Validation of Physical Performance Tests in Individuals with Advanced Knee Osteoarthritis



Individuals with advanced osteoarthritis (OA) of the knee experience significant impairments in balance and in essential physical functions such as walking and rising from a chair. There is limited evidence on valid outcome measures to capture these impairments.


We sought to examine the construct validity of three physical performance measures in patients with advanced knee OA: a gait speed (GS) test, the Short Physical Performance Battery (SPPB), and the Timed Up and Go (TUG) test.


We designed a cross-sectional clinical measurement study in which patients with advanced knee OA completed two self-reported measures: the Knee Injury and Osteoarthritis Outcome Score—Physical Function Shortform (KOOS-PS) and a four-part numeric pain rating scale (Q-NPRS). They were also administered the GS test, TUG test, and SPPB. Convergent and divergent construct validity were assessed by examining relationships between the GS test, the SPPB, the TUG test, the KOOS-PS, and the Q-NPRS and calculating Pearson correlation coefficients (r). The scores for the GS, TUG test, and SPPB were compared with established normative values for age-matched healthy controls.


Forty-four subjects (mean age, 66.9 ± 8.1 years) participated in the study. The GS test showed low concordance with the SPPB component tests and the TUG test. The relationships between the physical performance measures and the self-reported measures were low. The scores for the GS test, TUG test, and SPPB in our sample were significantly worse when compared with age-matched normative values, indicating impairments in physical performance.


These results advance the understanding of the validity of the GS test, TUG test, and SPPB in demonstrating the impairments in physical performance that patients with advanced knee OA experience in walking, balancing, and rising from a chair. Future research should examine the reproducibility and responsiveness of the GS test, TUG test, and SPPB in patients with advanced knee OA, in order to facilitate the integration of these measures into clinical practice.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Alghadir A, Anwer S, Brismee JM. The reliability and minimal detectable change of Timed Up and Go test in individuals with grade 1–3 knee osteoarthritis. BMC Musculoskelet Disord. 2015;16:174.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test–retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018;11:851–856.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Arnold JB, Walters JL, Ferrar KE. Does physical activity increase after total hip or knee arthroplasty for osteoarthritis? A systematic review. J Orthop Sports Phys Ther. 2016;46(6):431–442.

    PubMed  Google Scholar 

  4. 4.

    Balasubramanian CK. The community balance and mobility scale alleviates the ceiling effects observed in the currently used gait and balance assessments for the community-dwelling older adults. J Geriatr Phys Ther. 2015;38(2):78–89.

    PubMed  Google Scholar 

  5. 5.

    Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17(4):571–582.

    PubMed  Google Scholar 

  6. 6.

    Bohannon RW. Comfortable and maximum walking speed of adults aged 20–79 years: reference values and determinants. Age Ageing. 1997;26(1):15–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Davis AM, Perruccio AV, Ibrahim S, et al. The trajectory of recovery and the inter-relationships of symptoms, activity and participation in the first year following total hip and knee replacement. Osteoarthritis Cartilage. 2011;19(12):1413–1421.

    CAS  PubMed  Google Scholar 

  8. 8.

    Davis AM, Perruccio AV, Canizares M, et al. The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008;16(5):551–559.

    CAS  PubMed  Google Scholar 

  9. 9.

    Dobson F, Hinman RS, Hall M, et al. Reliability and measurement error of the Osteoarthritis Research Society International (OARSI) recommended performance-based tests of physical function in people with hip and knee osteoarthritis. Osteoarthritis Cartilage. 2017;25(11):1792–1796.

    CAS  PubMed  Google Scholar 

  10. 10.

    Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL. Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2012;20(12):1548–1562.

    CAS  PubMed  Google Scholar 

  11. 11.

    Dobson F, Hinman RS, Roos EM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage. 2013;21(8):1042–1052.

    CAS  PubMed  Google Scholar 

  12. 12.

    Dunlop DD, Song J, Semanik PA, Sharma L, Chang RW. Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Arthritis Rheumatol. 2011;63(1):127–136.

    Google Scholar 

  13. 13.

