Reliability, validity, and minimal detectable change of the Step Test in patients with total knee arthroplasty

ABSTRACT Objectives To clarify the longitudinal changes in patients with preoperative Stage-3 locomotive syndrome (LS) according to different types of surgeries, we investigated the changes in the LS stage in patients who underwent surgery for degenerative musculoskeletal diseases. Methods A prospective cohort study was conducted on 168 patients with degenerative diseases [46 spinal deformities treated with thoracolumbar interbody fusion (T/LIF), 86 hips with osteoarthritis treated with total hip arthroplasty (THA), and 36 knees with osteoarthritis treated with total knee arthroplasty (TKA)]. The results for the LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25) were evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively. Results Preoperatively, most patients had Stage-3 LS (89.1, 90.8, and 80.6% in the T/LIF, THA, and TKA groups, respectively). At 2 years postoperatively, the Stage-3 LS improved in 41.5, 75.6, and 55.2% of patients in the T/LIF, THA, and TKA groups, respectively. All groups showed similar improvements in the two-step test. The THA group showed the best result in the GLFS-25. Conclusions LS stage improved in different patterns over 2 years postoperatively and the LS risk test revealed differences in postoperative movement ability according to the type of surgery.

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AB1284-HPR RELIABILITY OF STEP TEST IN SUBJECTS WITH TOTAL KNEE ARTHROPLASTY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4853 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1932.1-1933

Author(s):

M. Eymir ◽

E. Yuksel ◽

B. Unver ◽

K. Sevik ◽

V. Karatosun

Keyword(s):

Total Knee Arthroplasty ◽

Motor Control ◽

Lower Extremity ◽

Knee Arthroplasty ◽

Lower Limb ◽

Standing Balance ◽

Step Test ◽

Retest Reliability ◽

Total Knee ◽

Test Retest Reliability

Background:Patients with TKA show impairments in standing balance up to 1 year after surgery. The impaired standing balance in TKA patients was found to be associated with falls risk and decreased functional level. Assessing of standing balance with objective and reliable assessments tools would therefore be extremely useful for determining accurate exercise program, and risks of falling, especially during the rehabilitative period when ambulation is at its most unsteady (1, 2). The stepping maneuver requires adequate strength and motor control to stabilize the body over the stance limb while the other leg is stepping, therefore the Step Test (ST) provides significant information for dynamic standing balance and lower limb motor control (3). The reliability of ST is reported in patient groups such as stroke, however, there is not any study that investigates the reliability of ST in patients with TKA in the current literature.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the ST in patients with TKA.Methods:40 patients with TKA due to knee osteoarthritis, operated by the same surgeon, were included in this study. Patients performed trials for ST twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The ST assesses an individual’s ability to place one foot onto a 7.5-cm-high step and then back down to the floor repeatedly as fast as possible for 15 seconds. The score is the number of steps completed in the 15-second period for each lower extremity. Scores for each lower extremity were recorded separately. Prior to the testing, the ST was demonstrated by the tester and all participants were allowed to a practice trial.Results:The ST showed an excellent test-retest reliability (ICC2,1=0.95) in this study. Standard error of measurement (SEM) and MDC95for ST were 0.37 and 1.02, respectively.Conclusion:This study found that the ST has an excellent test–retest reliability in patients with TKA. It is an effective and reliable tool for measuring dynamic standing balance and participant falls. As a performance-based clinical test, the ST is easy to score, can be applied in a short time as part of the routine medical examination. Therefore, inclusion of ST into a more comprehensive battery of performance-based measures of standing balance and lower limb motor control function in subjects with TKA should be considered.References:[1]Si, H. B., Zeng, Y., Zhong, J., et al. (2017). The effect of primary total knee arthroplasty on the incidence of falls and balance-related functions in patients with osteoarthritis. Scientific reports, 7(1), 1-9.[2]Moutzouri, M., Gleeson, N., Billis, E., et al. (2017). The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 25(11), 3439-3451.[3]Hill, K. D., Bernhardt, J., McGann, A. M., et al. (1996). A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiotherapy Canada, 48(4), 257-262.Disclosure of Interests:None declared

