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

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

scholarly journals AB0882 RELIABILITY OF THE 3-M BACKWARDS WALK TEST IN PATIENTS WITH REVISION TOTAL KNEE ARTHROPLASTY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1746.2-1746
Author(s):  
B. Unver ◽  
K. Sevik ◽  
V. Karatosun
Keyword(s):  
Total Knee Arthroplasty ◽  
Diagnostic Accuracy ◽  
Knee Arthroplasty ◽  
Fall Risk ◽  
Dynamic Balance ◽  
Fracture Dislocation ◽  
Walk Test ◽  
Retest Reliability ◽  
Total Knee ◽  
Test Retest Reliability

Background:Total knee arthroplasty (TKA) is an effective treatment for patients suffering from end-stage osteoarthritis with 10- to 15-year implant survivorship rates exceeding 90%. Infection, osteolysis due to polyethylene wear, loosening, stiffness and instability may cause to implant failure and revision of the TKA (rTKA). However, up to 20% of patients continue to have postoperative pain, functional limitations and low treatment satisfaction and 24% of patients were not able to walk unaided with no limp or a slight limp after TKA [1].Falls and related traumas can produce “fracture, dislocation, crushing, and other injuries” [2]. Falls often occur due to impaired physical function which includes changes in lower knee joint angle, weakened lower limb muscles, peripheral nerve blockade, deformity of the foot limited balance and gait.Several measures of fall risk have been previously developed however, recent research has demonstrated that backwards walking is more sensitive at identifying changes in mobility and balance compared to forward walking. Backwards walking is necessary to perform such tasks as backing up to a chair, opening up a door or getting out of the way of a sudden obstacle.3-M Backwards Walk Test (3MBWT) is used to evaluate walking skills, fall risk and dynamic balance. The 3MBWT demonstrated similar or better diagnostic accuracy for falls in the past year than the most commonly used measures and found to be reliable in healthy subjects. [3] However, its reliability in rTKA has not been investigated.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal clinically important difference (MCID) of the 3MBWT in patients with rTKAMethods:Twenty-two patients with rTKA, operated on by the same surgeon, were included. For the 3MBWT, a distance of 3 meters was marked with tape and participants were asked to align their heels with the black tape. They were instructed to walk backwards as quickly. Patients performed trials for 3MBWT twice on the same day. Between the trials, patients waited for an hour on sitting position to prevent fatigue.Results:The 3MBWT showed an excellent test-retest reliability. Intraclass correlation coefficient ICC for 3MBWT was 0.97. The standard error of measurement and MCID at the 95% confidence level for 3MBWT were 1,08 and 2,99 respectively.Conclusion:The 3MBWT has an excellent test-retest reliability in patients with rTKA. It is an effective and reliable tool for measuring fall risk, dynamic balance and walking skills. As a clinical test, the 3MBWT is easy to score, has no cost, needs no special equipment and can be applied in a short time as part of the routine medical examination.References:[1]Shan L, Shan B, Suzuki A et al. Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. JBJS 2015; 97: 156-168.[2]Johnson RL, Duncan CM, Ahn KS et al. Fall-Prevention Strategies and Patient Characteristics That Impact Fall Rates After Total Knee Arthroplasty. Anesthesia & Analgesia 2014; 119: 1113-1118.[3]Carter V, Jain T, James J et al. The 3-m Backwards Walk and Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure. J Geriatr Phys Ther 2017.Disclosure of Interests:None declared

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

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

Reliability of 3-m Backward Walk Test in Patients with Primary Total Knee Arthroplasty

2019 ◽  
Vol 33 (06) ◽  
pp. 589-592 ◽  
Author(s):  
Bayram Unver ◽  
Kevser Sevik ◽  
Haci Ahmet Yarar ◽  
Fatma Unver ◽  
Vasfi Karatosun
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Neuromuscular Control ◽  
Walk Test ◽  
Special Equipment ◽  
Retest Reliability ◽  
Total Knee ◽  
Test Retest Reliability ◽  
Primary Total Knee

