Assessing Balance Function in Patients With Total Knee Arthroplasty

BackgroundThe Balance Evaluation Systems Test (BESTest) is a relatively new balance assessment tool. Recently, the Mini-BESTest and the Brief-BESTest, which are shortened versions of the BESTest, were developed.ObjectiveThe purpose of this study was to estimate interrater and intrarater-interoccasion reliability, internal consistency, concurrent and convergent validity, and floor and ceiling effects of the 3 BESTests and other related measures, namely, the Berg Balance Scale (BBS), Functional Gait Assessment (FGA), and Activities-specific Balance Confidence (ABC) Scale, among patients with total knee arthroplasty (TKA).DesignThis was an observational measurement study.MethodsTo establish interrater reliability, the 3 BESTests were administered by 3 independent raters to 25 participants with TKA. Intrarater-interoccasion reliability was evaluated in 46 participants with TKA (including the 25 individuals who participated in the interrater reliability experiments) by repeating the 3 BESTests, BBS, and FGA within 1 week by the same rater. Internal consistency of each test also was assessed with Cronbach alpha. Validity was assessed in another 46 patients with TKA by correlating the 3 BESTests with BBS, FGA, and ABC. The floor and ceiling effects also were examined.ResultsThe 3 BESTests demonstrated excellent interrater reliability (intraclass correlation coefficient [ICC] [2,1]=.96–.99), intrarater-interoccasion reliability (ICC [2,1]=.92–.96), and internal consistency (Cronbach alpha=.96–.98). These values were comparable to those for the BBS and FGA. The 3 BESTests also showed moderate-to-strong correlations with the BBS, FGA, and ABC (r=.35–.81), thus demonstrating good concurrent and convergent validity. No significant floor and ceiling effects were observed, except for the BBS.LimitationsThe results are generalizable only to patients with TKA due to end-stage knee osteoarthritis.ConclusionsThe 3 BESTests have good reliability and validity for evaluating balance in people with TKA. The Brief-BESTest is the least time-consuming and may be more useful clinically.

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Translation, cross-cultural adaptation, and validation of the Italian language Forgotten Joint Score-12 (FJS-12) as an outcome measure for total knee arthroplasty in an Italian population

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2985-2 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Valerio Sansone ◽

Peter Fennema ◽

Rachel C. Applefield ◽

Stefano Marchina ◽

Raffaella Ronco ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Internal Consistency ◽

Knee Arthroplasty ◽

Effect Size ◽

Italian Population ◽

Maximum Score ◽

Ceiling Effects ◽

Total Knee ◽

Test Retest Reliability

Abstract Background With ever-increasing numbers of patients undergoing elective total knee arthroplasty (TKA) and as TKA is performed in increasingly younger patients, patient demands and expectations have also increased. With improved patient outcomes, new PROMs with heightened discriminatory power in well-performing patients are needed. The present study aimed to translate and validate the Italian version of the Forgotten Joint Score (FJS-12) as a tool for evaluating pre-operative through longitudinal post-operative outcomes in an Italian population. Methods In this prospective study, patients with unilateral osteoarthritis, undergoing TKA surgery between May 2015 and December 2017 were recruited to participate in the study. The FJS-12 and WOMAC were collected pre-operatively and at six and 12 months post-operatively. According to the COSMIN checklist, reliability, internal consistency, validity, responsiveness, effect size, and ceiling effects and floor effects were evaluated. Results One hundred twenty patients completed the study, 66 of which participated in the evaluation of test-retest reliability. Good test-retest reliability was found (ICC = 0.90). The FJS-12 also showed excellent internal consistency (Cronbach α = 0.81). Construct validity with the WOMAC, as a measure of the Pearson correlation coefficient, was moderate (r = 0.45 pre-operatively; r = 0.46 at 6 months and r = 0.42 at 12 months post-operatively). From six to 12 months, the change was slightly greater for the WOMAC than for the FJS-12 patients (effect size d = 0.94; d = 0.75, respectively). At 12-months follow-up, the ceiling effects reflecting the maximum score were 12% for the FJS-12 and 6% for the WOMAC; however, scores within 10% of the maximum score were comprised 30% of the FJS-12 scores and 59% for the WOMAC. Conclusion The Italian FJS-12 demonstrated strong measurement properties in terms of reliability, internal consistency, and construct validity in TKA patients. Furthermore, a more detailed look at ceiling effects shows a superior discriminatory capacity when compared to the WOMAC at 12-months follow-up, particularly in better-performing patients. Trial registration clinicaltrials.gov NCT03805490. Registered 18 January 2019 (retrospectively registered).