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Effects of Muscle Strengthening around the Hip on Pain, Physical Function, and Gait in Elderly Patients with Total Knee Arthroplasty: A Randomized Controlled Trial

Healthcare ◽

10.3390/healthcare8040489 ◽

2020 ◽

Vol 8 (4) ◽

pp. 489

Author(s):

KwangSun Do ◽

JongEun Yim

Keyword(s):

Total Knee Arthroplasty ◽

Physical Function ◽

Knee Arthroplasty ◽

Exercise Program ◽

Step Test ◽

Muscle Strengthening ◽

Strengthening Exercise ◽

Single Leg Stance ◽

Total Knee ◽

And Control

Background: Functional limitations may still remain even after a patient completes a traditional quadriceps-based rehabilitative program after total knee arthroplasty. Based on studies reporting that patients with knee osteoarthritis have muscle weakness around the hip joint after total knee arthroplasty, we investigated whether strengthening the hip muscles can reduce pain and improve the physical function and gait of patients who underwent total knee arthroplasty. Methods: Patients were randomly divided into three groups: hip, quadriceps, and control. The hip group (n = 19) completed an extensor, adductor, and external muscle strengthening exercise program. The quadriceps group (n = 20) completed a quadriceps strengthening exercise program. The control group (n = 16) completed an active range of motion exercises. Therapy was conducted thrice weekly for 12 weeks. Pain and function items from the Western Ontario and McMaster Universities Osteoarthritis Index, Alternate Step Test, Five Times Sit to Stand Test, and Single Leg Stance Test were performed to assess pain and physical function. In the gait analysis, stride, single-stance (%), double-stance (%), and gait speed were measured. Data were collected at baseline and at 4, 8, and 12 weeks after the intervention. Results: The hip group showed more significant improvements in pain and performance on the Alternate Step Test and Single Leg Stance Test than the quadriceps and control groups. In the gait analysis, the hip group showed the largest improvements in single stance and double stance. Conclusions: In conclusion, a 12-week hip muscle strengthening exercise program effectively improves the physical function and gait of patients who have undergone total knee arthroplasty.

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Total Knee Arthroplasty Improves Locomotive Syndrome in Patients with Knee Disease: A Prospective Cohort Study Focused on Total Clinical Decision Limits Stage 3

10.21203/rs.3.rs-136953/v1 ◽

2021 ◽

Author(s):

Shigeaki Miyazaki ◽

Saori Yoshinaga ◽

Kurumi Tsuruta ◽

Amy Hombu ◽

Yoshinori Fujii ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Motor Function ◽

Knee Arthroplasty ◽

Prospective Cohort ◽

Clinical Decision ◽

Step Test ◽

Locomotive Syndrome ◽

Improvement Rate ◽

Total Knee

Abstract Background:In 2020, the Japanese Orthopaedic Association added a new clinical decision limit (CDL), stage 3, to evaluate the stages of locomotive syndrome (LS). However, so far there has been no study of total knee arthroplasty (TKA) to examine the efficacy of LS treatment and there are no motor function indicators to predict LS improvement, focusing on stage 3. The purpose of this study is to investigate the treatment efficacy of TKA on LS focusing on total CDL stage 3 leading to revealing the motor function indicators that can predict LS improvement in patients who had received TKA.Methods:This prospective cohort study was conducted with 59 patients among 70 patients who underwent TKA, with total CDL stage 3 before TKA evaluation. LS was evaluated using stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. In addition, the motor function indicators which could predict the LS improvement were examined. All assessments were conducted before TKA and three months after TKA.Results:Of the 59 subjects who were evaluated to be in total CDL stage 3 before TKA, 17 patients (28.8%) were determined to show improvements in total CDL. From the result of the decision tree analysis, when the CDL of the two-step test before TKA was 1 or less, the improvement rate was 77.8%. Even if the CDL of the two-step test before TKA was higher than 2 and if the 3m-Timed Up & Go test (3m-TUG) before TKA was 9.15 or less, the improvement rate was 60%.Conclusions:As of three months after surgery, TKA can improve LS in about 30% of patients. A two-step test before TKA and 3m-TUG before TKA can be used as motor function indicators to predict LS improvement. This study provides useful information for setting the goal for rehabilitation prior to surgery.