AbstractThe 3-m backward walk test (3MBWT) is used to evaluate neuromuscular control, proprioception, protective reflexes, fall risk, and balance. The aim of the present study was to determine the test–retest reliability of the 3MBWT in patients with primary total knee arthroplasty (TKA). Twenty-eight patients with primary TKA, operated by the same surgeon, were included in this study. Patients performed trials for 3MBWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The 3MBWT showed an excellent test–retest reliability in this study. Intraclass correlation coefficient (ICC) for 3MBWT was 0.97. The standard error of measurement and smallest real difference at the 95% confidence level for 3MBWT were 1.06 and 2.94, respectively. The 3MBWT has an excellent test–retest reliability in patients with primary TKA. It is an effective and reliable tool for measuring dynamic balance and participant falls. As a clinical test, the 3MBWT is easy to score, requires little space, has no cost, needs no special equipment, and can be applied in a short time as part of the routine medical examination.

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

2020 ◽  
Author(s):  
Andrew D. Ardeljan ◽  
Teja S. Polisetty ◽  
Joseph Palmer ◽  
Rushabh M. Vakharia ◽  
Martin W. Roche
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Fall Risk ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Lower Extremity Fracture ◽  
Extremity Fracture ◽  
Total Knee ◽  
Primary Total Knee

AbstractDespite the high incidence of sarcopenia in the orthopaedic community, studies evaluating the influence of sarcopenia following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study is to determine if sarcopenic patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS); (2) medical complications; (3) implant-related complications; (4) fall risk; (5) lower extremity fracture risk; and (6) costs of care. Sarcopenia patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 90,438 patients with (n = 15,073) and without (n = 75,365) sarcopenia undergoing primary TKA. Primary outcomes analyzed included: in-hospital LOS, 90-day medical complications, 2-year implant-related complications, fall risk, lower extremity fracture risk, and costs of care. A p-value of less than 0.05 was considered statistically significant. Patients with sarcopenia undergoing primary TKA had greater in-hospital LOS (4 vs. 3 days, p < 0.0001). Sarcopenic patients were also found to have increased incidence and odds of 90-day medical complications (2.9 vs. 1.1%; odds ratio [OR] = 2.83, p < 0.0001), falls (0.9 vs. 0.3%; OR = 3.54, p < 0.0001), lower extremity fractures (1.0 vs. 0.2%; OR = 5.54, p < 0.0001), and reoperation (0.9 vs. 0.5%; OR = 1.87, p < 0.0001). Additionally, sarcopenic patients had greater 2-year implant-related complications (4.3 vs. 2.4%; OR = 1.80, p < 0.0001), as well as day of surgery ($52,900 vs. 48,248, p < 0.0001), and 90-day ($68,303 vs. $57,671, p < 0.0001) costs compared with controls. This analysis of over 90,000 patients demonstrates that patients with sarcopenia undergoing primary TKA have greater in-hospital LOS, increased odds of 90-day medical complications, falls, lower extremity fractures, and reoperations. Additionally, sarcopenia was associated with greater 2-year implant-related complications, day of surgery costs, and 90-day costs. The study is useful as it can allow orthopaedic surgeons to properly educate these patients of the potential complications which may occur following their surgery.

scholarly journals Reliability and validity of the Hebrew version of the forgotten joint score for assessing the outcomes of total knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Amit Pansky ◽  
Yaron Bar-Ziv ◽  
Eran Tamir ◽  
Aharon Finestone ◽  
Gabriel Agar ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Oxford Knee Score ◽  
Reliability And Validity ◽  
Retest Reliability ◽  
Forgotten Joint Score ◽  
Total Knee ◽  
Hebrew Version ◽  
Test Retest Reliability

Abstract Background This prospective study aimed to assess the reliability and validity of the Hebrew version of the forgotten joint score-12 in patients undergoing total knee arthroplasty, because it is going to be used in the Hebrew-speaking populations in Israel. Methods The English version of forgotten joint score-12 was translated into Hebrew version by using the standard procedures and in collaboration with its authors. The consecutive patients who had undergone total knee arthroplasty in a single hospital were asked to fill out the Hebrew version of forgotten joint score-12, Oxford knee score, Short Form 12, and visual analog scale. A random subgroup of 60 patients were then asked to fill out a second Hebrew version of forgotten joint score-12 at a minimum of 2-week interval. The reliability was assessed in terms of internal consistency, test-retest reliability and split-half reliability. The validity was measured in terms of the outcomes as mentioned above. Results A total of 102 patients participated in the study. The Hebrew version of forgotten joint score-12 showed high reliability. The internal consistency was excellent (Cronbachs’ α = 0.943) and test-retest reliability was high (Intraclass correlation = 0.97). The forgotten joint scores were correlated with the Oxford knee score, Short Form 12, and visual analog scale (r = 0.86, r = 0.72, and r=-0.8, respectively), indicating a high validity. Conclusions The Hebrew version of forgotten joint score-12 has excellent reliability, excellent test-retest reliability and good validity. It can be safely used for assessing outcomes of TKA.

