, Wu H, Li P, Zhao Y. Deficient gait function despite effect index of the Western Ontario and McMaster university osteoarthritis index score considered cured one year after bilateral total knee arthroplasty. BMC Musculoskelet Disord 2024; 25:230. [PMID: 38521939 PMCID: PMC10960387 DOI: 10.1186/s12891-024-07348-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND To clarify the value of gait analysis and its consistency with traditional scoring scales for the evaluation of knee joint function after total knee arthroplasty (TKA). METHODS This study included 25 patients with knee osteoarthritis (KOA) who underwent bilateral TKA, and 25 conditionally matched healthy individuals, categorised into the experimental and control groups, respectively. Patients in the experimental group underwent gait analysis and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) evaluation before and 1 year after TKA. Weight-bearing balance and walking stability were assessed using discrete trends of relevant gait indicators. Pearson's correlation analysis was performed on the gait and WOMAC score data of the experimental group before and after TKA. RESULTS One year after TKA, patients' gait indices (except gait cycle) were significantly better than before surgery, but significantly worse than that of the control group (P < 0.01). The shape of patients' plantar pressure curves did not return to normal. Additionally, the discrete trend of related gait indicators reflecting weight-bearing balance and walking stability were smaller than before TKA, but still greater than that of the control group. The WOMAC scores of patients 1 year after TKA were significantly lower than those before TKA (P < 0.001), and the efficacy index was > 80%. The WOMAC scores and gait analysis results were significantly correlated before TKA (P < 0.05). CONCLUSIONS Gait analysis should be used in conjunction with scoring scales to assess joint functions.
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Affiliation(s)
- Ruipeng Zhao
- Department of Orthopaedics, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Xiaochun Wei
- Department of Orthopaedics, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Shuai Hu
- Department of Orthopaedics, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yixuan Zhang
- Department of Orthopaedics, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Hongru Wu
- Shanxi Institute of Sports Science, Taiyuan, 030001, Shanxi, China
| | - Pengcui Li
- Department of Orthopaedics, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yu Zhao
- Department of Orthopaedics, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China.
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Christensen JC, Blackburn B, Browning B, Wilbur C, Trinity JD, Gililland JM, Pelt CE. 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. Disabil Rehabil 2023; 45:3677-3685. [PMID: 36255156 DOI: 10.1080/09638288.2022.2134934] [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: 03/14/2022] [Revised: 08/25/2022] [Accepted: 10/02/2022] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Jesse C Christensen
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine & Rehabilitation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Brenna Blackburn
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Bennett Browning
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Chelsey Wilbur
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Joel D Trinity
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine & Rehabilitation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Jeremy M Gililland
- Department of Physical Medicine & Rehabilitation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Pua YH, Tan BY, Low J, Woon EL, Yeo SJ, Clark RA, Bettger JP, Pereira MJ, Tan CY, Thumboo J. Discordance Between Self-Reported and Performance-Based Physical Function in Patients Who Have Knee Osteoarthritis: Associations With Pain Intensity and Negative Affect. J Arthroplasty 2023; 38:1705-1713.e1. [PMID: 36940758 DOI: 10.1016/j.arth.2023.03.044] [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: 01/25/2023] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Although self-reported measures of physical disability are strong indication criterion for total knee arthroplasty (TKA) in painful knee osteoarthritis (OA), some patients may report greater-than-observed disability. Contributing factors to this discordance are relatively unexplored. We aimed to examine whether pain and negative affect, including anxiety and depression, were associated with the discordance of self-reported measures with performance-based measures (PPM) of physical function. METHODS We used cross-sectional data (n = 212) from two randomized rehabilitation trials in knee OA. All patients were assessed for knee pain intensity and symptoms of anxiety and depression. Self-reported function was assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical-function subscale. Objective performance-based measures (PPMs) of physical function were assessed by timed gait and stair tests. Continuous discordance scores were quantified by the difference in percentiles between WOMAC and PPMs (WOMAC-PPM), where a positive discordance, WOMAC-PPM >0, implied greater perceived than observed disability. RESULTS Around 1 in 4 patients had >20 percentile units in WOMAC-PPM discordance. In Bayesian regression analyses, knee pain intensity had >99% posterior probability of positive associations with WOMAC-PPM discordance. Among patients awaiting TKA, anxiety intensity had approximately 99% probability of positive associations with discordance, and these associations had >65% probability of exceeding 10 percentile units. In contrast, depression had low (79% to 88%) probability of any association with discordance. CONCLUSION In patients who have knee OA, a sizable proportion reported substantially greater physical disability than actually observed. Pain and anxiety intensity, but not depression, were meaningful predictors of this discordance. If validated, our findings may help in refining patient selection criteria for 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
| | - Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health Campus, National Healthcare Group, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Juanita Low
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Ross A Clark
- Research Health Institute, University of the Sunshine Coast, Australia
| | - Janet P Bettger
- Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Michelle J Pereira
- Health Services and Outcome Research, National Healthcare Group, Singapore
| | - Chun-Yue Tan
- Department of Orthopaedic Surgery, Woodlands Health Campus, National Healthcare Group, Singapore
| | - 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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Meiser S, Arora R, Petersen J, Keiler A, Liebensteiner MC, Pallua JD, Wurm A. Radiographic and clinical outcome of tibial plateau fractures treated with bone allograft. Arch Orthop Trauma Surg 2022; 143:2447-2454. [PMID: 35534713 PMCID: PMC9085366 DOI: 10.1007/s00402-022-04461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND To determine the clinical outcome of patients who had been treated with bone allografts during open reduction and internal fixation (ORIF) of tibial head fractures. METHODS Patients who suffered a medial, lateral, or bicondylar fracture of the tibial plateau and underwent surgical treatment by open reduction and internal fixation (ORIF) using human femoral head bone allografts were included. Patients were invited to provide information for the following: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol Five Dimension score (EQ-5D), Lower Extremity Functional Scale (LEFS) and Parker Mobility Score. Bone mineral density (BMD) of the allograft area and the healthy human bone tissue were measured by quantitative computed tomography. RESULTS A total of 22 patients with a mean follow-up time of 2.88 ± 2.46 years were included in our study. The most common fractures observed in this study were classified as Schatzker II (11 patients, 50.0%) or AO/OTA 41.B3 (12 patients, 54.5%) fractures. Postoperative WOMAC total was 13.0 (IQR = 16.3, range 0-33). Median quality of life (EQ-5D) score was 0.887 ± 0.121 (range 0.361-1.000). Median Lower Extremity Functional Scale (LEFS) score was 57.5 ± 19.0 (range 33-79). Mean Parker Mobility Score was 9 (range 6-9). Median bone mineral density (BMD) for the whole group was 300.04 ± 226.02 mg/cm3 (range - 88.68 to 555.06 mg/cm3) for region of interest (ROI 5) (central), 214.80 ± 167.45 mg/cm3 (range - 7.16 to 597.21 mg/cm3) for ROI 1-4 (marginal zones: medial, lateral, ventral, dorsal) and 168.14 ± 65.54 mg/cm3 (range 17.47-208.97 mg/cm3) for healthy bone tissue (femur and tibia). CONCLUSION Based on WOMAC scores, LEFS, ambulatory status, and quality of life findings, it can be concluded that following tibial head ORIF with allograft bone patients has promising results.
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Affiliation(s)
- Sarah Meiser
- Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- Dept. of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Johannes Petersen
- Dept. of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria ,Klinikum Freising, Radiologie Klinikum Freising, Alois-Steinecker-Straße 18, 85354 Freising, Germany
| | - Alexander Keiler
- Dept. of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michael C. Liebensteiner
- Dept. of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Johannes Dominikus Pallua
- Dept. of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Alexander Wurm
- Dept. of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Razmjou H, Savona A, Szafirowicz A, Deel L, Richards R. Psychosocial risk factors and physical and mental well-being following a compensable knee injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1995896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Helen Razmjou
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
| | - Alicia Savona
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Analia Szafirowicz
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lauren Deel
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robin Richards
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Cross-Cultural Adaptation and Validation of the Simplified Chinese Version of the Lower Extremity Functional Scale. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1421429. [PMID: 32258101 PMCID: PMC7086410 DOI: 10.1155/2020/1421429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/15/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022]
Abstract
Purpose The purpose of this study was to cross-culturally adapt and validate the Simplified Chinese version of the Lower Extremity Functional Scale (SC-LEFS). Methods The original English version of the Lower Extremity Functional Scale was translated and cross-culturally adapted into Simplified Chinese according to international guidelines. The SC-LEFS and 36-Item Short-Form Health Survey were administered to 213 patients with lower extremity musculoskeletal disorders. Psychometric properties including internal consistency, test-retest reliability, content validity, and construct validity were tested. Results There were no floor or ceiling effects for the SC-LEFS. The scale had high values for internal consistency (Cronbach α = 0.97) and test-retest reliability (intraclass correlation coefficient = 0.97). Corrected item-total correlations for every item ranged from 0.67 to 0.89. And the item-level content validity index (I-CVI) for each item ranged from 0.78 to 1.00. Principal component analysis revealed a one-factor structure. Nine of ten prior hypotheses were confirmed, which further supports good construct validity within the SC-LEFS. Conclusion The SC-LEFS has high internal consistency, good test-retest reliability and content validity, convergent construct validity, and a one-factor structure. Thus, it could be regarded as a reliable and valid tool to assess activity limitations in Chinese patients with lower extremity musculoskeletal disorders.