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Single-Step Test for Unilateral Limb Ability Following Total Knee Arthroplasty

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2013.4372 ◽

2013 ◽

Vol 43 (2) ◽

pp. 66-73 ◽

Cited By ~ 6

Author(s):

Adam Rubin Marmon ◽

Jodie A. McClelland ◽

Jennifer Stevens-Lapsley ◽

Lynn Snyder-Mackler

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Single Step ◽

Step Test ◽

Total Knee

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AB0883 RELIABILITY OF THE MODIFIED FOUR SQUARE STEP TEST IN PATIENTS WITH REVISION TOTAL KNEE ARTHROPLASTY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5494 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1746.3-1747

Author(s):

B. Unver ◽

K. Sevik ◽

V. Karatosun

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Fall Risk ◽

Dynamic Balance ◽

Primary Total Knee Arthroplasty ◽

Step Test ◽

Retest Reliability ◽

Total Knee ◽

Four Square ◽

Test Retest Reliability

Background:Patients with total knee arthroplasty (TKA) often experience pain and reduced balance control, which may predispose them to greater fall risk. The patients with revision total knee arthrooplasty (rTKA), have more pain, stiffness and physical dysfunction and less postoperative improvement compared to the patients with TKA [1]. Falls in people with gait or balance disorders have significant consequences. Fear of falling can also predispose people to inactivity, which can lead to problems of debilitation, increased handicap, and disability by itself. Most of the falls take place in the course of movement, and the trips and slips were determined as the most common cause of elderly falls. Trips are responsible of falls between 40% to 60% and slips between 10% to 15%, showing that the capability to take a quick step would prevent many falls [2]. Literature has found stepping speed to the different directions declines with aging and are lesser for fallers than for nonfallers [3].Modified four square step test (mFSST) was developed to assessing fall risk and dynamic balance by scoring time while participants stepping in multiple directions but its reliability has not been investigated in patients undergoing rTKA.Objectives:The aims of this study were to determine the test-retest reliability and the minimal clinically important change (MCID) of the mFSST in patients with rTKAMethods:mFSST administered on 22 patients undergoing rTKA. mFSST is performed by using tapes to make one horizontal and one vertical line like a cross to create 4 quadrants. Patients’ performances were timed as patients were successfully stepping clockwise and counter-clockwise while avoid touching on tapes, turning their body or losing balance. Two trials performed and patients rested between trials and were encouraged to rest as often as they required to prevent fatigue.Results:ICC(2.1)for mFSST was 0.83. The standard error of measurement and MCID were 0.67 and 1.85 respectively (95 %. confidence level).Conclusion:The mFSST has a good test-retest reliability in patients with rTKA. It is a reliable and responsive tool for measuring fall risk, dynamic balance and mobility. The mFSST is an excellent measure of gait variability, stepping in multipl directions and dynamic balance, also can easily identify real clinically important changes in patients with rTKA in simple environments and minimal equipment.References:[1]Järvenpää J, Kettunen J, Miettinen H, Kröger H. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. International Orthopaedics 2010; 34: 649-653.[2]Cumming RG, Klineberg RJ. Fall frequency and characteristics and the risk of hip fractures. Journal of the American Geriatrics Society 1994; 42: 774-778.[3]Medell JL, Alexander NB. A clinical measure of maximal and rapid stepping in older women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2000; 55: M429-M433.Disclosure of Interests:None declared

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Total Knee Arthroplasty Improved Locomotive Syndrome in Knee Osteoarthritis Patients: A Prospective Cohort Study Focused on Total Clinical Decision Limits Stage 3

BioMed Research International ◽

10.1155/2021/3919989 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Shigeaki Miyazaki ◽

Saori Yoshinaga ◽

Kurumi Tsuruta ◽

Amy Hombu ◽

Yoshinori Fujii ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Knee Osteoarthritis ◽

