Assessing functional recovery shortly after knee or hip arthroplasty: a comparison of the clinimetric properties of four tools

Abstract

BackgroundFollowing hip or knee arthroplasty, it is clinically warranted to get patients functional as quickly as possible. However, valid tools to assess function shortly after knee or hip arthroplasty are lacking. The objective was to compare the clinimetric properties of four instruments to assess function shortly after arthroplasty.MethodsOne hundred eight patients undergoing hip or knee arthroplasty were assessed preoperatively, 1 and 2 days postoperatively, and 2 and 6 weeks postoperatively with the Timed Up and Go (TUG), Iowa Level of Assistance Scale (ILAS), Postoperative Quality of Recovery Scale (PQRS), and Readiness for Hospital Discharge Scale (RHDS). Descriptive data, floor and ceiling effects, responsiveness, interpretation and construct validity were determined.ResultsOnly the ILAS and RHDS support subscale demonstrated floor or ceiling effects. A large deterioration from preoperative to postoperative, followed by large improvements after surgery were seen in the TUG and ILAS scores. The RHDS personal status subscale and the PQRS pain and function dimensions demonstrated large improvements after surgery. Changes in the RHDS global scale and personal status subscale, PQRS pain dimension and TUG were significantly related to patient perceived improvement. Minimal important changes were obtained for the RHDS global (1.1/10) and personal status subscale (2.3/10), and the TUG (43.4 s at 6 weeks). For construct validity, the PQRS function dimension and RHDS were moderately related to the TUG or ILAS. The correlation between TUG and ILAS was high from preoperative to postoperative day 2, but substantially decreased at 2 and 6 weeks.ConclusionsThe TUG and RHDS personal status subscale demonstrated the best clinimetric properties to assess function in the first 6 weeks after hip or knee arthroplasty.

Physical Therapist Management of Total Knee Arthroplasty

“…The TUG test has been shown to be moderately correlated with the functional dimension of the Postoperative Quality of Recovery Scale and the Readiness for Hospital Discharge Scale and highly correlated with the Iowa Level of Assistance Scale. 128 These findings provide some evidence of the TUG test’s validity for use in patients with TKA. The new short knee PROM, the KOOS JR, provides a single score representing “knee health” as it combines pain, symptoms, and functional limitations in a single score.…”

Prognostic factors for inpatient functional recovery following total hip and knee arthroplasty: a systematic review

“…Low to moderate correlations are reported between PROMs and performance measures in the early postoperative period following THA and TKA (Mizner et al 2011, Poitras et al 2016. PROMs are subjective and may be influenced by many factors (Poitras et al 2016), including perceived level of exertion (Mizner at al.…”

“…Low to moderate correlations are reported between PROMs and performance measures in the early postoperative period following THA and TKA (Mizner et al 2011, Poitras et al 2016. PROMs are subjective and may be influenced by many factors (Poitras et al 2016), including perceived level of exertion (Mizner at al. 2011), anxiety, and expectations regarding recovery (Salmon et al 2001b); therefore performance-based measures are necessary to objectively assess actual patient function (Mizner et al 2011).…”

Patient and surgical prognostic factors for inpatient functional recovery following THA and TKA: a prospective cohort study

“…However, a 30-point version of the mILAS has recently been described and validated by Elings et al [55] which may be of greater clinical relevance as it only assesses functional tasks. Implementation of a valid, standardised performance measure, such as this newer version of the mILAS, would assist in objective assessment of post-operative functional recovery, identification of patients at risk of prolonged LOS, and evaluation of ERP interventions [54], and also facilitate the benchmarking of patient-centred outcomes between organisations.…”

“…Validated tools for assessing short-term post-operative function following lower limb arthroplasty are lacking [ 11 , 54 ]. In the absence of a gold standard for evaluating functional recovery in acute hospital inpatients, the mILAS [ 11 ] was used in this study.…”