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Lourduraj DB, Barnawal SP, Pattabi K, Gnanasekaran V, Sadhasivam A, Vinod KS, Sharma D, Jayaram Y. Application of the Lower Extremity Functional Scale and Its Correlation with Lymphedema Health-Related Quality of Life on Lower Limb Filarial Lymphedema Patients. Lymphat Res Biol 2019; 18:254-260. [PMID: 31532703 PMCID: PMC7310210 DOI: 10.1089/lrb.2019.0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: This study carried out as a part of the lymphedema (LE)—osteoarthritis project to know the feasibility and applicability of lower extremity functional scale (LEFS) and LE health-related quality of life (LEHRQoL) among filarial LE patients of the lower extremity. Materials and Methods: Following inclusion and exclusion criteria 30 LE patients and 30 controls were recruited in the study. After obtaining informed written consent, Tamil version of the two “self-reporting assessment tools” LEFS and LEHRQoL were applied to all the participants by two examiners independently. Feasibility was assessed by the time schedule. Internal consistency and the correlation between two examiners was assessed by calculating Cronbach's alpha and Karl Pearson correlation coefficient and Spearman rank correlation respectively. Results: The mean time taken for completing the LEFS and LEHRQoL questionnaire was 5 minutes and 2 seconds and 12 minutes and 8 seconds respectively. Internal consistency reliability assessment showed good internal consistency for both the examiners (Cronbach's alpha 0.816 and 0.812). There was a strong positive correlation for the cases (r = 0.956, p < 0.001; r = 0.908, p < 0.001) and controls (r = 0.992, p < 0.001; r = 0.985, p < 0.001) between the two examiners. Conclusions: LEFS and LEHRQoL were well accepted among filarial LE patients and the patients with low literacy were able to respond without any difficulty to both assessment tools. LEFS was found suitable for the assessment of lower extremity functions of the LE patients as in other diseases affecting the lower limb and it also indirectly brought out the impact on the QoL.
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Affiliation(s)
- De Britto Lourduraj
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Pondicherry, India
| | | | - Kamaraj Pattabi
- Division of Epidemiology & Biostatistics, National Institute of Epidemiology-ICMR, Chennai, India
| | - Vijayalakshmi Gnanasekaran
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Pondicherry, India
| | - Anbusivam Sadhasivam
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Pondicherry, India
| | - K Supriya Vinod
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Pondicherry, India
| | - Deep Sharma
- Department of Orthopaedics, JIPMER, Pondicherry, India
| | - Yuvaraj Jayaram
- Division of Epidemiology & Biostatistics, National Institute of Epidemiology-ICMR, Chennai, India
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Cinnamon CC, Longworth JA, Brunner JH, Chau VK, Ryan CA, Dapiton KR, Chmell SJ, Foucher KC. Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2019; 67:127-133. [PMID: 31103962 DOI: 10.1016/j.clinbiomech.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A subset of total hip arthroplasty patients experience functional impairments past the first postoperative year. Poor hip abductor function is common before and in the early postoperative period. It is not known if abductor impairment is associated with long-term functional impairment. This study evaluated the relationships between static and dynamic abductor function and performance-based and self-reported function >1 year post-total hip arthroplasty. METHODS Eighteen adults 1-5 years post-total hip arthroplasty participated. Static and dynamic abductor function were assessed through dynamometry and gait analysis, respectively. Subjects completed four physical performance tests and two self-report instruments. FINDINGS Higher peak isometric abductor strength was associated with better performance-based function (P ≤ 0.001-0.030) and with self-reported function (P ≤ 0.001-0.012). Higher peak external adduction moment was associated with better results on 3 of 4 performance tests (P = 0.007-0.026). Together, static and dynamic abductor function predicted 35-77% of the variation in physical function. Abductor strength best predicted walking test results and self-reported function, while dynamic abductor function best predicted tests involving sit-to-stand INTERPRETATION: Static and dynamic abductor function were associated with physical function 1-5 years after total hip arthroplasty. These results support further investigation of interventions targeting abductor function for persons experiencing persistent impairments.
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Affiliation(s)
- Christopher C Cinnamon
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica A Longworth
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - J Heather Brunner
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Vivian K Chau
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Colleen A Ryan
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; School of Nursing, DePaul University, Chicago, Illinois, Chicago, IL, USA
| | - Kris R Dapiton
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Samuel J Chmell
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA.
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Horng YS, Hou WH, Liang HW. Responsiveness of the modified lower extremity functional scale in patients with low back pain and sciatica: A comparison with pain intensity and the modified Roland-Morris Disability Scale. Medicine (Baltimore) 2019; 98:e15105. [PMID: 30946376 PMCID: PMC6455991 DOI: 10.1097/md.0000000000015105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We tested the responsiveness of the modified Lower Extremity Functional Scale (LEFS) for patients with low back pain (LBP) and sciatica and made a comparison with the modified Roland-Morris Disability Scale for sciatica (RMS-L) and self-reported pain intensity measured by visual analogue scale (VAS).One hundred and forty-eight participants were recruited from 2 university hospitals. The evaluation included demographic data, LBP history, and the modified LEFS, RMS-L, and VAS, with a follow-up one month later. Several responsiveness statistics were calculated.The study followed 132 participants, approximately 25% reported improvement. Guyatt responsiveness index (GRI) was 0.8 or higher for 3 measures, while standardized response means were 0.8 or higher for the RMS-L and VAS, but only 0.6 for the modified LEFS among improved group. According to ROC analysis, the modified LEFS had an area under curve (AUC) similar to that of the modified RMS-L, but significantly smaller than that of the VAS.The responsiveness of the modified LEFS was moderate but not superior to the VAS or RMS-L. Although, the modified LEFS could not replace the RMS-L or VAS, it could still be used as a complementary measure since these three measurements covered different body function, activity and participation domains.
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Affiliation(s)
- Yi-Shiung Horng
- Department of Rehabilitation Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, New Taipei City
- Department of Medicine, Tzu Chi University, Hualien
| | - Wen-Hsuan Hou
- School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
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Doiron-Cadrin P, Kairy D, Vendittoli PA, Lowry V, Poitras S, Desmeules F. Feasibility and preliminary effects of a tele-prehabilitation program and an in-person prehablitation program compared to usual care for total hip or knee arthroplasty candidates: a pilot randomized controlled trial. Disabil Rehabil 2019; 42:989-998. [DOI: 10.1080/09638288.2018.1515992] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Patrick Doiron-Cadrin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Orthopaedic Clinical Research Unit, Centre-intégré-universitaire-de-santé-et-de-services-sociaux Est-de-l’île-de Montréal, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montréal, Québec, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehablitation of Greater Montreal, Montréal, Québec, Canada
| | - Pascal-André Vendittoli
- Orthopaedic Clinical Research Unit, Centre-intégré-universitaire-de-santé-et-de-services-sociaux Est-de-l’île-de Montréal, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montréal, Québec, Canada
- Department of Surgery, University of Montreal, Montreal, Canada
| | - Véronique Lowry
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Orthopaedic Clinical Research Unit, Centre-intégré-universitaire-de-santé-et-de-services-sociaux Est-de-l’île-de Montréal, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montréal, Québec, Canada
| | - Stéphane Poitras
- School of rehabilitation sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Orthopaedic Clinical Research Unit, Centre-intégré-universitaire-de-santé-et-de-services-sociaux Est-de-l’île-de Montréal, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montréal, Québec, Canada
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Stratford P, Kennedy D, Clarke H. Confounding pain and function: the WOMAC's failure to accurately predict lower extremity function. Arthroplast Today 2018; 4:488-492. [PMID: 30569009 PMCID: PMC6287962 DOI: 10.1016/j.artd.2018.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 01/26/2023] Open
Abstract
Background Investigations have revealed the Western Ontario and McMaster Universities Osteoarthritis Index's (WOMAC) inability to provide distinct assessments of pain and function. The Lower Extremity Functional Scale (LEFS) has not displayed this deficiency. Our purposes were to investigate further the WOMAC physical function's (WOMAC-PF) ability to accurately assess lower extremity mobility in patients undergoing total knee arthroplasty (TKA) and to establish a relationship between pre- and post-TKA WOMAC-PF and LEFS scores that accounts for the apparent bias WOMAC pain scores impose on WOMAC-PF scores. Methods WOMAC, LEFS, and Timed-up-and-go measures were administered before TKA and 4 days, 6 weeks, and 3 months after TKA. To evaluate the WOMAC-PF and LEFS ability to provide a distinct assessment of pain and function, a paired t-test compared pre-TKA and 4 days after TKA values. Generalized estimating equation (GEE) analysis assessed the relationship between pre- and post-TKA values: dependent variable WOMAC-PF scores; independent variables LEFS scores, and measurement occasions. Results Timed-up-and-go and LEFS demonstrated a reduction in lower extremity function (P < .001); pain decreased (P < .001); and there was no significant change in WOMAC-PF scores (P = .61). GEE analysis revealed a linear relationship between WOMAC-PF and LEFS with similar slope coefficients for all four occasions. The relationship between WOMAC-PF and LEFS scores was virtually identical for the postarthroplasty assessment occasions. Conclusions Our findings support previous investigations that showed the WOMAC-PF's inability to provide a valid assessment in change in function. The GEE analysis coefficients can be used to convert LEFS scores to WOMAC-PF scores that adjust for the bias between pre- and post-TKA assessments.
