Hirschhorn A1,2, Dale M2, Ko V1,2, Wynne C1,2, Ahangangoda R1, Falchi B1,2, Li I1, Potter J2, Boon V2
1Macquarie University, MQ Health Physiotherapy, Sydney, Australia, 2Macquarie University, Department of Health Professions, Sydney, Australia
Background: International guidelines recommend a core set of performance measures for patients with knee and hip osteoarthritis, both as outcome measures of clinical intervention, e.g. arthroplasty, and to allow comparison across clinical/research settings. Self-report (questionnaire) measures provide complementary information on pain and function - there are limited data however on correlations between self-report and performance measures of function in patients awaiting joint arthroplasty in the private healthcare setting.
Purpose: To describe the physical function status of patients awaiting elective lower limb arthroplasty at a private academic health sciences centre. To assess correlations between performance and self-report measures of physical function.
Methods: Patients awaiting lower limb arthroplasty at Macquarie University Hospital, Sydney routinely attend preoperative physiotherapy assessment, including: i) three guideline-recommended performance measures of physical function: 30-second chair stand test (30s-CST), 40-metre fast-paced walk test (40m-FPWT), 8-step stair climb test (8s-SCT); and ii) three self-report measures of pain/function: Hip/Knee dysfunction and Osteoarthritis Outcomes Score - Activities of Daily Living subscale (HOOS/KOOS-ADL), Lower Extremity Functional Score (LEFS), and Oxford Hip/Knee Score (OHS/OKS). We undertook a retrospective analysis of assessment data for consenting patients attending preoperative physiotherapy over a 12-week period.
Results: 17 patients (5M:12F), age 60±14 years attended before hip arthroplasty; 14 patients (5M:9F), age 71±11 years attended before knee arthroplasty. Mean outcomes of performance measures were: hip arthroplasty: 30s-CST: 10±4 repetitions; 40m-FPWT: 31±10 s; 8s-CST: 17±9 s; knee arthroplasty: 30s-CST: 8±3 repetitions; 40m-FPWT: 38±9 s; 8s-CST: 23±5 s. Mean outcomes of self-report measures were: hip arthroplasty: HOOS-ADL: 60±18/100; LEFS: 36±16/80; OHS: 26±9/48; knee arthroplasty; KOOS-ADL: 44±16/100; LEFS: 25±11/80; OKS: 19±6/48. For performance measures, there was a moderate correlation only between outcomes of the 40m-FPWT and 8s-CST for patients awaiting hip arthroplasty (r=0.69, p 0.01) and the 40m-FPWT and 30s-CST for patients awaiting knee arthroplasty (r=0.68, p 0.01). There were strong to very strong correlations (0.83 r 0.94, p 0.001) between all self-report measures for patients awaiting hip arthroplasty, and moderate to very strong correlations (0.66 r 0.88, p 0.01) between all self-report measures for patients awaiting knee arthroplasty.
Conclusion(s): Patients awaiting lower limb arthroplasty at Macquarie University Hospital both demonstrate and report substantial impairment of physical function. In contrast to self-report measures, outcomes of performance measures show limited correlation with one another. Patients awaiting hip versus knee arthroplasty are impaired differentially across performance measures. Future research might compare physical function for patient populations across private academic, private 'for-profit' and/or public settings, and compare physical function before and after lower limb arthroplasty.
Implications: Results support that performance measures reflect different aspects of physical function, hence comprehensive assessment of patients awaiting lower limb arthroplasty requires at minimum the guideline-recommended core set. To reduce physiotherapist/patient burden, a single self-report measure may be sufficient to provide complementary subjective data.
Keywords: Arthroplasty, Function, Assessment
Funding acknowledgements: Nil
Purpose: To describe the physical function status of patients awaiting elective lower limb arthroplasty at a private academic health sciences centre. To assess correlations between performance and self-report measures of physical function.
Methods: Patients awaiting lower limb arthroplasty at Macquarie University Hospital, Sydney routinely attend preoperative physiotherapy assessment, including: i) three guideline-recommended performance measures of physical function: 30-second chair stand test (30s-CST), 40-metre fast-paced walk test (40m-FPWT), 8-step stair climb test (8s-SCT); and ii) three self-report measures of pain/function: Hip/Knee dysfunction and Osteoarthritis Outcomes Score - Activities of Daily Living subscale (HOOS/KOOS-ADL), Lower Extremity Functional Score (LEFS), and Oxford Hip/Knee Score (OHS/OKS). We undertook a retrospective analysis of assessment data for consenting patients attending preoperative physiotherapy over a 12-week period.
Results: 17 patients (5M:12F), age 60±14 years attended before hip arthroplasty; 14 patients (5M:9F), age 71±11 years attended before knee arthroplasty. Mean outcomes of performance measures were: hip arthroplasty: 30s-CST: 10±4 repetitions; 40m-FPWT: 31±10 s; 8s-CST: 17±9 s; knee arthroplasty: 30s-CST: 8±3 repetitions; 40m-FPWT: 38±9 s; 8s-CST: 23±5 s. Mean outcomes of self-report measures were: hip arthroplasty: HOOS-ADL: 60±18/100; LEFS: 36±16/80; OHS: 26±9/48; knee arthroplasty; KOOS-ADL: 44±16/100; LEFS: 25±11/80; OKS: 19±6/48. For performance measures, there was a moderate correlation only between outcomes of the 40m-FPWT and 8s-CST for patients awaiting hip arthroplasty (r=0.69, p 0.01) and the 40m-FPWT and 30s-CST for patients awaiting knee arthroplasty (r=0.68, p 0.01). There were strong to very strong correlations (0.83 r 0.94, p 0.001) between all self-report measures for patients awaiting hip arthroplasty, and moderate to very strong correlations (0.66 r 0.88, p 0.01) between all self-report measures for patients awaiting knee arthroplasty.
Conclusion(s): Patients awaiting lower limb arthroplasty at Macquarie University Hospital both demonstrate and report substantial impairment of physical function. In contrast to self-report measures, outcomes of performance measures show limited correlation with one another. Patients awaiting hip versus knee arthroplasty are impaired differentially across performance measures. Future research might compare physical function for patient populations across private academic, private 'for-profit' and/or public settings, and compare physical function before and after lower limb arthroplasty.
Implications: Results support that performance measures reflect different aspects of physical function, hence comprehensive assessment of patients awaiting lower limb arthroplasty requires at minimum the guideline-recommended core set. To reduce physiotherapist/patient burden, a single self-report measure may be sufficient to provide complementary subjective data.
Keywords: Arthroplasty, Function, Assessment
Funding acknowledgements: Nil
Topic: Orthopaedics; Outcome measurement
Ethics approval required: Yes
Institution: Macquarie University
Ethics committee: Macquarie University Human Research Ethics Committee
Ethics number: 5201700899
All authors, affiliations and abstracts have been published as submitted.