    Ghasemi A, Zahediasl S. Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metabolism. 2012;10(2):486–489.

    Google Scholar 

  14. 14.

    Gignac MA, Backman CL, Davis AM, et al. Understanding social role participation: what matters to people with arthritis? J Rheumatol. 2008;35(8):1655–1663.

    PubMed  Google Scholar 

  15. 15.

    Graham JE, Ostir GV, Fisher SR, Ottenbacher KJ. Assessing walking speed in clinical research: a systematic review. J Eval Clin Pract. 2008;14(4):552–562.

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221-M231.

    CAS  PubMed  Google Scholar 

  17. 17.

    Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–M94.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Hatfield GL, Morrison A, Wenman M, Hammond CA, Hunt MA. Clinical tests of standing balance in the knee osteoarthritis population: systematic review and meta-analysis. Phys Ther. 2016;96(3):324–337.

    PubMed  Google Scholar 

  19. 19.

    Hawker GA, Stewart L, French MR, et al. Understanding the pain experience in hip and knee osteoarthritis—an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008;16(4):415–422.

    CAS  PubMed  Google Scholar 

  20. 20.

    Hiyama Y, Asai T, Wada O, et al. Gait variability before surgery and at discharge in patients who undergo total knee arthroplasty: a cohort study. PloS One. 2015;10(1):e0117683.

    PubMed  PubMed Central  Google Scholar 

  21. 21.

    Ibrahim A, Singh DKA, Shahar S. “Timed Up and Go” test: age, gender and cognitive impairment stratified normative values of older adults. PloS One. 2017;12(10):e0185641.

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–163.

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Marcum ZA, Zhan HL, Perera S, Moore CG, Fitzgerald GK, Weiner DK. Correlates of gait speed in advanced knee osteoarthritis. Pain Med. 2014;15(8):1334–1342.

    PubMed  Google Scholar 

  24. 24.

    Medina-Mirapeix F, Bernabeu-Mora R, Llamazares-Herran E, Sanchez-Martinez MP, Garcia-Vidal JA, Escolar-Reina P. Interobserver reliability of peripheral muscle strength tests and short physical performance battery in patients with chronic obstructive pulmonary disease: a prospective observational study. Arch Physical Med Rehabil. 2016;97(11):2002–2005.

    Google Scholar 

  25. 25.

    Mehta SP, Sankar A, Venkataramanan V, et al. Cross-cultural validation of the ICOAP and physical function short forms of the HOOS and KOOS in a multi-country study of patients with hip and knee osteoarthritis. Osteoarthritis Cartilage. 2016;24(12):2077–2081.

    CAS  PubMed  Google Scholar 

  26. 26.

    Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. J Aging Phys Act. 2015;23(2):314–322.

    PubMed  Google Scholar 

  27. 27.

    Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Olsen CF, Bergland A. Reliability of the Norwegian version of the short physical performance battery in older people with and without dementia. BMC Geriatr. 2017;17(1):124.

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Ortega-Perez de Villar L, Martinez-Olmos FJ, Junque-Jimenez A, et al. Test–retest reliability and minimal detectable change scores for the short physical performance battery, one-legged standing test and timed up and go test in patients undergoing hemodialysis. PloS One. 2018;13(8):e0201035.

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Perruccio AV, Stefan Lohmander L, Canizares M, et al. The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS)—an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008;16(5):542–550.

    CAS  PubMed  Google Scholar 

  31. 31.

    Peters DM, Fritz SL, Krotish DE. Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults. J Geriatr Phys Ther. 2013;36(1):24–30.

    PubMed  Google Scholar 

  32. 32.

    Sankar A, Davis AM, Palaganas MP, Beaton DE, Badley EM, Gignac MA. Return to work and workplace activity limitations following total hip or knee replacement. Osteoarthritis Cartilage. 2013;21(10):1485–1493.

    CAS  PubMed  Google Scholar 

  33. 33.

    Sebastião E, Sandroff BM, Learmonth YC, Motl RW. Validity of the Timed Up and Go Test as a measure of functional mobility in persons with multiple sclerosis. Arch Phys Med Rehabil. 2016;97(7):1072–1077.