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Affiliation(s)
- Paul Stratford
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Deborah Kennedy
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,Holland Orthopaedic & Arthritic Centre of Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, and Department of Anesthesia, University of Toronto, Toronto, ON, Canada
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Donor-Site Morbidity and Functional Status following Medial Femoral Condyle Flap Harvest. Plast Reconstr Surg 2018; 142:734e-741e. [DOI: 10.1097/prs.0000000000004886] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Fillingham YA, Darrith B, Lonner JH, Culvern C, Crizer M, Della Valle CJ. Formal Physical Therapy May Not Be Necessary After Unicompartmental Knee Arthroplasty: A Randomized Clinical Trial. J Arthroplasty 2018; 33:S93-S99.e3. [PMID: 29555497 DOI: 10.1016/j.arth.2018.02.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/23/2018] [Accepted: 02/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this randomized clinical trial was to compare formal outpatient physical therapy (PT) and unsupervised home exercises after unicompartmental knee arthroplasty (UKA). METHODS Fifty-two patients were randomized to 6 weeks of outpatient PT or an unsupervised home exercise program after UKA. The primary outcome was change in range of motion at 6 weeks with secondary outcomes including total arc of motion, Knee Society Score, Knee Injury and Osteoarthritis Outcome Score Jr, Lower Extremity Functional Scale, and Veterans Rands-12 score. RESULTS Twenty-five patients received outpatient PT, 22 patients the self-directed exercise program, while 3 patients deviated from the protocol, 1 patient withdrew, and 1 patient was lost to follow-up. There was no difference in the change of range of motion (P = .43) or total arc of motion at 6 weeks (P = .17) between the groups and likewise no significant differences were found in any of the secondary outcomes. Two patients who crossed over from the unsupervised home exercise program to formal outpatient PT within the first 2 weeks postoperatively required a manipulation under anesthesia. CONCLUSIONS Our results suggest self-directed exercises may be appropriate for most patients following UKA. However, there is a subset of patients who may benefit from formal PT.
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Affiliation(s)
- Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Brian Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Jess H Lonner
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Chris Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Meredith Crizer
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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15
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Lowry V, Ouellet P, Vendittoli PA, Carlesso LC, Wideman TH, Desmeules F. Determinants of pain, disability, health-related quality of life and physical performance in patients with knee osteoarthritis awaiting total joint arthroplasty. Disabil Rehabil 2017; 40:2734-2744. [PMID: 28728444 DOI: 10.1080/09638288.2017.1355412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance. MATERIAL AND METHODS Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteoarthritis Index, (2) Lower Extremity Functional Scale (LEFS) and (3) Short-Form 36 (SF-36). Physical performance was also assessed with four validated performance tests. Demographic, socioeconomic, psychosocial and clinical characteristics of the participants were also measured. Multivariate regression analyses were used to evaluate potential associations. RESULTS Higher fear-avoidance beliefs, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse pain, function or HRQOL (p < 0.05) and explained 12%-35% of the variances of the self-reported measure scores. Pretest pain and change in pain during posttest, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse performance on the physical tests (p < 0.05) and explained 41%-59% of the variances of the different physical tests results. CONCLUSIONS Several determinants were significantly associated with worse pain, disability, health-related quality of life or physical performance. Several of these associations may be considered clinically important, including psychosocial determinants in relation to self-reported measures, but to physical performance as well. Implications for rehabilitation Knee osteoarthritis is a highly prevalent and disabling condition incurring important socioeconomic costs. Several modifiable determinants have been shown to contribute to pain and disability in individuals suffering from knee OA awaiting TKA. Recent studies demonstrated the efficacy of education and rehabilitation (prehabilitation) in individuals awaiting TKA.
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Affiliation(s)
- Véronique Lowry
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada
| | - Philippe Ouellet
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Pascal-André Vendittoli
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,c Department of Surgery, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Lisa C Carlesso
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Timothy H Wideman
- d School of Physical and Occupational Therapy , McGill University , Montreal , Canada
| | - François Desmeules
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
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Bream E, Black N. What is the Relationship Between Patients’ And Clinicians’ Reports of the Outcomes of Elective Surgery? J Health Serv Res Policy 2017; 14:174-82. [DOI: 10.1258/jhsrp.2009.008115] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To identify studies in which patients’ and clinicians’ reports of health status and complications of one of four elective operations - hip and knee replacement, varicose vein surgery and groin hernia repair - are reported, and to describe the associations that have been reported between clinicians’ and patients’ reports. Methods Systematic search of several bibliographic databases and review of citations of articles meeting inclusion criteria. A narrative summary of the findings was conducted. Results Most of the 62 studies of health status identified were for hip (23) or knee (33) disease. The literature on complications was even more limited with 12 studies of surgical site infection, one for urinary tract infection and none for lower respiratory tract infections. Procedure-specific complications were restricted to one for arthroplasties and three for hernia repair. Despite considerable variation in the findings of studies, some clear patterns emerge, albeit they are largely based on arthroplasty. Patients’ and clinicians’ views of health status generally correlate moderately (0.5-0.6) when both are reporting on the same dimension of health status. Inevitably this is confined to disability, though patients’ and clinicians’ reports of symptoms are also moderately correlated. In contrast, comparisons of different dimensions, such as patients’ reports of disability and clinicians’ reports of impairment, result in poor correlation (0.3). There is huge variation in the way postoperative complications are measured which limits the extent to which an overview can be undertaken. Despite that, moderate to strong correlations have been reported between patients’ and clinicians’ views of complications. Conclusions Patients’ views of their level of disability reflect clinicians’ views and can be relied upon to assess this dimension of health status. In addition, patients are the ‘gold standard’ judges of symptoms and quality of life. Given these findings, clinicians, provider managers, commissioners and politicians can be confident that patients’ reports provide an accurate indication of the outcome of elective surgery.
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Affiliation(s)
| | - Nick Black
- Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Stratford P, Kennedy D. Responsiveness of four patient-reported outcome measures to assess physical function in patients with knee osteoarthritis: comments on the article by Mahler et al. Scand J Rheumatol 2016; 46:168-169. [PMID: 27928927 DOI: 10.1080/03009742.2016.1238960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P Stratford
- a School of Rehabilitation Science , McMaster University , Hamilton , ON , Canada
| | - D Kennedy
- b Holland Orthopaedic and Arthritic Centre , Toronto , ON , Canada
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Oh J, Perlas A, Lau J, Gandhi R, Chan VW. Functional outcome and cost-effectiveness of outpatient vs inpatient care for complex hind-foot and ankle surgery. A retrospective cohort study. J Clin Anesth 2016; 35:20-25. [DOI: 10.1016/j.jclinane.2016.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/21/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Alghadir A, Iqbal ZA, Anwer S. Comparison of the effect of pre- and post-operative physical therapy versus post-operative physical therapy alone on pain and recovery of function after total knee arthroplasty. J Phys Ther Sci 2016; 28:2754-2758. [PMID: 27821929 PMCID: PMC5088120 DOI: 10.1589/jpts.28.2754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to compare the effect of pre-operative and
post-operative physical therapy versus post-operative physical therapy alone on pain and
recovery of function after total knee arthroplasty. [Subjects and Methods] Fifty patients
(18 males and 32 females) ranging in age from 48 to 80 years (mean 63.28, SD 9.44)
participated in a 6-week two-arm randomized rater-blinded trial. One group received pre-
and post-operative physical therapy whereas the other group received only post-operative
physical therapy. Pain and function were measured with a visual analogue scale and a lower
extremity functional scale at baseline (pre-operative) as well as week 3 and week 6
post-operative. [Results] The differences in pain intensity and functional score at week 3
and week 6 post-operative remained statistically insignificant between the two groups.
[Conclusion] The reduction of pain and recovery of function was similar in subjects who
received pre- and post-operative physical therapy and those who received only
post-operative physical therapy after total knee arthroplasty. Additional pre-operative
physical therapy did not bring about any further improvement in pain intensity or recovery
of function after total knee arthroplasty.
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Affiliation(s)
- Ahmad Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Zaheen Ahmed Iqbal
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia; Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India
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Effects of a tele-prehabilitation program or an in-person prehabilitation program in surgical candidates awaiting total hip or knee arthroplasty: Protocol of a pilot single blind randomized controlled trial. Contemp Clin Trials Commun 2016; 4:192-198. [PMID: 29736482 PMCID: PMC5935896 DOI: 10.1016/j.conctc.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 01/22/2023] Open
Abstract
Background The accessibility for total joint arthroplasty often comes up against long wait lists, and may lead to deleterious effects for the awaiting patients. This pilot single blind randomized controlled trial aims to evaluate the impact of a telerehabilitation prehabilitation program before a hip or knee arthroplasty compared to in-person prehabilitation or to usual wait for surgery. Methods/design Thirty-six patients on a wait list for a total hip or knee arthroplasty will be recruited and randomly assigned to one of three groups. The in-person prehabilitation group (n = 12) will receive a 12-week rehabilitation program (2 sessions/week) including education, exercises of the lower limb and cardiovascular training. Patients in the tele-prehabilitation group (n = 12) will receive the same intervention using a telecommunication software. The control group (n = 12) will be provided with the hospital's usual documentation before surgery. The Lower Extremity Functional Scale (LEFS) will be the primary outcome measure taken at baseline and at 12 weeks. Secondary measures will include self-reported function and quality of life as well as performance tests. A mixed-model, 2-way repeated-measure ANOVA will be used to analyse the effects of the rehabilitation programs. Discussion This pilot study is the first to evaluate the feasibility and the impact of a telerehabilitation prehabilitation program for patients awaiting a total joint arthroplasty. The results of this pilot-RCT will set the foundations for further research in the fields of rehabilitation and tele-medicine for patients suffering from lower limb osteoarthritis. Trial registration ClinicalTrials.gov: NCT02636751.