Motor Function ◽

Knee Arthroplasty ◽

Clinical Decision ◽

Step Test ◽

Locomotive Syndrome ◽

Improvement Rate ◽

Total Knee

Purpose. The purpose of this study is to investigate the treatment efficacy of total knee arthroplasty (TKA) on locomotive syndrome (LS) focusing on total clinical decision limit (CDL) stage 3 leading to revealing the motor function indicators that can predict LS improvement in knee osteoarthritis patients who had received TKA. Methods. This prospective cohort study was conducted in 47 patients evaluated as total CDL stage 3 before TKA who received primary TKA on the operated side and were diagnosed with Kellgren-Lawrence grade 2, 3, or 4 knee osteoarthritis on the nonoperated side. LS was evaluated using stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. In addition, the motor function indicators which could predict the LS improvement were examined. All assessments were conducted before TKA and three months after TKA. Results. Of the 47 subjects who were evaluated to be in total CDL stage 3 before TKA, 13 patients (27.7%) were determined to show improvements in total CDL. From the result of the decision tree analysis, when the CDL of the two-step test before TKA was 1 or less, the improvement rate was 83.3%. Even if the CDL of the two-step test before TKA was higher than 1 and if the 3 m-Timed Up and Go test (3m-TUG) before TKA was 9.6 or less, the improvement rate was 50%. Conclusions. As of three months after surgery, TKA can improve LS in about 30% of knee osteoarthritis patients. A two-step test before TKA and 3m-TUG before TKA can be used as motor function indicators to predict LS improvement. This study provides useful information for setting the goal for rehabilitation prior to surgery.

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Efficacy of Total Knee Arthroplasty in Elderly Patients With Locomotive Syndrome: a Prospective Longitudinal Study

10.21203/rs.3.rs-841197/v1 ◽

2021 ◽

Author(s):

Toru Ogata ◽

Keiko Yamada ◽

Hiromasa Miura ◽

Kazunori Hino ◽

Tatsuhiko Kutsuna ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

The Elderly ◽

Step Test ◽

Locomotive Syndrome ◽

Total Knee ◽

Prospective Longitudinal ◽

The Impact ◽

Three Components

Abstract Background: To preserve the ability to perform physical activities among the elderly, the concept of locomotive syndrome and its evaluation method, the locomotive syndrome risk test, have been applied in an integrated manner to capture the decline in mobility resulting from musculoskeletal disorders. During treatment, physicians can use the locomotive syndrome risk test to evaluate the impact of each therapy such as total knee arthroplasty for knee osteoarthritis, a common disorder found in locomotive syndrome. The purpose of this study was to evaluate the impact of total knee arthroplasty in the elderly with respect to locomotive syndrome.Methods: A total of 111 patients were registered at six hospitals prior to total knee arthroplasty and postoperatively followed up for 1 year. Three components of the locomotive syndrome risk test (the two-step test, stand-up test, and geriatric locomotive function scale-25) were assessed together with the EuroQol-5 Dimension scores pre- and postoperatively.Results: Post surgery, all three components of the locomotive syndrome　risk test as well as the EuroQol-5 Dimension utility score showed significant improvements from the baseline (two-step test, 1.01±0.25 to 1.12±0.21; stand-up test, 2.02±1.14 to 2.38±1.20; geriatric locomotive function scale-25, 38.3±15.8 to 18.7±16.6, mean ± standard deviation). The ratio of stage 3 locomotive syndrome patients (progressed stage of decrease in mobility, restricting social engagement) reduced from 82.3% to 33.9% postoperatively. There was no significant difference in the degree of change in the three test scores between the younger (60-74 years) and older (≥75 years) age groups. Conclusions: We found that total knee arthroplasty has a major impact in preventing the progression of locomotive syndrome in patients with knee osteoarthritis. The locomotive syndrome risk test is a feasible tool for longitudinal evaluation of patients with musculoskeletal diseases of varying severity and with multiple symptoms.Trial registration: This study was registered as UMIN000023595 (10/08/2016)

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