scholarly journals Reliability of Physical Activity Measures During Free-Living Activities in People After Total Knee Arthroplasty

2016 ◽  
Vol 96 (6) ◽  
pp. 898-907 ◽  
Author(s):  
Gustavo J. Almeida ◽  
James J. Irrgang ◽  
G. Kelley Fitzgerald ◽  
John M. Jakicic ◽  
Sara R. Piva
Keyword(s):  
Physical Activity ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Time Frame ◽  
Systematic Bias ◽  
Free Living ◽  
Retest Reliability ◽  
Repeated Measures Design ◽  
Total Knee ◽  
Test Retest Reliability

Background Few instruments that measure physical activity (PA) can accurately quantify PA performed at light and moderate intensities, which is particularly relevant in older adults. The evidence of their reliability in free-living conditions is limited. Objective The study objectives were: (1) to determine the test-retest reliability of the Actigraph (ACT), SenseWear Armband (SWA), and Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire in assessing free-living PA at light and moderate intensities in people after total knee arthroplasty; (2) to compare the reliability of the 3 instruments relative to each other; and (3) to determine the reliability of commonly used monitoring time frames (24 hours, waking hours, and 10 hours from awakening). Design A one-group, repeated-measures design was used. Methods Participants wore the activity monitors for 2 weeks, and the CHAMPS questionnaire was completed at the end of each week. Test-retest reliability was determined by using the intraclass correlation coefficient (ICC [2,k]) to compare PA measures from one week with those from the other week. Results Data from 28 participants who reported similar PA during the 2 weeks were included in the analysis. The mean age of these participants was 69 years (SD=8), and 75% of them were women. Reliability ranged from moderate to excellent for the ACT (ICC=.75–.86) and was excellent for the SWA (ICC=.93–.95) and the CHAMPS questionnaire (ICC=.86–.92). The 95% confidence intervals (95% CI) of the ICCs from the SWA were the only ones within the excellent reliability range (.85–.98). The CHAMPS questionnaire showed systematic bias, with less PA being reported in week 2. The reliability of PA measures in the waking-hour time frame was comparable to that in the 24-hour time frame and reflected most PA performed during this period. Limitations Reliability may be lower for time intervals longer than 1 week. Conclusions All PA measures showed good reliability. The reliability of the ACT was lower than those of the SWA and the CHAMPS questionnaire. The SWA provided more precise reliability estimates. Wearing PA monitors during waking hours provided sufficiently reliable measures and can reduce the burden on people wearing them.

scholarly journals Reliability and Feasibility of the Four Square Step Test for Use in Children with Cerebral Palsy: A Pilot Study

2014 ◽  
Author(s):  
Edward James Gorgon ◽  
Gilbert Madriaga ◽  
Minerva Gomez-Cailao ◽  
Levin Abdon ◽  
Mary Boniquit
Keyword(s):  
Cerebral Palsy ◽  
Pilot Study ◽  
Interrater Reliability ◽  
Dynamic Balance ◽  
Standing Balance ◽  
Step Test ◽  
Retest Reliability ◽  
Children With Cerebral Palsy ◽  
Four Square ◽  
Test Retest Reliability