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Key Words
- ANOVA, Analysis of variance
- Arthroplasty
- FRSQ, Fonds de recherche du Québec – Santé
- GRS, Global Rating Scale
- Hip
- ICC, Intraclass correlation coefficient
- Knee
- LEFS, Lower Extremity Functional Scale
- Prehabilitation
- RCT, Randomized clinical trial
- SF-36, The Short Form (36) Health Survey
- SPW, Self-paced Walk
- ST, Stair Test
- THA, Total hip arthroplasty
- TJA, Total joint arthroplasty
- TKA, Total knee arthroplasty
- TUG, Timed Up and Go
- Telemedicine
- WOMAC, Western Ontario & McMaster Universities Osteoarthritis Index
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Sensitivity to Change of a Computer Adaptive Testing Instrument for Outcome Measurement After Hip and Knee Arthroplasty and Periacetabular Osteotomy. J Orthop Sports Phys Ther 2016; 46:756-67. [PMID: 27494055 DOI: 10.2519/jospt.2016.6442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Clinical measurement study. Background Computer adaptive testing (CAT) methods may allow detection of change across the continuum of osteoarthritis (OA) care. Objective To evaluate the sensitivity to change of a self-report OA CAT instrument (OA-CAT) following surgery. Methods Core measures consisted of the 5-item OA-CAT function, pain, and disability scales; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); the University of California at Los Angeles activity rating scale; and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12), which were administered in 3 samples. Fifty-three patients with hip dysplasia completed the core measures, the Hip disability and Osteoarthritis Outcome Score physical function short form (HOOS-PS), and the Modified Harris Hip Score (MHHS) before periacetabular osteotomy, and at 6 months, 1 year, and 2 years after periacetabular osteotomy. The hip (n = 62) and knee (n = 66) arthroplasty samples completed core measures and the MHHS or the Knee Society's Knee Scoring System at baseline and at 3-month follow-up. Mean change, floor and ceiling effects (percent), and effect size were calculated. Results For osteotomy, the 6-month physical function effect sizes for the OA-CAT, WOMAC, HOOS-PS, MHHS, and SF-12 physical component summary scores were 0.66 (95% confidence interval [CI]: 0.08, 1.61), 0.78 (95% CI: 0.56, 1.10), 0.91 (95% CI: 0.70, 1.21), 0.64 (95% CI: 0.22, 1.07), and 0.87 (95% CI: 0.53, 1.38), respectively. Effect-size trends were all increased at 1 year, and most were level at 2 years. For hip arthroplasty, the OA-CAT, WOMAC, MHHS, and SF-12 effect sizes were 1.27 (95% CI: 0.88, 1.84), 1.50 (95% CI: 1.20, 1.80), 0.68 (95% CI: 0.35, 1.04), and 0.56 (95% CI: 0.29, 0.88), respectively. For knee arthroplasty, the OA-CAT, WOMAC, Knee Society Knee Scoring System, and SF-12 effect sizes were 0.81 (95% CI: 0.56, 1.14), 0.85 (95% CI: 0.61, 1.10), 0.09 (95% CI: -0.22, 0.40), and -0.01 (95% CI: -0.39, 0.31), respectively. The OA-CAT and SF-12 demonstrated smaller ceiling effects than the HOOS-PS and other instruments, especially at 1 and 2 years. Administration time was less for the OA-CAT than for the WOMAC physical function subscale. Conclusion The OA-CAT shows potential for outcome measurement after hip and knee surgery. Larger studies are needed to better understand relative performance. J Orthop Sports Phys Ther 2016;46(9):756-767. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6442.
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Wainwright AV, Kennedy DM, Stratford PW. The Group Experience: Remodelling Outpatient Physiotherapy after Knee Replacement Surgery. Physiother Can 2016; 67:350-6. [PMID: 27504034 DOI: 10.3138/ptc.2014-44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
UNLABELLED Purpose : To estimate responses to short-duration (4-6 weeks) group-based physiotherapy after knee replacement in terms of pain, function, and satisfaction. METHOD The study used a prospective, observational design. A total of 169 participants (111 women, 58 men) were consecutively recruited to attend a twice-weekly post-operative knee replacement class focused on mobility, strength, balance, and functional retraining. Changes in pain, function, and satisfaction were measured using the P4 pain intensity measure, the Lower Extremity Functional Scale (LEFS), a timed stair test (TST), knee range of motion (ROM), the Patient Specific Functional Scale (PSFS), and the Client Satisfaction Questionnaire (CSQ-8). Using Stata version 12.1, the data were summarized descriptively, and change scores were calculated with 95% CIs. Results : On average, participants were discharged within 11 classes, having achieved their treatment goals. More than 77% exceeded the minimal detectable change at the 90% confidence level (MDC90) on the LEFS, TST, PSFS, and ROM assessments. The mean CSQ-8 score at discharge was 31.8 (SD 1.46); 66.7% recorded a perfect score of 32. Conclusions : Patients attending a short group-based outpatient knee replacement class demonstrated significant improvements in pain and lower extremity function and were highly satisfied with their physiotherapy treatment.
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Affiliation(s)
- Amy V Wainwright
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Deborah M Kennedy
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto; School of Rehabilitation Science, McMaster University, Hamilton, Ont
| | - Paul W Stratford
- School of Rehabilitation Science, McMaster University, Hamilton, Ont
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23
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Schache MB, McClelland JA, Webster KE. Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial. BMC Musculoskelet Disord 2016; 17:259. [PMID: 27295978 PMCID: PMC4906815 DOI: 10.1186/s12891-016-1104-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/27/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis. However, muscle weakness and functional limitations persist despite assistance from post-operative rehabilitation programs that traditionally focus on quadriceps strengthening and range of movement exercises. Hip abductor muscle weakness is evident in knee osteoarthritis and hip muscle strengthening reduces knee pain in this group. Following TKA, people with weak hip abductor strength perform more poorly on measures of physical function. However, very little is known of the effectiveness of including hip abductor strengthening exercises in post-operative rehabilitation. The aim of this trial is to compare the effects of targeted hip abductor strengthening to those of traditional care in a TKA rehabilitation program on muscle strength, patient reported outcomes and functional performance measures. METHODS/DESIGN This protocol describes a single-blinded randomized controlled trial, where 104 participants referred for inpatient rehabilitation following TKA will be recruited. Participants will be randomized using computer-generated numbers to one of two groups: usual care or usual care with additional hip strengthening exercises. Participants will attend physiotherapy daily during their inpatient length of stay, and will then attend between six and eight physiotherapy sessions as an outpatient. Primary outcomes are isometric hip abductor strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes are stair climb test, 6 min walk test, timed up and go, 40 m fast-paced walk test, 30 second chair stand test, isometric quadriceps strength, Lower Extremity Functional Scale (LEFS) and SF-12. Outcome measures will be recorded at baseline (admission to inpatient rehabilitation), and then 3 weeks, 6 weeks and 6 months post admission to rehabilitation. DISCUSSION The findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation. This will then determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty. TRIAL REGISTRATION The trial protocol was registered with the Australian Clinical Trial Registry ( ACTRN12615000863538 ) on 18 August 2015.
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Affiliation(s)
- Margaret B Schache
- School of Allied Health, La Trobe University, Melbourne, Australia. .,Physiotherapy Department, Donvale Rehabilitation Hospital, Ramsay Health Care, 1119 Doncaster Rd, Donvale, Melbourne, 3111, Australia.
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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MacLean KF, Callaghan JP, Maly MR. Effect of obesity on knee joint biomechanics during gait in young adults. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1173778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kathleen F.E. MacLean
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Jack P. Callaghan
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Monica R. Maly
- Department of Rehabilitation Sciences, McMaster University, Room 435 Institutes of Applied Health Sciences, 1400 Main Street West, Hamilton, Ontario, Canada L8S 1C7
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Mahler E, Cuperus N, Bijlsma J, Vliet Vlieland T, van den Hoogen F, den Broeder AA, van den Ende CH. Responsiveness of four patient-reported outcome measures to assess physical function in patients with knee osteoarthritis. Scand J Rheumatol 2016; 45:518-527. [PMID: 27053134 DOI: 10.3109/03009742.2016.1140226] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the responsiveness of four patient-reported outcome measures (PROMs) to measure change in physical function simultaneously in patients with knee osteoarthritis (OA) following currently recommended COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) standards. METHOD Patients with knee OA receiving conservative treatment following a stepped care approach were invited to complete a set of questionnaires at baseline and 3 months. Questionnaires included four widely used measures of physical function: the Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), the Lequesne algofunctional index (LAI), the Lower Extremity Functional Scale (LEFS), and the Western Ontario and McMaster University Osteoarthritis Index Physical Function subscale (WOMAC-PF). Responsiveness of physical function was investigated according to the COSMIN standards by testing 15 a priori defined hypotheses. Responsiveness was considered positive if > 75% of the hypotheses could be confirmed. RESULTS A total of 161 patients participated [61% female, mean (sd) age 59 (9) years and body mass index 29.7 (5.0) kg/m2]. Baseline values of the four PROMs were, mean (sd): KOOS-PS 53.6 (16.8), LAI 11.0 (4.0), LEFS 40.6 (14.1), and WOMAC-PF 51.8 (19.4). We could confirm 12 out of 15 predefined hypotheses (80%) about expected correlations for the WOMAC-PF whereas for the KOOS-PS, LAI, and LEFS < 75% hypotheses could be confirmed (73, 67, and 73%. respectively). CONCLUSIONS Our results suggest that the WOMAC-PF is able to detect changes over time in physical function and therefore should be the measure of first choice in clinical trials evaluating the effectiveness of an intervention on physical function in knee OA patients.
