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No correlation between symmetry-based performance measures and patient-related outcome prior to and after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Standardized outcome measures are crucial for the evaluation of different treatment and rehabilitation regimes in patients after total knee arthroplasty (TKA). Performance-based measures are necessary to capture different aspects of physical function. High reliability and agreement of five performance-based measures were hypothesized to differentiate between measurement error and change in test performance. Secondary outcomes are the correlation of performance-based measurements to KSS and WOMAC prior to surgery (baseline) and 10 weeks thereafter (t3).

Methods

The test–retest reliabilities and agreements of the 1-m walk test, the stair-climbing test, the timed-up-and-go test, the weight-balanced-chair-rising test and the isometric maximum knee extension force in patients undergoing total knee replacements were studied. The intraclass correlation coefficient was calculated and a Bland–Altman analysis performed.

Results

The weight-balanced-chair-rising test showed a symmetry at baseline = 0.77, 5 ± 1 days after surgery (t1) = 0.50, 9 ± 1 days (t2) = 0.59 and (t3) = 0.80. All performance tests showed high intraclass correlation coefficients (ICC = 0.81–0.99). The 10-m walk test, stair climbing test, and the timed-up-and-go test showed high agreement in the Bland–Altman analysis. The Bland–Altman analysis for the weight-balanced-chair-rising test and isometric knee extension force indicated high agreement at 5 and 9 days postoperatively, but the relative measurement error increased pre- and 10 weeks postoperatively.

Conclusion

In conclusion, symmetry, as an important outcome after TKA, is a reliable and rather unique item that should unquestionably be added to established measurements like walking tests or survey-based function assessment. The implementation of standardized performance-based measures to assess physical function in rehabilitation procedures will help to improve the more objectively based assessment of different rehabilitation protocols.

Level of evidence

II.

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Availability of data and materials

All data is available from the corresponding author on reasonable request.

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Acknowledgements

We thank Peggy Hommel and Daniel Kunze for their contribution to the data collection.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The work was done with institutional capacities from the listed institutions.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, Brandenburg Medical School Theodor Fontane, Hochstraße 29, 14770, Brandenburg, Germany

    Robert Prill, Roland Becker & Hagen Hommel

  2. Berlin Institute of Health Quest Center, Berlin, Germany

    Robert Schulz

  3. Brandenburg University of Technology-CS, Senftenberg, Germany

    Sven Michel

  4. District Hospital Märkisch Oderland GmbH, Wriezen, Germany

    Hagen Hommel

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  1. Robert Prill
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Contributions

RP and HH have developed the method for the study and the whole project to which this study belongs. RP, RS and HH have organized the study and collected the data. RS is responsible for statistical analysis. RP, RB and RS have written the manuscript. SM and HH have reviewed the manuscript critically, organized institutional capacities and equipment. All authors have made substantial contributions to the manuscript.

Corresponding author

Correspondence to Robert Prill.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical approval

Ethics committee of the state medical association of Brandenburg, S3(a)/2017.

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All patients gave written informed consent for participation.

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The authors of this manuscript declare that a written consent to publish was obtained for any individual person’s data in any form (including individual details, images or videos) from that person, or in the case of children, their parent or legal guardian.

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Supplementary Information

Below is the link to the electronic supplementary material.

167_2021_6570_MOESM1_ESM.png

Supplementary file 1 Bland–Altmann plots show performance of the 10mWT at the four perioperative timepoints. Pre, the mean difference was 0.12 (95% limits of agreement, − 0.64 to 0.88). 5d-po, the mean difference was 0.59 (95% limits of agreement, − 5.32 to 6.50). 9d-po, the mean difference was 0.56 (95% limits of agreement, − 1.18 to 2.32). 10w-po, the mean difference was 0.23 (95% limits of agreement, − 0.63 to 1.08). Continuous line = zero line, dashed line = LoA, green line = bias) (PNG 135 kb)

167_2021_6570_MOESM2_ESM.png

Supplementary file 2 Bland–Altmann plots show performance of the TUG at the four perioperative timepoints. Pre, the mean difference was 0.31 (95% limits of agreement, − 0.80 to 1.42). 5d-po, the mean difference was 1.48 (95% limits of agreement, − 2.81 to 5.77). 9d-po, the mean difference was 0.61 (95% limits of agreement, − 1.84 to 3.06). 10w-po, the mean difference was 0.07 (95% limits of agreement, − 1.18 to 1.32). Continuous line = zero line, dashed line = LoA, green line = bias) (PNG 109 kb)

167_2021_6570_MOESM3_ESM.png

Supplementary file 3 Bland–Altmann plots show performance of the SCT at the four perioperative timepoints. Pre, the mean difference was 0.65 (95% limits of agreement, − 3.34 to 4.64). 9d-po, the mean difference was 3.89 (95% limits of agreement, − 7.00 to 14.79). 10w-po, the mean difference was 0.57 (95% limits of agreement, − 1.84 to 2.97). Continuous line = zero line, dashed line = LoA, green line = bias) (PNG 91 kb)

167_2021_6570_MOESM4_ESM.png

Supplementary file 4 Bland–Altmann plots show performance of the HHD at the four perioperative timepoints. Pre, the mean difference was 9.06 (95% limits of agreement, − 65.52 to 86.63). 5d-po, the mean difference was 8.38 (95% limits of agreement, − 59.26 to 76.02). 9d-po, the mean difference was − 7.83 (95% limits of agreement, − 64.35 to 48.69). 10w-po, the mean difference was − 2.80 (95% limits of agreement, − 74.31 to 68.72). Continuous line = zero line, dashed line = LoA, green line = bias) (PNG 142 kb)

167_2021_6570_MOESM5_ESM.png

Supplementary file 5 Bland–Altmann plots show performance of the WB-CRT at the four perioperative timepoints. Pre, the mean difference was 14.23 (95% limits of agreement, − 96.09 to 124.55). 5d-po, the mean difference was − 6.81 (95% limits of agreement, − 128.54 to 114.93). 9d-po, the mean difference was − 2.72 (95% limits of agreement, − 83.45 to 78.01). 10w-po, the mean difference was 6.97 (95% limits of agreement, − 87.88 to 101.83). Continuous line = zero line, dashed line = LoA, green line = bias) (PNG 140 kb)

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Prill, R., Becker, R., Schulz, R. et al. No correlation between symmetry-based performance measures and patient-related outcome prior to and after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 3155–3161 (2022). https://doi.org/10.1007/s00167-021-06570-3

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