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Agreement and Reliability of Lateral Patellar Tilt and Displacement following Total Knee Arthroplasty with Patellar Resurfacing

The Journal of Knee Surgery ◽

10.1055/s-0039-1700843 ◽

2019 ◽

Author(s):

John P. Kleimeyer ◽

Thomas J. McQuillan ◽

Diren Arsoy ◽

Vinay K. Aggarwal ◽

Derek F. Amanatullah

Keyword(s):

Total Knee Arthroplasty ◽

Correlation Coefficient ◽

Knee Arthroplasty ◽

Intraclass Correlation ◽

Patellar Resurfacing ◽

Intraobserver Agreement ◽

Patellar Tilt ◽

Patellar Position ◽

Axial Radiograph ◽

Total Knee

AbstractPatellar position and alignment may be measured on routine axial radiographs by various techniques; however, the agreement and reliability of such measurements with a resurfaced patella remain unknown. This study evaluated the range and reliability of lateral patellar tilt and lateral patellar displacement following total knee arthroplasty (TKA) with a resurfaced patella among three observers on 45° Merchant view in 139 TKAs. Intraclass correlation coefficient (ICCs) were used to evaluate intraobserver agreement (IOA) and inter-rater reliability (IRR). IRR was high between each of the observers for lateral patellar tilt (ICC = 0.8) and lateral patellar displacement (ICC = 0.87). IOA was also high upon repeat measurement for the same observer for lateral patellar tilt (ICC ≥ 0.90) and lateral patellar displacement (ICC ≥ 0.86). Therefore, lateral patellar tilt and lateral patellar displacement are reproducible measurements of patellar position on a Merchant axial radiograph following a well-functioning TKA with a resurfaced patella.

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Rotational alignment of the tibial component in total knee arthroplasty: the anterior tibial cortex is a reliable landmark

Joints ◽

10.11138/jts/2013.1.4.1455 ◽

2013 ◽

Vol 01 (04) ◽

pp. 155-160 ◽

Cited By ~ 16

Author(s):

Andrea Baldini ◽

Pier Indelli ◽

Lapo De Luca ◽

Pierpaolo Mariani ◽

Massimiliano Marcucci

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Intraclass Correlation ◽

Surface Curvature ◽

Tibial Tubercle ◽

Component Alignment ◽

Anterior Tibial ◽

Total Knee ◽

Tibial Cortex

Purpose: to compare the anterior tibial surface curvature, the Akagi’s line and the medial third of the tibial tubercle in order to assess which is the most reliable landmark for correct tibial component rotational positioning in total knee arthroplasty. Methods: three independent investigators reviewed 124 knee MRI scans. The most suitable tibial baseplate tracing for the Nexgen Total Knee System (Zimmer, Warsaw, USA) was superimposed on the scan matching the anterior tibial cortex with the anterior aspect of the baseplate. The rotation of the tibial baseplate tracing was calculated with respect to the transepicondylar axis (TEA), the medial third of the tibial tubercle line, Akagi’s line and the femoral posterior condylar axis (PCA). Customized software was created and used for analysis of the MRI datasets.The reliability of each measurement was then calculated by using the intraclass correlation coefficient for interobserver agreement. Results: observer agreement on the position of the Akagi’s line was within 3° in 64% of the cases and within 5°in 85% of the cases. Agreement on the position of the medial third of the tibial tubercle was within 3°in 29% of the cases and within 5°in 70% of the cases. Agreement on the localization of the anterior tibial surface curvature was within 3°in 89% of the cases and within 5°in 99% of the cases. Component alignment along the anterior cortex guaranteed full matching ± 3° with the epicondylar axis in 75% of the knees. Conclusions: the anterior tibial surface curvature was found to be a more reliable and more easily identifiable landmark for correct tibial component alignment than either Akagi’s line or the medial third of the tibialtubercle. Level of evidence: level III, retrospective cohort study.