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Affiliation(s)
- Eam Mahler
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - N Cuperus
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - Jwj Bijlsma
- b Department of Rheumatology and Clinical Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Tpm Vliet Vlieland
- c Department of Orthopaedics , University Medical Centre , Leiden , The Netherlands
| | - Fhj van den Hoogen
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - A A den Broeder
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - C H van den Ende
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
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Gardner BT, Dale AM, Buckner-Petty S, Rachford R, Strickland J, Kaskutas V, Evanoff B. Functional Measures Developed for Clinical Populations Identified Impairment Among Active Workers with Upper Extremity Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:84-94. [PMID: 26091980 PMCID: PMC5301801 DOI: 10.1007/s10926-015-9591-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Few studies have explored measures of function across a range of health outcomes in a general working population. Using four upper extremity (UE) case definitions from the scientific literature, we described the performance of functional measures of work, activities of daily living, and overall health. METHODS A sample of 573 workers completed several functional measures: modified recall versions of the QuickDASH, Levine Functional Status Scale (FSS), DASH Work module (DASH-W), and standard SF-8 physical component score. We determined case status based on four UE case definitions: (1) UE symptoms, (2) UE musculoskeletal disorders (MSD), (3) carpal tunnel syndrome (CTS), and (4) work limitations due to UE symptoms. We calculated effect sizes for each case definition to show the magnitude of the differences that were detected between cases and non-cases for each case definition on each functional measure. Sensitivity and specificity analyses showed how well each measure identified functional impairments across the UE case definitions. RESULTS All measures discriminated between cases and non-cases for each case definition with the largest effect sizes for CTS and work limitations, particularly for the modified FSS and DASH-W measures. Specificity was high and sensitivity was low for outcomes of UE symptoms and UE MSD in all measures. Sensitivity was high for CTS and work limitations. CONCLUSIONS Functional measures developed specifically for use in clinical, treatment-seeking populations may identify mild levels of impairment in relatively healthy, active working populations, but measures performed better among workers with CTS or those reporting limitations at work.
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Affiliation(s)
- Bethany T Gardner
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA.
| | - Skye Buckner-Petty
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Robert Rachford
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Jaime Strickland
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Vicki Kaskutas
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA
- Program in Occupational Therapy, Washington University School of Medicine, Campus Box 8505, 4444 Forest Park Avenue, Saint Louis, MO, 63108, USA
| | - Bradley Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA
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Abstract
STUDY DESIGN Systematic review of measurement properties. BACKGROUND Many primary studies have examined the measurement properties, such as reliability, validity, and sensitivity to change, of the Lower Extremity Functional Scale (LEFS) in different clinical populations. A systematic review summarizing these properties for the LEFS may provide an important resource. OBJECTIVE To locate and synthesize evidence on the measurement properties of the LEFS and to discuss the clinical implications of the evidence. METHODS A literature search was conducted in 4 databases (PubMed, MEDLINE, Embase, and CINAHL), using predefined search terms. Two reviewers performed a critical appraisal of the included studies using a standardized assessment form. RESULTS A total of 27 studies were included in the review, of which 18 achieved a very good to excellent methodological quality level. The LEFS scores demonstrated excellent test-retest reliability (intraclass correlation coefficients ranging between 0.85 and 0.99) and demonstrated the expected relationships with measures assessing similar constructs (Pearson correlation coefficient values of greater than 0.7). The responsiveness of the LEFS scores was excellent, as suggested by consistently high effect sizes (greater than 0.8) in patients with different lower extremity conditions. Minimal detectable change at the 90% confidence level (MDC90) for the LEFS scores varied between 8.1 and 15.3 across different reassessment intervals in a wide range of patient populations. The pooled estimate of the MDC90 was 6 points and the minimal clinically important difference was 9 points in patients with lower extremity musculoskeletal conditions, which are indicative of true change and clinically meaningful change, respectively. CONCLUSION The results of this review support the reliability, validity, and responsiveness of the LEFS scores for assessing functional impairment in a wide array of patient groups with lower extremity musculoskeletal conditions.
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Alnahdi AH, Alrashid GI, Alkhaldi HA, Aldali AZ. Cross-cultural adaptation, validity and reliability of the Arabic version of the Lower Extremity Functional Scale. Disabil Rehabil 2015; 38:897-904. [PMID: 26186622 DOI: 10.3109/09638288.2015.1066452] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim was to translate and cross-culturally adapt the Lower Extremity Functional Scale (LEFS) into Arabic language and to examine its measurement properties in patients with musculoskeletal disorders of the lower extremity. METHODS Standard forward and backward translation followed by expert committee review, then preliminary testing was carried out to produce the final Arabic version of LEFS (LEFS-Ar). The test-retest reliability, measurement error, internal consistency and construct validity of the LEFS-Ar were examined in patients with musculoskeletal disorders of the lower extremity (N = 116). RESULTS The LEFS-Ar had excellent test-retest reliability (ICC2,1 = 0.96). LEFS-Ar standard error of measurement was 3.5 points while the minimal detectable change MDC95 was 9.8 points. LEFS-Ar showed excellent internal consistency with Cronbach's alpha of 0.95. Parallel analysis and factor analysis showed that LEFS-Ar measures one underlying factor with all items loading heavily on this single factor. LEFS-Ar showed significant positive correlation with patient's global assessment of function (r = 0.59) and that patients recovering from surgery reported lower LEFS-Ar score compared to patients with no surgery further supporting the construct validity of the LEFS-Ar. CONCLUSION LEFS-Ar has excellent internal consistency, test-retest reliability with relatively small measurement error and is a valid measure of activity limitation due to lower extremity musculoskeletal disorders. All these measurement properties of the LEFS-Ar suggest the clinical usefulness of this measure. IMPLICATIONS FOR REHABILITATION The Arabic Lower Extremity Functional Scale (LEFS-Ar) is a reliable and valid measure of activity limitation due to lower extremity musculoskeletal disorders with relatively small measurement error. LEFS-Ar can be used in daily clinical practice and for research purposes to quantify activity limitation in Arabic-speaking individuals with lower extremity musculoskeletal disorders.
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Affiliation(s)
- Ali H Alnahdi
- a Department of Rehabilitation Sciences , College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia and
| | - Ghada I Alrashid
- b Department of Rehabilitation , King Khalid University Hospital, King Saud University , Riyadh , Saudi Arabia
| | - Hatem A Alkhaldi
- b Department of Rehabilitation , King Khalid University Hospital, King Saud University , Riyadh , Saudi Arabia
| | - Ali Z Aldali
- a Department of Rehabilitation Sciences , College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia and
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Abstract
The International Classification of Functioning Disability and Health (ICF) represents a general framework for concepts of health and disability. The number of patients undergoing Total knee arthroplasty (TKA) is increasing worldwide. Capturing the different health-related ICF domains in this increasing number of patients with TKA requires clinicians and researchers to be familiar with the tools that can be used in daily clinical practice to capture these health-related domains. This paper aimed to review the outcome measures related to the different ICF domains in patients with TKA and to review the psychometric properties of these outcome measures. An electronic search for relevant articles using MEDLINE and CINHAL databases up to March 2014 was performed. In addition to the electronic search, the articles retrieved were searched manually for relevant studies. Impairment-based outcome measures important to patients with TKA included measures of knee pain intensity, knee joint mobility, and muscle performance. Outcome measures capturing activity limitation in patients with TKA included both self-reported and performance-based measures as each capture a different aspect of the activity limitation construct. The disability component of the late life function and disability instrument can be used to quantify participation restriction patients with TKA. Clinicians and researchers are encouraged to measure the different health-related domains in patients with TKA using the outcome measures presented in this review.
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Tambascia RA, Vasconcelos RA, Mello W, Teixeira PP, Grossi DB. Pre-operative Functional Parameters of Patients Undergoing Total Knee Arthroplasty. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 21:77-83. [DOI: 10.1002/pri.1622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/19/2014] [Accepted: 12/13/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Rafael Andrade Tambascia
- Program Performance and Functional Rehabilitation, Faculty of Medicine of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
- Center for Studies and Research; Instituto Wilson Mello; Campinas São Paulo Brazil
| | - Rodrigo Antunes Vasconcelos
- Program Performance and Functional Rehabilitation, Faculty of Medicine of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
- Center for Studies and Research; Instituto Wilson Mello; Campinas São Paulo Brazil
| | - Wilson Mello
- Center for Studies and Research; Instituto Wilson Mello; Campinas São Paulo Brazil
| | | | - Debora Bevilaqua Grossi
- Program Performance and Functional Rehabilitation, Faculty of Medicine of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
- Center for Studies and Research; Instituto Wilson Mello; Campinas São Paulo Brazil
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Gandek B. Measurement properties of the Western Ontario and McMaster Universities Osteoarthritis Index: a systematic review. Arthritis Care Res (Hoboken) 2015; 67:216-29. [PMID: 25048451 DOI: 10.1002/acr.22415] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To conduct a systematic review of the measurement properties of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and to evaluate the quality of WOMAC measurement studies using COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) criteria. METHODS A search was conducted in the MEDLINE, CINAHL, Embase, PsycINFO, Scopus, and SPORTDiscus databases through September 2013. Data that assessed the WOMAC measurement model, reliability, validity, respondent burden, and equivalence across methods of administration were extracted. Overall study quality was rated following COSMIN criteria. RESULTS A total of 76 articles from 22 countries were included. Internal consistency reliability was consistently high (≥0.90) for the function scale and acceptable (≥0.70) for the pain and stiffness scales. Test-retest reliability was acceptable. Score equivalence was demonstrated across paper and electronic methods of data collection. Floor and ceiling effects were low except for notable (24-38%) proportions of patients achieving the best possible scores on the pain and stiffness scales 1-23 years after arthroplasty. Five exploratory factor analyses did not support a measurement model in which the pain and function items were distinct. Correlations between the WOMAC pain and function scales were high (median 0.79). The WOMAC pain and function scales had similar correlations with other pain measures, and therefore the WOMAC pain scale did not show divergent validity. COSMIN criteria were not fully met in most studies. CONCLUSION The WOMAC scales were reliable, but its pain scale was highly related to physical function. Further research into joint-specific pain measures that have broader content validity is needed.
