Gorgon EJ1,2, Dela Cruz PK1, Galang JM1, Garcia JA1, Lopez AP1, Marqueses L1, Villena DE1
1University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, 2The University of Sydney, Faculty of Health Sciences, Sydney, Australia
Background: Impaired standing balance is common and increases risk of falls among individuals with lower limb osteoarthritis. To accurately identify balance impairments, predict risk of falls, and quantify change resulting from intervention, outcome measures with sufficient measurement properties (i.e., reliability, validity, and responsiveness) are required. However, little is known regarding which outcome measures can best assess standing balance in this population. This knowledge gap has resulted in unwarranted variations in outcome measures used in previous clinical trials. Evidence-driven consensus on outcome measures can promote structured comparisons and pooling of results across clinical trials that examine the effects of interventions aimed at increasing standing balance in patients with lower limb osteoarthritis.
Purpose: This systematic review synthesized the evidence on the measurement properties of clinical measures used in the assessment of standing balance in adults with lower limb osteoarthritis.
Methods: The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Protocol for Systematic Reviews of Measurement Properties guided study design. Researchers initially applied keyword searching in PubMed, EMBASE, CINAHL, Web of Science, and Scopus from inception until March 31, 2018. The literature search was updated up to August 31, 2018. Included studies: (1) examined at least one measurement property of at least one clinical measure of standing balance; 2) involved adults who had been radiographically diagnosed with osteoarthritis; and 3) were published research reports written in the English language. Researchers independently conducted screening of articles, data extraction, and methodological quality assessment of included studies using a modified COSMIN checklist. Researchers synthesized overall level of evidence based on the Cochrane Collaboration Back Review criteria.
Results: The initial search of databases yielded 4,227 records. The updated search yielded no additional included studies. Eight studies provided evidence for measurement properties of 11 outcome measures. Available studies examined reliability (10 measures), measurement error (7 measures), construct validity (3 measures), responsiveness (2 measures), or a combination of these properties. None of the studies addressed criterion validity. Overall, methodological quality of studies was fair for reliability (8 of 10 measures), measurement error (5 of 7 measures), and construct validity (2 of 3 measures). Best evidence synthesis revealed limited positive to unknown evidence for reliability, construct validity, and responsiveness for 50-80% of the measures. In the absence of information on minimal important change, level of evidence could not be determined for measurement error for 86% of the measures. The Tinetti Performance Oriented Mobility Assessment demonstrated limited positive evidence for reliability and construct validity; however, none of the other measures showed positive evidence for more than 1 measurement property.
Conclusion(s): Significant methodological and quality limitations in the available evidence preclude strong recommendation of any of the measures. Future research should address this important knowledge gap through optimal study design and adequate data reporting.
Implications: Findings of this study can guide further testing and development of outcome measures for adults with lower limb osteoarthritis. Use of robust outcome measures in assessing standing balance can promote effective identification of at-risk patients and monitoring of intervention effects in this population.
Keywords: osteoarthritis, measurement properties, standing balance
Funding acknowledgements: No funding was received for this study.
Purpose: This systematic review synthesized the evidence on the measurement properties of clinical measures used in the assessment of standing balance in adults with lower limb osteoarthritis.
Methods: The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Protocol for Systematic Reviews of Measurement Properties guided study design. Researchers initially applied keyword searching in PubMed, EMBASE, CINAHL, Web of Science, and Scopus from inception until March 31, 2018. The literature search was updated up to August 31, 2018. Included studies: (1) examined at least one measurement property of at least one clinical measure of standing balance; 2) involved adults who had been radiographically diagnosed with osteoarthritis; and 3) were published research reports written in the English language. Researchers independently conducted screening of articles, data extraction, and methodological quality assessment of included studies using a modified COSMIN checklist. Researchers synthesized overall level of evidence based on the Cochrane Collaboration Back Review criteria.
Results: The initial search of databases yielded 4,227 records. The updated search yielded no additional included studies. Eight studies provided evidence for measurement properties of 11 outcome measures. Available studies examined reliability (10 measures), measurement error (7 measures), construct validity (3 measures), responsiveness (2 measures), or a combination of these properties. None of the studies addressed criterion validity. Overall, methodological quality of studies was fair for reliability (8 of 10 measures), measurement error (5 of 7 measures), and construct validity (2 of 3 measures). Best evidence synthesis revealed limited positive to unknown evidence for reliability, construct validity, and responsiveness for 50-80% of the measures. In the absence of information on minimal important change, level of evidence could not be determined for measurement error for 86% of the measures. The Tinetti Performance Oriented Mobility Assessment demonstrated limited positive evidence for reliability and construct validity; however, none of the other measures showed positive evidence for more than 1 measurement property.
Conclusion(s): Significant methodological and quality limitations in the available evidence preclude strong recommendation of any of the measures. Future research should address this important knowledge gap through optimal study design and adequate data reporting.
Implications: Findings of this study can guide further testing and development of outcome measures for adults with lower limb osteoarthritis. Use of robust outcome measures in assessing standing balance can promote effective identification of at-risk patients and monitoring of intervention effects in this population.
Keywords: osteoarthritis, measurement properties, standing balance
Funding acknowledgements: No funding was received for this study.
Topic: Musculoskeletal: lower limb; Outcome measurement
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: No ethics approval was required for this study, as data collection involved published research reports only.
All authors, affiliations and abstracts have been published as submitted.