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Validity of Tools to Measure Physical Activity in Older Adults Following Total Knee Arthroplasty

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0240 ◽

2020 ◽

pp. 1-8

Author(s):

Lisa Jasper ◽

Lauren A. Beaupre ◽

John C. Spence ◽

C. Allyson Jones

Keyword(s):

Physical Activity ◽

Older Adults ◽

Total Knee Arthroplasty ◽

Energy Expenditure ◽

Knee Arthroplasty ◽

Intraclass Correlation ◽

Self Report ◽

Measurement Tool ◽

Energy Expenditures ◽

Total Knee

Few validated tools exist for measuring physical activity following total knee arthroplasty (TKA) despite the importance of returning to sufficient levels of physical activity post-TKA to achieve health benefits. This study examined the validity of two clinical measures—the Fitbit, a commercially available personal activity monitor, and the Community Healthy Activities Model Program for Seniors (CHAMPS), a self-report questionnaire—compared with a reference standard accelerometer, the SenseWearTM Armband (SWA). At 6-month post-TKA, 47 participants wore the Fitbit and SWA for 4 days and then completed the CHAMPS. Moderate-to-good correlation was observed between the Fitbit and SWA for steps (intraclass correlation coefficient [ICC] = .79), energy expenditure (ICC = .78), and energy expenditure <3 METS (ICC = .79). Poor-to-moderate correlation was observed between the CHAMPS and SWA (ICC = .43) with the questionnaire reporting lower daily energy expenditures than the SWA. Results showed that Fitbit may be a reasonable measurement tool to measure steps and energy expenditures in older adults following TKA.

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Intra- and inter-rater reliability of the Knee Society Knee Score when used by two physiotherapists in patients post total knee arthroplasty

South African Journal of Physiotherapy ◽

10.4102/sajp.v66i1.59 ◽

2010 ◽

Vol 66 (1) ◽

Author(s):

S. Gopal ◽

W. Wood ◽

H. Myezwa ◽

A. Stewart

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Intraclass Correlation ◽

Time Interval ◽

Knee Score ◽

Clinical Testing ◽

Good Reliability ◽

Rater Reliability ◽

Knee Society Knee Score ◽

Total Knee

Background and Purpose: It has yet to be shown whether routine physiotherapy plays a role in the rehabilitation of patients post totalknee arthroplasty (Rajan et al 2004). Physiotherapists should be using validoutcome measures to provide evidence of the benefit of their intervention. The aim of this study was to establish the intra and inter-rater reliability of the Knee Society Knee Score, a scoring system developed by Insall et al(1989). The Knee Society Knee Score can be used to assess the integrity of theknee joint of patients undergoing total knee arthroplasty. Since the scoreinvolves clinical testing, the intra-rater reliability of the clinician should be established prior to using the scores as datain clinical research. W here multiple clinicians are involved, inter-rater reliability should also be established.Design: This was a correlation study.Subjects: A sample of thirty patients post total knee arthroplasty attending the arthroplasty clinic at Johannesburg Hospital between six weeks and twelve months postoperatively.M ethod: Recruited patients were evaluated twice with a time interval of one hour between each assessment. Statistical A nalysis: The intra- and inter-rater reliability were estimated using Intraclass Correlation Coefficient (ICC). R esults: The intra-rater reliability showed excellent reliability (h= 0.95) for Examiner A and good reliability (h= 0.71)for Examiner B. The inter-rater reliability showed moderate reliability (h= 0.67 during test one and h= 0.66 during test two).Conclusion: The KSKS has good intra-rater reliability when tested within a period of one hour. The KSKS demonstrated moderate agreement for inter rater reliability.

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Psychometric properties of the Czech Integrated Palliative Outcome Scale: Reliability and content validity analysis

10.21203/rs.2.20850/v2 ◽

2020 ◽

Author(s):

Karolina Vlckova ◽

Eva Hoschlova ◽

Eva Chroustova ◽

Martin Loucka

Keyword(s):