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Logerstedt DS, Zeni J, Snyder-Mackler L. Sex differences in patients with different stages of knee osteoarthritis. Arch Phys Med Rehabil 2014; 95:2376-81. [PMID: 25152171 PMCID: PMC4254053 DOI: 10.1016/j.apmr.2014.07.414] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/25/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To quantify the differences in physical impairments and in performance-based measures and patient-reported outcomes in men and women seeking nonoperative management of symptomatic moderate knee osteoarthritis (OA) and those with symptomatic end-stage knee OA scheduled for total knee arthroplasty compared with healthy controls. DESIGN Cross-sectional analysis of individuals referred to physical therapy, community participants, and subjects from a 2-year longitudinal study. SETTING University research department. PARTICIPANTS Cross-sectional analysis of participants (N=289) consisting of a moderate OA group (n=83), a severe OA group (n=143), and a healthy control group (n=63). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Quadriceps strength, timed Up and Go test, stair-climbing test, 6-minute walk test, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), and Physical Component Summary (PCS) of the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS Women had worse scores than men for physical impairment and performance-based measures (P<.001). In the moderate OA group, women had significantly lower KOS-ADLS (P=.007) and PCS (P=.026) scores than men, with no differences seen between sexes in the other 2 groups for patient-reported measures. CONCLUSIONS Differences between women and men with knee OA on physical impairments and performance-based measures are not echoed in the differences seen in patient-reported measures. These measures signal different domains of knee function in patients with knee OA and should be used as part of a comprehensive functional evaluation.
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Affiliation(s)
| | - Joseph Zeni
- Department of Physical Therapy, University of Delaware, Newark, DE
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Abstract
BACKGROUND The KOOS-PS represents a shortened version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) Function and Sport scales. Previous investigations have not evaluated the KOOS-PS against performance measures or self-report measures composed of items that assess a broad spectrum of ability levels. OBJECTIVE The purpose of this study was to compare the construct validity of the KOOS Function and Sport subscales with a shorter version of the measure (KOOS-PS). METHODS Using a cross-sectional, observational design, consecutive consenting patients diagnosed with knee osteoarthritis were recruited at an assessment center visit to determine need for conservative or surgical management. Participants completed the Lower Extremity Functional Scale (LEFS), KOOS, Timed "Up & Go" Test, and Six-Minute Walk Test. A single function-sport score (KOOS FunSportsum) and the KOOS-PS were abstracted from the KOOS. Pearson correlation coefficients were compared between the reference standards' scores (performance measures and LEFS) and KOOS scores. KOOS-PSraw scores were compared with KOOS-PSRasch scores. RESULTS Three hundred seventy-seven patients with a mean age of 64.4 years (SD=10.5) participated. The correlation between performance reference standard and KOOS-PSRasch scores was significantly lower than with KOOS FunSportsum scores (mean difference in r=.08 [95% confidence interval=.03, .11], z=4.45, P1<.001). A similar finding was observed with the LEFS comparison. LIMITATIONS The study sample did not consist of many patients with mild or severe functional status limitations. CONCLUSIONS For patients with knee osteoarthritis, the KOOS-PS appears too restricted in item content to provide a comprehensive estimate of lower extremity functional status level relative to the KOOS Function and Sport subscales. Pursuit of a computer-adapted test may be a productive direction for future inquiry.
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Naal FD, Impellizzeri FM, Torka S, Wellauer V, Leunig M, von Eisenhart-Rothe R. The German Lower Extremity Functional Scale (LEFS) is reliable, valid and responsive in patients undergoing hip or knee replacement. Qual Life Res 2014; 24:405-10. [PMID: 25108549 DOI: 10.1007/s11136-014-0777-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the measurement properties of a German version of the Lower Extremity Functional Scale (LEFS) in patients with hip or knee osteoarthritis undergoing total joint replacement (TJR). METHODS This prospective cohort study included 486 consecutive patients. The LEFS and other self-reported outcome measures were administered at different time points and several classical measurement properties were determined. RESULTS The German LEFS was highly reliable (ICC 0.98) and internally consistent (CA 0.95). Construct validity was proven by large to very large correlations (r = 0.52-0.91) with all other instruments in the expected directions. Factor analysis using a polychoric correlation matrix revealed two factors at baseline and 6 months explaining about 70% of the total variance. There were no floor or ceiling effects for the total score, but significant floor effects for the single items 16-19 at baseline. The LEFS was highly responsive at 6 months. CONCLUSIONS The German LEFS proved to be a reliable, valid and responsive tool for the self-assessment of patients undergoing total hip or knee replacement. Nevertheless, the questionnaire seems to summarize more than one construct as highlighted by the factor analysis. Further research seems therefore warranted.
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Affiliation(s)
- Florian D Naal
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany,
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Development and validation of the ankle fracture outcome of rehabilitation measure (A-FORM). J Orthop Sports Phys Ther 2014; 44:488-99, B1-2. [PMID: 24853921 DOI: 10.2519/jospt.2014.4980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Delphi panel and cohort study. OBJECTIVE To develop and refine a condition-specific, patient-reported outcome measure, the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), and to examine its psychometric properties, including factor structure, reliability, and validity, by assessing item fit with the Rasch model. BACKGROUND To our knowledge, there is no patient-reported outcome measure specific to ankle fracture with a robust content foundation. METHODS A 2-stage research design was implemented. First, a Delphi panel that included patients and health professionals developed the items and refined the item wording. Second, a cohort study (n = 45) with 2 assessment points was conducted to permit preliminary maximum-likelihood exploratory factor analysis and Rasch analysis. RESULTS The Delphi panel reached consensus on 53 potential items that were carried forward to the cohort phase. From the 2 time points, 81 questionnaires were completed and analyzed; 38 potential items were eliminated on account of greater than 10% missing data, factor loadings, and uniqueness. The 15 unidimensional items retained in the scale demonstrated appropriate person and item reliability after (and before) removal of 1 item (anxious about footwear) that had a higher-than-ideal outfit statistic (1.75). The "anxious about footwear" item was retained in the instrument, but only the 14 items with acceptable infit and outfit statistics (range, 0.5-1.5) were included in the summary score. CONCLUSION This investigation developed and refined the A-FORM (Version 1.0). The A-FORM items demonstrated favorable psychometric properties and are suitable for conversion to a single summary score. Further studies utilizing the A-FORM instrument are warranted. J Orthop Sports Phys Ther 2014;44(7):488-499. Epub 22 May 2014. doi:10.2519/jospt.2014.4980.
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Assessing the patient-specific functional scale's ability to detect early recovery following total knee arthroplasty. Phys Ther 2014; 94:838-44. [PMID: 24557654 DOI: 10.2522/ptj.20130399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Patient-Specific Functional Scale (PSFS) has received considerable attention over the last 2 decades; however, validation studies have not examined its performance in patients after total knee arthroplasty (TKA). OBJECTIVE The purpose of this study was to investigate the ability of the PSFS to detect change in patients post-TKA by comparing PSFS change scores with Lower Extremity Functional Scale (LEFS) and pooled impairment change scores. METHODS One hundred thirty-three patients participating in a post-TKA exercise class were assessed at their initial and discharge visits. Initial assessments occurred within 28 days of arthroplasty; follow-up assessments occurred within 80 days of surgery. At both assessments, participants completed the PSFS, LEFS, and the P4 pain measure, and their knee range of motion (ROM) and extensor strength were measured. The ability to detect change was expressed as the standardized response mean (SRM) and as a correlation between the PSFS change scores and 2 reference standards: (1) LEFS change scores and (2) pooled impairment change scores. The pooled impairment measure consisted of pain, ROM, and strength change scores. RESULTS The SRMs were PSFS 4.60 (95% confidence interval [CI]=4.00, 5.36) for the PSFS and 2.28 (95% CI=2.04, 2.60) for the LEFS. The correlation between the PSFS and pooled impairment change scores was 0.12 (95% CI=-0.04, 0.25), and the correlation between the PSFS and LEFS changes scores was 0.18 (0.02, 0.34). LIMITATIONS The order of measure administration was not standardized, and fixed activity set does not reflect clinical application in many instances. CONCLUSIONS The results suggest that the PSFS is adept at detecting improvement in patients post-TKA but that the PSFS, like other patient-specific measures, is likely to be of limited value in distinguishing different levels of change among patients.
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Cuesta-Vargas AI, Gabel CP, Bennett P. Cross cultural adaptation and validation of a Spanish version of the Lower Limb Functional Index. Health Qual Life Outcomes 2014; 12:75. [PMID: 24885123 PMCID: PMC4038853 DOI: 10.1186/1477-7525-12-75] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/10/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Lower Limb Functional Index (LLFI) is a relatively recently published regional outcome measure. The development article showed the LLFI had robust and valid clinimetric properties with sound psychometric and practical characteristics when compared to the Lower Limb Extremity Scale (LEFS) criterion standard. OBJECTIVE The purpose of this study was cross cultural adaptation and validation of the LLFI Spanish-version (LLFI-Sp) in a Spanish population. METHODS A two stage observational study was conducted. The LLFI was initially cross-culturally adapted to Spanish through double forward and single backward translation; then subsequently validated for the psychometric characteristics of validity, internal consistency, reliability, error score and factor structure. Participants (n = 136) with various lower limb conditions of >12 weeks duration completed the LLFI-Sp, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Euroqol Health Questionnaire 5 Dimensions (EQ-5D-3 L). The full sample was employed to determine internal consistency, concurrent criterion validity, construct validity and factor structure; a subgroup (n = 45) determined reliability at seven days concurrently completing a global rating of change scale. RESULTS The LLFI-Sp demonstrated high but not excessive internal consistency (α = 0.91) and high reliability (ICC = 0.96). The factor structure was one-dimensional which supported the construct validity. Criterion validity with the WOMAC was strong (r = 0.77) and with the EQ-5D-3 L fair and inversely correlated (r = -0.62). The study limitations included the lack of longitudinal data and the determination of responsiveness. CONCLUSIONS The LLFI-Sp supports the findings of the original English version as being a valid lower limb regional outcome measure. It demonstrated similar psychometric properties for internal consistency, validity, reliability, error score and factor structure.
