R. Prill1, R. Schulz2, J. Kirschner3, S. Michel3, R. Becker1, H. Hommel4,1
1Brandenburg Medical School Theodor Fontane, Orthopedics and Traumatology, Brandenburg, Germany, 2Berlin Institute of Health QUEST Center, Berlin, Germany, 3Brandenburg University of Technology Cottbus - Senftenberg, Therapy Sciences, Senftenberg, Germany, 4Krankhaus Märkisch Oderland GmbH, Department of Orthopaedics, Wriezen, Germany
Background: Knee osteoarthritis is the most prevalent joint disease worldwide and total knee arthroplasty (TKA) is often the only evidence-based treatment option left for patients with endstage osteoarthritis. The postoperative outcomes as well as the different rehabilitation procedures are most commonly evaluated by patient-reported outcome measurements (PROMs). However, in acute clinical-stage stages, performance-based measures were shown to yield greater responsiveness than PROMs, which failed to capture functional declines and may overestimate long-term functional improvements. Moreover, these tests represent a variety of daily life activities which helps to estimate whether a patient is functioning adequately prior to discharge from hospital and in the following rehabilitation.
The ability to rise from a sitting position is one of those activities which is important for an elderly person to maintain an independent life. Also, it was shown that chair rising test performance is highly correlated with deviations in gait patterns.
The ability to rise from a sitting position is one of those activities which is important for an elderly person to maintain an independent life. Also, it was shown that chair rising test performance is highly correlated with deviations in gait patterns.
Purpose: However, there is no data available yet if this test can be used at perioperative time-points in patients undergoing TKA and how reliable this test is. Therefore, this study investigates the reliability and the minimal detectable change and the development of the performance of the weight-balanced chair rising test in patients before and after TKA.
Methods: This study was designed as a test-retest reliability study. Participants were recruited in an orthopedic hospital after they were scheduled for total knee arthroplasty. The participants performed two chair rising tests (five-times-sit-to-stand) on a ground reaction force plate at one-day preoperatively (M0), five days- (M1), ten days (M2)- and ten weeks postoperatively (M3). The test-retest reliability of the weight balanced asymmetry measured as ground reaction force in Newton was analyzed for each of the four time-points. Therefore, the minimal detectable change within a confidence interval of 95% (MDC95) and the ICC were calculated.
Results: 16 male and 8 female subjects (N=24) with a mean age of age 63,93 (±9,59) were included. The mean side-to-side difference in N was 138(±104) at M0, 319(±125) at M1, 254(±109) at M2 and 116(±74) at M3. The test-retest reliability ranged between ICC=.84-.96 at all four time points, indicating good to excellent reliability. The MDC95 ranges from 79–113 N. No adverse events were recorded after the performance of the test and no participants dropped out because of study-related reasons.
Conclusion(s): The weight-balanced chair rising test shows good- to excellent reliability. After an initial decrease of loading symmetry at M1 and M2 preoperative levels are reached as early as at M3.
Implications: The weight-balanced chair rising test provides objective data about loading symmetry during an activity of daily living. It is reliable and feasible to use in as well in-patient as out-patient rehabilitation of patients with TKA.
Funding, acknowledgements: This research received no funding.
Keywords: Total Joint Replacement, Total Knee Arthroplasty, functional testing
Topic: Orthopaedics
Did this work require ethics approval? Yes
Institution: Medical Association of Brandenburg
Committee: Chamber of Physicians
Ethics number: S3(a)/2017
All authors, affiliations and abstracts have been published as submitted.