Palliative Care ◽

Factor Analysis ◽

Psychometric Properties ◽

Exploratory Factor Analysis ◽

Internal Consistency ◽

Convergent Validity ◽

Intraclass Correlation ◽

Retest Reliability ◽

Cronbach Alpha ◽

Test Retest Reliability

Abstract Background: Outcome measurement is an essential part of the evaluation of palliative care and the measurements need to be reliable, valid and adapted to the culture in which they are used. The Integrated Palliative Outcome Scale (IPOS) is a widely used tool for assessing personal-level outcomes in palliative care. The aim of this study was to provide Czech version of IPOS and asses its psychometric properties. Methods: Patients receiving palliative care in hospice or hospitals completed the IPOS. The reliability of Czech IPOS was tested with Cronbach alpha (for internal consistency), the intraclass correlation coefficient for total IPOS score and weighted Kappa (for test-retest reliability of individual items). Factor analysis was used for elucidating the construct (Exploratory Factor Analysis). Convergent validity was tested with correlation analysis (Spearman correlation) in a part of the sample, who completed also the Edmonton Symptom Assessment System (ESAS) and the Palliative Performance Scale (PPS). Results: The sample consisted of 140 patients (mean age 72; 90 women; 81 % oncological disease). The Cronbach alpha was 0.789; intraclass correlation was 0.88. The correlations of IPOS with ESAS was R= 0.4 and PPS R= -0.2. Exploratory factor analysis revealed a 2-factor solution on our data. The first factor covers emotional and information needs and the second factor covers physical symptoms. Conclusion: Czech IPOS has very good reliability regarding both internal consistency and test-retest reliability. Together with an item analysis results, we can conclude that the Czech adaptation of the tool was successful. The convergent validity needs to be assessed on the larger sample and the proposed 2-factor internal structure of the questionnaire has to be confirmed by using CFA.

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Reliability and convergent validity of the Emotional Intelligence Admission Essay Scale, revised

British Journal of Occupational Therapy ◽

10.1177/0308022618763053 ◽

2018 ◽

Vol 81 (9) ◽

pp. 543-550

Author(s):

Sharon A Gutman ◽

Janet P Falk-Kessler

Keyword(s):

Emotional Intelligence ◽

Behavior Problems ◽

Internal Consistency ◽

Behavioral Problems ◽

Convergent Validity ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Professional Behavior ◽

Scale Scores ◽

High Intraclass Correlation Coefficient

Introduction The purpose of this study was to reassess the reliability and convergent validity of the revised Emotional Intelligence Admission Essay Scale, and determine whether the scale could identify students demonstrating professional behavior problems in the classroom and fieldwork environments. Method Thirty-six student participants completed the revised Emotional Intelligence Admission Essay Scale and Schutte Assessing Emotions Scale. Interrater reliability, internal consistency, and convergent validity were established. Results Interrater reliability and internal consistency were found to be high (intraclass correlation coefficient = .82, p < .001; Cronbach’s alpha = .96, p < .001, respectively). When participants were separated by age, convergent validity between the Emotional Intelligence Admission Essay Scale and Schutte Assessing Emotions Scale of participants aged ≥ 26 years was high ( rs = .83, p < .002) compared to those ≤ 25 years ( rs = .58, p < .002). Six participants (16.6%) received Emotional Intelligence Admission Essay Scale scores of 0 and were identified as potentially exhibiting professional behavioral problems; three of these students demonstrated professional behavior problems in the academic and/or fieldwork settings. Conclusion The Emotional Intelligence Admission Essay Scale can be used as a screen to identify whether students may exhibit professional behavior problems; however, caution should be used as some identified students may be able to prevent professional behavior problems once aware of program expectations.

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A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty

10.21203/rs.3.rs-38838/v2 ◽

2020 ◽

Author(s):

Hua Han ◽

Xiaohui Zhang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Measurement Method ◽

Intraclass Correlation ◽

Patellar Height ◽

Joint Line ◽

New Method ◽

Line Position ◽

Before And After ◽

Total Knee

Abstract Background: The measurement of patellar height and restoration of the natural position of the joint line are crucial to total knee arthroplasty (TKA). However, there remains a lack of consensus on an optimal measurement method to associate the patellar height with the joint line position. The objective of this study was to introduce a new method and validate the application in TKA both preoperatively and postoperatively.Methods: Instead of taking marginal landmarks as the tibial references, the tibial shaft axis was used to construct the new measurement method, which comprises the axis-patella (AP), joint axis-patella (jAP) indices and joint line height (JLH). Patellar heights were measured using the Insall-Salvati (IS), modified Insall-Salvati (mIS), Blackburne-Peel (BP), Caton-Deschamps (CD) indices, and the new method in 175 knees both preoperatively and postoperatively. Intraclass correlation coefficients and Pearson’s correlation analyses were respectively used to evaluate the reliabilities and correlations.Results: There were good correlations between the proposed method and the mIS, CD, and BP indices. High inter-observer reproducibility was found for AP (preoperative and postoperative 0.83), jAP (preoperative 0.82; postoperative 0.86) indices and JLH (preoperative 0.88; postoperative 0.95). High intra-observer repeatability was also found for AP (preoperative 0.85; postoperative 0.87), jAP (preoperative 0.83; postoperative 0.87) indices and JLH (preoperative 0.80; postoperative 0.92).Conclusions: The new method is reliable for measuring patellar height before and after TKA, providing an alternative to distinguish between true and pseudo patella baja. Furthermore, JLH can be applied to assess and restore the joint line position in TKA.

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