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Affiliation(s)
- Antonio I Cuesta-Vargas
- Departamento de Psiquiatría y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Malaga, Andalucia Tech, Instituto de Biomedicina de Malaga (IBIMA), Grupo de Clinimetria (AE-14), Málaga, Spain
- School of Clinical Science, Faculty of Health at the Queensland University of Technology, Brisbane, Australia
| | - Charles P Gabel
- Centre for Healthy Activities, Sport and Exercise of the Faculty of Science at the University of the Sunshine Coast Queensland, Marochydore, Queensland, Australia
| | - Paul Bennett
- School of Clinical Science, Faculty of Health at the Queensland University of Technology, Brisbane, Australia
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Reliability and validity of the Taiwan Chinese version of the Lower Extremity Functional Scale. J Formos Med Assoc 2014; 113:313-20. [DOI: 10.1016/j.jfma.2012.07.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 07/17/2012] [Accepted: 07/23/2012] [Indexed: 01/20/2023] Open
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Judd DL, Dennis DA, Thomas AC, Wolfe P, Dayton MR, Stevens-Lapsley JE. Muscle strength and functional recovery during the first year after THA. Clin Orthop Relat Res 2014; 472:654-64. [PMID: 23817756 PMCID: PMC3890211 DOI: 10.1007/s11999-013-3136-y] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients undergoing total hip arthroplasty (THA) often are satisfied with the decrease in pain and improvement in function they achieve after surgery. Even so, strength and functional performance deficits persist after recovery, but these remain poorly characterized; knowledge about any ongoing strength or functional deficits may allow therapists to design rehabilitation programs to optimize recovery after THA. QUESTIONS/PURPOSES The purposes of this study were to (1) evaluate postoperative muscle strength, function, and quality of life during the first year after THA; and (2) compare strength and function in patients 1 year after THA with a cohort of healthy peers. METHODS Twenty-six patients undergoing THA were assessed 1, 3, 6, and 12 months postoperatively, and 19 adults with no hip pathology were tested as a control group. Isometric muscle strength (hip flexors, extensors, abductors, knee extensors, and flexors), functional performance (stair climbing, five times sit-to-stand, timed-up-and-go, 6-minute walk, and single-limb stance tests), and self-reported function (Hip Disability and Osteoarthritis Score, SF-36, and UCLA activity score) were compared. RESULTS One month after THA, patients had 15% less hip flexor and extensor torque, 26% less abductor torque, 14% less knee extensor and flexor torque, and worse performance on the stair climbing, timed-up-and-go, single-limb stance, and 6-minute walk. Compared with healthy adults, patients 12 months after THA had 17% less knee extensor and 23% less knee flexor torque; however, the functional testing (including stair climbing, five times sit-to-stand, and the 6-minute walk) showed no significant differences with the patient numbers available between individuals undergoing THA and healthy control subjects. SF-36 Physical Component Scores, although significantly improved from preoperative levels, were significantly worse than healthy adults 1 year after THA (p < 0.01). CONCLUSIONS Patients experience early postoperative strength losses and decreased functional capacity after THA, yet strength deficits may persist after recovery. This may suggest that rehabilitation may be most effective in the first month after surgery.
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Affiliation(s)
- Dana L Judd
- Physical Therapy Program, University of Colorado, Anschutz Medical Campus, 13121 E 17th Avenue, Mail Stop C244, Aurora, CO, 80045, USA,
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Desmeules F, Hall J, Woodhouse LJ. Prehabilitation improves physical function of individuals with severe disability from hip or knee osteoarthritis. Physiother Can 2014; 65:116-24. [PMID: 24403671 DOI: 10.3138/ptc.2011-60] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of prehabilitation (enhancing physical capacity before total hip or knee joint arthroplasty) on pain and physical function of adults with severe hip and knee osteoarthritis (OA). METHODS Consecutive patients (n=650) from 2006 to 2008 with hip or knee OA awaiting total joint arthroplasty (TJA) attended a hospital outpatient clinic for a prehabilitation assessment. All participants completed self-report (Lower Extremity Functional Scale [LEFS] and visual analogue scale for pain [VAS]) and functional performance measures (self-paced walk [SPW], timed stair, and timed up-and-go [TUG] tests). A subset of 28 participants with severe disability participated in a structured outpatient prehabilitation programme. Between-group differences were assessed via independent t-tests; paired Student's t-tests and Wilcoxon signed rank tests were used to compare changes in pain and function following the prehabilitation programme. RESULTS A total of 28 individuals (16 female) with mean age 67 (SD 10) years and BMI 33 (8) kg/m(2) awaiting TJA (10 hips, 18 knees) participated in a prehabilitation programme of 9 (6) weeks' duration. Relative to baseline, there was significant improvement in LEFS score (mean change 7.6; 95% CI, 1.7-13.5; p=0.013), SPW (mean change 0.17 m/s; 95% CI, 0.07-0.26; p=0.001), TUG (mean change 4.2 s; 95% CI, 2.0-6.4; p<0.001), and stair test performance (mean change 3.8 s [SD 14.6]; p=0.005) following prehabilitation. CONCLUSION This study presents preliminary evidence that prehabilitation improves physical function even in the most severely compromised patients with OA awaiting TJA.
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Affiliation(s)
- François Desmeules
- School of Rehabilitation, Faculty of Medicine ; University of Montreal Public Health Research Institute, University of Montreal ; Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal
| | - Jayne Hall
- Hamilton Health Sciences Corporation, Hamilton, Ont
| | - Linda June Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton ; McCaig Institute for Bone and Joint Health, Calgary, Alta
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Abstract
STUDY DESIGN This was a cross-sectional study. OBJECTIVE We sought to test the psychometric properties of the modified lower extremity functional scale (LEFS) for low back pain (LBP). SUMMARY OF BACKGROUND DATA Low back and lower extremities are anatomically and functionally related, and radiating leg pain is common among patients with LBP. The LEFS is a reliable and valid questionnaire for patients with lower extremity conditions caused by musculoskeletal disorders, although its utility in LBP with or without radiating leg pain has not been tested. METHODS We recruited subjects with LBP from physical medicine and rehabilitation outpatient clinics whose age was at least 18 years. The evaluation included demographic data, back pain history, pain intensity by the visual analogue scale, the Roland-Morris Disability Questionnaire, and the modified LEFS, in which "lower limb problem" was substituted with "low back/lower limb problem" in the introductory sentence of the questionnaire. Data from 242 patients were analyzed for the psychometric properties of the modified LEFS, including floor and ceiling effects, internal consistency, test-retest reliability, dimensionality, and construct validity. RESULTS The modified LEFS had no floor or ceiling effects, high internal consistency (Cronbach α: 0.94), and good test-retest reliability (intraclass correlation coefficient[2,1]: 0.86). Principal component analysis identified one major factor that had an eigenvalue of 9.9 and explained 49.6% of the total variance. The correlations between the modified LEFS and Roland-Morris Disability Questionnaire was high (Pearson correlation coefficient: -0.71). The modified LEFS also discriminated well between the subgroups of LBP with unilateral leg pain and those with bilateral leg pain. CONCLUSION The modified LEFS had satisfactory psychometric properties in patients with LBP and could serve as a supplementary outcome measure to assess their activity limitations.
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Wright A, O'Hearn MA. Differential diagnosis and early management of rapidly progressing hip pain in a 59-year-old male. J Man Manip Ther 2013; 20:96-101. [PMID: 23633889 DOI: 10.1179/2042618611y.0000000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Rapidly progressing degeneration of the hip joint is an uncommon condition presenting to physical therapy. Differential diagnosis can often be difficult, as clinical and radiographic findings do not always coincide leaving clinicians with difficult decision making regarding course of treatment. The purpose of this case report was to describe the differential diagnosis and early management of a patient with rapidly progressing hip pain. CLINICAL PRESENTATION A 59-year-old male with a complicated medical history was referred with a diagnosis of severe bilateral hip osteoarthritis. Clinical presentation of insidious onset, severe bilateral groin and anterior thigh pain with rapid progression of functional decline lead to the differential diagnosis of bilateral avascular necrosis. INTERVENTION The patient received seven manual physical therapy sessions over the course of one month. CONCLUSION During this time, the patient's Lower Extremity Functional Scale score worsened from 33 to 21. The persistence of the patient's painful symptoms and continued functional decline helped determine cessation of manual therapy and referral back to his GP for further diagnostic testing and eventual correct diagnosis. This case highlights the importance of monitoring patient prognosis using outcome measures leading to a change in patient management strategies.
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Psychometric properties of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) in patients with musculoskeletal disorders: a replication study with additional findings. Phys Ther 2013; 93:672-80. [PMID: 23392182 DOI: 10.2522/ptj.20120444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is a recently developed self-report outcome instrument designed to measure the extent of activity limitation as defined by the World Health Organization. OBJECTIVE The purposes of the study were to replicate some aspects of the original study of the OPTIMAL Difficulty and Confidence scales and to conduct additional psychometric tests. DESIGN A cross-sectional design was used in the study. METHODS Of a total of 1,150 patients who received treatment at 4 outpatient centers over the study period, 1,030 patients were recruited for this study and completed the OPTIMAL instrument and previously validated region-specific functional status measures. A variety of analytic methods were used to examine the extent of redundancy between the OPTIMAL Difficulty and Confidence scales, as well as the internal consistency reliability, standard error of measurement, known-groups validity, and convergent validity of OPTIMAL Difficulty Scale scores. RESULTS The OPTIMAL Difficulty and Confidence scale scores were found in a factor analysis to be load-based on anatomical region rather than on difficulty and confidence concepts. Internal consistency reliability for the subscales of the Confidence Scale varied and was .80 or higher for the lower-extremity subscale but .50 or less for the trunk and upper-extremity subscales. LIMITATIONS Only cross-sectional relationships were examined, and another pure measure of activity limitation was not used for comparison. CONCLUSIONS The findings generally did not support the psychometric properties of the OPTIMAL instrument. Although not conclusive, the data suggested that the OPTIMAL Difficulty and Confidence scales demonstrate substantial overlap. Reliability was generally low, with the exception of the lower-extremity subscale. Scores for the subscales of the Difficulty Scale differentiated among patients with lower-extremity versus trunk or upper-extremity diagnoses, but associations with previously validated region-specific measures were generally weak or absent. Clinicians treating outpatients with musculoskeletal disorders should consider alternative measures when attempting to quantify the extent of activity limitations.