Purpose: The ability to maintain standing balance with a moving base of support and while making rapid postural adjustments is important for independence in various functional activities. Clinical tests and measures have not addressed this ability in children with disability. This pilot study examined the feasibility and reliability of the Four Square Step Test (FSST) as a test of dynamic balance in children with cerebral palsy (CP). Method: Four children with CP (Gross Motor Function Classification Scale levels I-II) were tested on the FSST by 3 assessors on the first occasion (interrater reliability) and repeat-tested by 1 assessor after 2 weeks (test-retest reliability). Six children with typical development (TD) were tested on a separate occasion to explore any between-group difference in performance. Results: The FSST was easy to setup, required no specialized equipment, could be completed in 5 minutes, and might be carried out by clinicians with limited experience in pediatric therapy. It demonstrated excellent interrater reliability (ICC = 0.832) and test-retest reliability (ICC = 0.979) in children with CP. Compared with FSST times for children with TD (mean = 9.12 ± 2.67 seconds), times for children with CP (mean = 18.38 ± 9.02 seconds) were significantly slower (p = 0.019, Mann-Whitney U = -2.345). Conclusions and Recommendations: The pilot study provides initial evidence on the potential usefulness of the FSST as a test of dynamic standing balance in children with CP. This warrants further investigation of the clinimetric properties of the FSST using an adequate sample size.

scholarly journals AB1293-HPR DETERMINING FUNCTIONAL MOBILITY AND BALANCE FOR PATIENTS AFTER TOTAL KNEE ARTHROPLASTY: RELIABILITY OF L-TEST

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1937.2-1937
Author(s):  
B. Unver ◽  
E. Yuksel ◽  
M. Eymir ◽  
K. Sevik ◽  
V. Karatosun
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Mobility ◽  
Theory And Practice ◽  
Measurement Properties ◽  
Functional Evaluation ◽  
Retest Reliability ◽  
Straight Line ◽  
Total Knee ◽  
Test Retest Reliability

Background:Total knee arthroplasty (TKA) is a very common procedure, particularly implemented for the treatment of knee osteoarthritis (OA). Patient expectations after TKA surgery now include being able to enjoy appropriate recreational activities representing ambulatory activities beyond that of just pain relief and adequate knee motion (1). Since recreational activity comprises of more complex functions and requires longer standing durations, walking for 6-meter in a straight line in the timed up and go test (TUG) does not fully reflect the functional capacity of patients with TKA, and TUG test may be limited to detect the balance and mobility capacity in TKA patients (2, 3). As such, there is a need to determine more effective and functional evaluation tools that better reflect realistic situations in order to assess ambulatory performance level for patients with TKA. However, no studies have been conducted in patients with TKA to examine the applicability of the L-test, which assesses ambulation of individuals and consists of complex mobilization activity.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the L-test for TKA patients.Methods:Twenty-four patients with TKA due to knee OA, operated by the same surgeon, were included in this study. Patients performed trials for L-test twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The tester recorded the performance time while the participant was asked to get up from a chair, walk 3 m in a straight line, turn right, continue walking for 7 m in a straight line, turn left, walk back along the same path and sit down in the chair at their usual walking speed. Prior to the real testing session, the L-test was demonstrated by the tester and all participants were allowed to a practice trial.Results:The L-test showed an excellent test-retest reliability (ICC2,1= 0,98) in this study. Standard error of measurement (SEM) and MDC95for L-test were 1,01 second and 2,8 second, respectively.Conclusion:This study found that the L-test is a reliable test for patients following TKA. Overall, the excellent test-retest reliability of the L-test indicates that it may be an applicable standardized method to assess TKA patients who are able to walk greater distances and have better gait in more functional situations. Clinicians and researchers can be confident that changes in L-test time above 2,8 seconds, represent a “real” clinical change in an individual patient with TKA. We, therefore, recommend the use of L-test as complementary outcome measures for balance and functional evaluation in TKA patients.References:[1]Swinkels, A., & Allain, T. J. (2013). Physical performance tests, self-reported outcomes, and accidental falls before and after total knee arthroplasty: an exploratory study. Physiotherapy theory and practice, 29(6), 432-442.[2]Deathe, A. B., & Miller, W. C. (2005). The L test of functional mobility: measurement properties of a modified version of the timed “up & go” test designed for people with lower-limb amputations. Physical therapy, 85(7), 626-635.[3]Kim, J. S., Chu, D. Y., & Jeon, H. S. (2015). Reliability and validity of the L test in participants with chronic stroke. Physiotherapy, 101(2), 161-165.Disclosure of Interests:None declared

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