    PubMed  Google Scholar 

  34. 34.

    Segal NA, Yack HJ, Brubaker M, Torner JC, Wallace R. Association of dynamic joint power with functional limitations in older adults with symptomatic knee osteoarthritis. Arch Phys Med Rehabil. 2009;90(11):1821–1828.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Sharma L, Cahue S, Song J, Hayes K, Pai YC, Dunlop D. Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors. Arthritis Rheumatol. 2003;48(12):3359–3370.

    Google Scholar 

  36. 36.

    Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82(2):128–137.

    PubMed  Google Scholar 

  37. 37.

    Steffen T, Seney M. Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther. 2008;88(6):733–746.

    PubMed  Google Scholar 

  38. 38.

    Stratford PW, Kennedy DM. Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol. 2006;59(2):160–167.

    PubMed  Google Scholar 

  39. 39.

    Stratford PW, Kennedy DM, Maly MR, Macintyre NJ. Quantifying self-report measures’ overestimation of mobility scores postarthroplasty. Phys Ther. 2010;90(9):1288–1296.

    PubMed  Google Scholar 

  40. 40.

    Stratford PW, Kennedy DM, Woodhouse LJ. Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Phys Ther. 2006;86(11):1489–1496.

    PubMed  Google Scholar 

  41. 41.

    Takacs J, Garland SJ, Carpenter MG, Hunt MA. Validity and reliability of the community balance and mobility scale in individuals with knee osteoarthritis. Phys Ther. 2014;94(6):866–874.

    PubMed  PubMed Central  Google Scholar 

  42. 42.

    Tasci Bozbas G, Sendur OF, Aydemir AH. Primary knee osteoarthritis increases the risk of falling. J Back Musculoskelet Rehabil. 2017;30(4):785–789.

    PubMed  Google Scholar 

  43. 43.

    Tsonga T, Michalopoulou M, Kapetanakis S, et al. Risk factors for fear of falling in elderly patients with severe knee osteoarthritis before and one year after total knee arthroplasty. J Orthop Surg (Hong Kong). 2016;24(3):302–306.

    Google Scholar 

  44. 44.

    Umehara T, Tanaka R. Effective exercise intervention period for improving body function or activity in patients with knee osteoarthritis undergoing total knee arthroplasty: a systematic review and meta-analysis. Braz J Phys Ther. 2018;22(4):265–275.

    PubMed  Google Scholar 

  45. 45.

    van Leeuwen DM, van de Bunt F, de Ruiter CJ, van Schoor NM, Deeg DJH, Emanuel KS. Functioning without cartilage: older people with radiographic knee osteoarthritis who self-report no functional limitations do score lower on a performance battery. J Aging Phys Act. 2017;25(4):570–575.

    PubMed  Google Scholar 

  46. 46.

    Vasunilashorn S, Coppin AK, Patel KV, et al. Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2009;64A(2):223–229.

    PubMed Central  Google Scholar 

  47. 47.

    Waller B, Munukka M, Rantalainen T, et al. Effects of high intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up. Osteoarthritis Cartilage. 2017;25(8):1238–1246.

    CAS  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Saurabh P. Mehta PT, PhD.

Ethics declarations

Conflict of Interest

Saurabh P. Mehta, PT, PhD, Nathan Morelli, PT, DPT, Caleb Prevatte, PT, DPT, and Derrick White, PT, DPT, declare that they have no conflicts of interest. Ali Oliashirazi, MD, reports grants and personal fees from DePuy Synthes and personal fees from Medtronic and from Zimmer Biomet, outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was obtained from all patients for being included in this study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Level III, Clinical Measurement Study

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mehta, S.P., Morelli, N., Prevatte, C. et al. Validation of Physical Performance Tests in Individuals with Advanced Knee Osteoarthritis. HSS Jrnl 15, 261–268 (2019).

Download citation


  • knee osteoarthritis
  • gait speed
  • physical functioning
  • balance
  • clinical measurement study