Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty

Kennedy, Deborah; Stratford, Paul W.; Wessel, Jean; Gollish, Jeffrey; Penney, Dianne

doi:10.1186/1471-2474-6-3

Cited by 450 publications

(476 citation statements)

References 30 publications

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“…(257) There are, however, data on normal scores and scores associated with adverse outcomes as falls. In a healthy population a normal score is less than 10 seconds, while spending more time than 16 seconds is associated with increased risk of falling.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

et al. 2015

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Bakgrunn: Hoftebrudd er en viktig årsak til sykdom og død med 1.3 millioner brudd årlig i verden og en fortsatt stigende insidens. Risikofaktorer er høy alder, osteoporose og skrøpelighet, og de fleste bruddene skyldes lav energitraumer på grunn av fall. Høy alder, nedsatt funksjon før bruddet og mannlig kjønn øker risiko for et uheldig resultat, mens fall utendørs er prognostisk gunstig.Utvikling av såkalt ortogeriatriske behandlingsmodeller for hoftebrudd som bruker teknikker og prinsipper utviklet i geriatrien er en måte å bedre prognosen for pasientene. Det er utviklet flere modeller:1. Konsultasjonsmodeller der pasienten på vanlig måte behandles i en ortopedisk avdeling, men får tilsyn og vurdering av geriater eller et geriatrisk team under oppholdet, og der teamet deretter foreslår tiltak til ortoped. 2. Modeller med felles ansvar der geriater og ortoped inngår i et team som utreder og behandler pasienten og legger en felles plan for videre oppfølging. 3. Geriatrisk team modeller der utredning og behandling (med unntak av selve kirurgien)foregår i en geriatrisk avdeling tilpasset bruddbehandling, og der ortopeder ansvarlig for operasjon, men ellers kun konsulteres ved behov. Målsetninger for studien: Overordnet mål for studien var å undersøke om bred geriatrisk utredning og behandling (CGC) ga en tilleggsgevinst sammenlignet med tradisjonell ortopedisk behandling (OC).Målsetninger for denne avhandlingen er:1. Å beskrive bakgrunn, utvikling og prinsippene bak de orthogeriatriske modellen og hvordan den skiller seg fra vanlig behandling (Artikkel I). 2. Å presentere kliniske resultat (Artikkel II): a. Mobilitet fire måneder etter bruddet (primaert endepunkt) b. Sekundaere endepunkt: i. Mobilitet etter en og 12 måneder, og p-i-ADL, kognisjon, frykt for å falle, stemningsleie og livskvalitet en, fire og 12 måneder etter bruddet, ii. Bruk av helsetjenester første året etter bruddet 3. Finne ut om effekten på mobilitet, p-og-i-ADL og kognisjon var avhengig av alder, kjønn, bruddtype og funksjon før bruddet (Artikkel III).Metode: Hoftebruddsstudien i Trondheim er en randomisert kontrollert studie basert på ortogeriatrimodell 3 ovenfor. Studien sammenligner standard ortopedisk behandling (OC) med ortogeriatrisk behandling i en egen enhet (CGC). Hjemmeboende pasienter 70 år eller eldre som klarer å gå minst 10m og som har et lavenergibrudd kunne inkluderes, mens pasienter fra sykehjem, høy-energi brudd, patologisk fraktur eller annen sykdom med forventede leveutsikter på mindre enn 3 måneder ble ekskludert. Behandlingen er basert på bred geriatrisk utredning (CGA) og gjennomføres av et tverrfaglig team bestående av geriater (overlege eller lege i spesialisering), sykepleier, fysioterapeut og ergoterapeut; teamet har regelmessige møter der det lages individuelle behandlingsplaner og settes mål for opphold og klargjør videre behov etter utreise samt behandlingsmål. Behandlingen er helhetlig og fokuserer på tidlig mobilisering, gjennomgang av den enkelte pasient med tanke på bakenforliggende sykdom, medisingjennomgang...

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Section: Discussionmentioning

confidence: 99%

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

et al. 2015

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“…We instructed patients to cover as much distance as they could in 6 minutes and we gave them verbal cues on time elapsed at 2, 4, and 5 minutes. The 6 MW test [3] is a reliable measure in healthy, older adult populations (r = 0.95) [8] and considered one of the most responsive measures of function after TKA [13].…”

Section: Methodsmentioning

confidence: 99%

The Chitranjan Ranawat Award: The Nonoperated Knee Predicts Function 3 Years after Unilateral Total Knee Arthroplasty