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Negahban H, Hessam M, Tabatabaei S, Salehi R, Sohani SM, Mehravar M. Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders. Disabil Rehabil 2013; 36:10-5. [DOI: 10.3109/09638288.2013.775361] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Riddle DL, Stratford PW. Body weight changes and corresponding changes in pain and function in persons with symptomatic knee osteoarthritis: a cohort study. Arthritis Care Res (Hoboken) 2013; 65:15-22. [PMID: 22505346 DOI: 10.1002/acr.21692] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 03/26/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine if a dose-response relationship exists between percentage changes in body weight in persons with symptomatic knee osteoarthritis (OA) and self-reported pain and function. METHODS Data from persons in the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis (MOST) study data sets (n = 1,410) with symptomatic function-limiting knee OA were studied. For the OAI, we used baseline and 3-year followup data, while for the MOST study, baseline and 30-month data were used. Key outcome variables were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function and pain change scores. In addition to covariates, the predictor variable of interest was the extent of weight change over the study period divided into 5 categories representing different percentages of body weight change. RESULTS A significant dose-response relationship (P < 0.003) was found between the extent of percentage change in body weight and the extent of change in WOMAC physical function and WOMAC pain scores. For example, persons who gained ≥10% of body weight had WOMAC physical function score changes of -5.4 (95% confidence interval -8.7, -2.00) points, indicating worsening physical function relative to the reference group of persons with weight changes between <5% weight gain and <5% weight reduction. CONCLUSION Our data suggest a dose-response relationship exists between changes in body weight and corresponding changes in pain and function. The threshold for this response gradient appears to be body weight shifts of ≥10%. Weight changes of ≥10% have the potential to lead to important changes in pain and function for patient groups as well as individual patients.
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Affiliation(s)
- Daniel L Riddle
- Departments of Physical Therapy and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA.
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McPhail SM, Dunstan J, Canning J, Haines TP. Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. BMC Musculoskelet Disord 2012; 13:224. [PMID: 23171034 PMCID: PMC3517753 DOI: 10.1186/1471-2474-13-224] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 11/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. METHODS A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. RESULTS Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. CONCLUSIONS The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome measure can be developed.
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Affiliation(s)
- Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Buranda Plaza, Corner Ipswich Road and Cornwall Street Buranda, Brisbane, Australia.
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Hoogeboom TJ, de Bie RA, den Broeder AA, van den Ende CHM. The Dutch Lower Extremity Functional Scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study. BMC Musculoskelet Disord 2012; 13:117. [PMID: 22748143 PMCID: PMC3406936 DOI: 10.1186/1471-2474-13-117] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 07/02/2012] [Indexed: 11/17/2022] Open
Abstract
Background The WOMAC is the most widely used self-report measure to evaluate physical functioning in hip or knee osteoarthritis, however its ability to discriminate pain and physical functioning (i.e. discriminate validity) has repeatedly been questioned. Little to no data is available on the discriminant validity of alternative questionnaires that measure the same construct, for instance the Hip and Knee Osteoarthritis Outcome Score (HOOS and KOOS, respectively) and the Lower Extremity Function Scale (LEFS). Therefore, we translated the LEFS to Dutch and studied its psychometric properties (i.e. validity, reliability and responsiveness). In addition, we assessed the discriminate validity of the LEFS, HOOS and KOOS. Methods After translation with a forward/backward protocol, 401 individuals with hip or knee osteoarthritis completed the LEFS, HOOS/KOOS, SF-36, Hospital Anxiety and Depression Scale and Checklist Individual Strength questionnaires. To assess reliability and responsiveness, a sample of 106 and 108 patients completed a comparable set of questionnaires within 3 weeks and 3 months, respectively. Feasibility, validity, reliability and responsiveness were evaluated. Discriminant validity of the LEFS, HOOS and KOOS was examined by contrasting the scales’ correlations with the physical functioning subscale of the SF-36 with the scales’ correlations with the bodily pain subscale of the SF-36. Results The Dutch version of the LEFS was feasible, had good internal consistency (0.96), good reliability (ICC = 0.86), good construct and discriminant validity, and showed no floor or ceiling effects. The minimal detectable change (MDC90) was ten points. Area under the receiver operating characteristic curve (AUC) analyses revealed good (AUC = 0.76) and fair (AUC = 0.63) responsiveness for the LEFS in improved and worsened patients, respectively. Discriminant validity for pain was apparent for the LEFS (p < 0.01), but not for the HOOS and KOOS (p = 0.21 and p = 0.20, respectively). Conclusions Considering the LEFS’ good psychometric qualities and ability to discriminate between pain and functioning, we recommend the LEFS as the outcome measure of choice to assess self-reported physical functioning in individuals with hip or knee osteoarthritis.
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Affiliation(s)
- Thomas J Hoogeboom
- Department of Rheumatology, Sint Maartenskliniek, PO Box 9011, Nijmegen, 6500 GM, The Netherlands.
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Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports Phys Ther 2012; 42:716-23. [PMID: 22402677 PMCID: PMC3435439 DOI: 10.2519/jospt.2012.4038] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Secondary analysis, pretreatment-posttreatment observational study. OBJECTIVE To compare the reliability and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Outcome Survey activities of daily living subscale (KOS-ADL), and the Lower Extremity Functional Scale (LEFS) in individuals with knee osteoarthritis (OA). BACKGROUND The WOMAC is the current standard in patient-reported measures of function in patients with knee OA. The KOS-ADL and LEFS were designed for potential use in patients with knee OA. If the KOS-ADL and LEFS are to be considered viable alternatives to the WOMAC for measuring patient-reported function in individuals with knee OA, they should have measurement properties comparable to the WOMAC. It would also be important to determine whether either of these instruments may be superior to the WOMAC in terms of reliability or responsiveness in this population. METHODS Data from 168 subjects with knee OA, who participated in a rehabilitation program, were used in the analyses. Reliability and responsiveness of each outcome measure were estimated at follow-ups of 2, 6, and 12 months. Reliability was estimated by calculating the intraclass correlation coefficient (ICC2,1) for subjects who were unchanged in status from baseline at each follow-up time, based on a global rating of change score. To examine responsiveness, the standard error of the measurement, minimal detectable change, minimal clinically important difference, and the Guyatt responsiveness index were calculated for each outcome measure at each follow-up time. RESULTS All 3 outcome measures demonstrated reasonable reliability and responsiveness to change. Reliability and responsiveness tended to decrease somewhat with increasing follow-up time. There were no substantial differences between outcome measures for reliability or any of the 3 measures of responsiveness at any follow-up time. CONCLUSION The results do not indicate that one outcome measure is more reliable or responsive than another when applied to subjects with knee OA. We believe that all 3 instruments are appropriate outcome measures to examine change in functional status of patients with knee OA.
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Abstract
BACKGROUND Existing lower-limb, region-specific, patient-reported outcome measures have clinimetric limitations, including limitations in psychometric characteristics (eg, lack of internal consistency, lack of responsiveness, measurement error) and the lack of reported practical and general characteristics. A new patient-reported outcome measure, the Lower Limb Functional Index (LLFI), was developed to address these limitations. OBJECTIVE The purpose of this study was to overcome recognized deficiencies in existing lower-limb, region-specific, patient-reported outcome measures through: (1) development of a new lower-extremity outcome scale (ie, the LLFI) and (2) evaluation of the clinimetric properties of the LLFI using the Lower Extremity Functional Scale (LEFS) as a criterion measure. DESIGN This was a prospective observational study. METHODS The LLFI was developed in a 3-stage process of: (1) item generation, (2) item reduction with an expert panel, and (3) pilot field testing (n=18) for reliability, responsiveness, and sample size requirements for a larger study. The main study used a convenience sample (n=127) from 10 physical therapy clinics. Participants completed the LLFI and LEFS every 2 weeks for 6 weeks and then every 4 weeks until discharge. Data were used to assess the psychometric, practical, and general characteristics of the LLFI and the LEFS. The characteristics also were evaluated for overall performance using the Measurement of Outcome Measures and Bot clinimetric assessment scales. RESULTS The LLFI and LEFS demonstrated a single-factor structure, comparable reliability (intraclass correlation coefficient [2,1]=.97), scale width, and high criterion validity (Pearson r=.88, with 95% confidence interval [CI]). Clinimetric performance was higher for the LLFI compared with the LEFS on the Measurement of Outcome Measures scale (96% and 95%, respectively) and the Bot scale (100% and 83%, respectively). The LLFI, compared with the LEFS, had improved responsiveness (standardized response mean=1.75 and 1.64, respectively), minimal detectable change with 90% CI (6.6% and 8.1%, respectively), and internal consistency (α=.91 and .95, respectively), as well as readability with reduced user error and completion and scoring times. LIMITATIONS Limitations of the study were that only participants recruited from outpatient physical therapy clinics were included and that no specific conditions or diagnostic subgroups were investigated. CONCLUSION The LLFI demonstrated sound clinimetric properties. There was lower response error, efficient completion and scoring, and improved responsiveness and overall performance compared with the LEFS. The LLFI is suitable for assessment of lower-limb function.
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