Farquhar

Snyder‐Mackler

2010

Clinical Orthopaedics &Amp; Related Research

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The long-term functional abilities of patients after a unilateral total knee arthroplasty (TKA) are influenced by the status of the nonoperated knee at the time of the TKA. We hypothesized that in the 3 years after TKA, the nonoperated limb would become more painful, and the quadriceps muscles would weaken; pain and strength would influence performance on functional testing by 3 years after TKA. Healthy control subjects were tested over the same time interval; we hypothesized the controls would also decline in strength and function over time. Individuals with unilateral knee pain (less than 4/10 on a verbal analog scale) were recruited preoperatively. We tested patients 1, 2, and 3 years after TKA to determine changes in strength, self-report outcome measures, and performance on a stair climbing test and the 6-minute walk test. Control subjects without osteoarthritis were tested twice, 2 years apart. The nonoperated limb of patients with TKA weakened from 1 to 2 years, and further weakened from 2 to 3 years after TKA; by 3 years after TKA, the nonoperated limb was more painful compared to the operated limb. Three years after TKA, nonoperated knee pain contributed 44% of the variability in the 6-minute walk and 33% of the variability in the stair climbing test. Patients with TKA were weaker, slower, and had lower self-report outcome measures compared with control subjects at both time intervals. Control subjects also weakened over time, yet were stable on self-report outcome measures and the 6 minute walk test. Weakening of the quadriceps muscles in all participants represents changes due to ageing; however on average the nonoperated limb weakened over time, possibly representing not only changes resulting from aging, but progression of osteoarthrosis in some patients with unilateral TKA.

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“…14,29 Based on previous results, 9 it was recognized that physical performance measures could determine whether functional change had occurred following our physiotherapy program. A baseline examination was performed for all patients, and physical performance measures were repeated after the treatment period (at approximately 9 weeks).…”

Section: Responsivenessmentioning

confidence: 99%

“…While reliability and validity of some commonly used physical performance measures have been investigated in an OA population, most require further research regarding clinical utility and responsiveness. 14 Physical performance measures have often been criticized, as detailed testing of their measurement properties has not been extensively reported. 14,22,33 Measures of responsiveness have commonly been reported as statistically significant change scores, which are useful in establishing the threshold of change needed beyond measurement error.…”

mentioning

confidence: 99%

“…14 Physical performance measures have often been criticized, as detailed testing of their measurement properties has not been extensively reported. 14,22,33 Measures of responsiveness have commonly been reported as statistically significant change scores, which are useful in establishing the threshold of change needed beyond measurement error. 10 Investigation of minimal clinically important differences (MCIDs) of physical performance measures is warranted, as these have become commonly used outcome measures in the treatment of OA.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A Comparison of 3 Methodological Approaches to Defining Major Clinically Important Improvement of 4 Performance Measures in Patients With Hip Osteoarthritis

Wright¹,

Cook²,

Baxter³

et al. 2011

Journal of Orthopaedic & Sports Physical Therapy

324

246

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For rehabilitation professionals engaged in the treatment of osteoarthritis (OA), it is standard practice to perform objective assessments of physical function (using both physical performance and self-report measures) to obtain a picture of patient status. These assessments also serve as a baseline value for estimating changes (treatment effects) over time. While reliability and validity of some commonly used physical performance measures have been investigated in an OA population, most require further research regarding clinical utility and responsiveness. 14 Physical performance measures have often been criticized, as detailed testing of their measurement properties has not been extensively reported. 14,22,33 Measures of responsiveness have commonly been reported as statistically significant change scores, which are useful in establishing the threshold of change needed beyond measurement error. 10 Investigation of minimal clinically important differences (MCIDs) of physical performance measures is warranted, as these have become commonly used outcome measures in the treatment of OA. 8,12,17,[35][36][37] At present, the responsiveness (in terms of MCID) of the timed up-and-go (TUG) test, 40-meter self-paced walk test (40-m SPWT), 30-second chair stand (30 CST), and 20-cm step test has not been investigated in T T STUDY DESIGN: Prospective cohort study. T T OBJECTIVES:To establish the major clinically important improvement (MCII) of the timed upand-go test (TUG), 40-meter self-paced walk test (40-m SPWT), 30-second chair stand (30 CST), and a 20-cm step test in patients with hip osteoarthritis (OA) undergoing physiotherapy treatment. As a secondary aim, a comparison of methods was employed to evaluate the effect of method on the reported MCII. T T BACKGROUND: Minimal clinically importantdifference scores are commonly used by rehabilitation professionals to determine patient response following treatment. A gold standard for calculating MCII has yet to be determined, which has resulted in problems of interpretation due to varied results. T T METHODS:As part of a randomized controlled trial, 65 patients were randomized into a physiotherapy treatment group for hip OA, in which they completed 4 physical performance measures at baseline and 9 weeks. Upon completion of physiotherapy, patients assessed their response to treatment on a 15-point global rating of change scale (GRCS). MCII was estimated using 3 variations of an anchor-based method, based on the patient's opinion. T T RESULTS:A comparison of 3 methods resulted in the following change scores being best associated with our definition of MCII: a reduction equal to or greater than 0.8, 1.4, and 1.2 seconds for the TUG; an increase equal to or greater than 0.2, 0.3, and 0.2 m/s for the 40-m SPWT; an increase equal to or greater than 2.0, 2.6, and 2.1 repetitions for the 30 CST; an increase equal to or greater than 5.0, 12.8, and 16.4 steps for the 20-cm step test. T T CONCLUSION:The variation in methods provided very different results. This illustrates the impor...

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Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty

Cited by 450 publications

References 30 publications

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

The Chitranjan Ranawat Award: The Nonoperated Knee Predicts Function 3 Years after Unilateral Total Knee Arthroplasty

A Comparison of 3 Methodological Approaches to Defining Major Clinically Important Improvement of 4 Performance Measures in Patients With Hip Osteoarthritis

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