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Stisen MB, Pedersen AB, Kjeldsen T, Mechlenburg I. Effect of an exercise intervention targeting hip strengthening in patients undergoing revision total hip replacement-A study protocol for a multicenter randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2101. [PMID: 38859640 DOI: 10.1002/pri.2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/19/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Limited evidence exists regarding the effectiveness of pain relief and functional improvement in patients undergoing revision total hip replacement (THR). Furthermore, there are no clinical guidelines or consensus on optimal rehabilitation after revision THR. PURPOSE The primary aim of this study was to compare the effectiveness of an exercise intervention targeting hip strengthening with standard community-based rehabilitation in patients undergoing revision THR. METHODS This multicenter randomized controlled assessor-blinded trial will be conducted at eight hospitals and multiple municipality rehabilitation centers in Denmark. A total of 84 patients undergoing revision THR are estimated to be allocated to either an exercise intervention targeting hip strengthening (NEMEX-STR) or standard community-based rehabilitation (Usual care). Recruitment was initiated in November 2022 and is expected to be completed by June 2024. The primary outcome is change in functional performance measured by the 30 s chair stand test, from baseline to 4 months after the start of intervention. Secondary outcomes include hip disability and osteoarthritis outcome score; 40 m fast-paced walk test; 9-step timed stair climb test; leg extensor muscle power; global perceived effect; and adverse events. Other outcomes include The International Physical Activity Questionnaires, pain intensity, and European quality of life-5 dimensions. An intention-to-treat approach will be used for analyzing changes in primary and secondary outcome measures. The trial was approved by the Central Denmark Region Committees on Health Research Ethics (Journal No 1-10-72-134-22) and registered on the Central Denmark Regions' internal list of research projects (Journal No 1-16-02-285-22). DISCUSSION To our knowledge, this study is the first to explore different rehabilitation programs after revision THR through a randomized controlled trial. The results will provide clinically relevant evidence for optimal rehabilitation after revision THR for improving functional performance, physical function, and quality of life, with great importance for patients, relatives, physiotherapists, and decision-makers. CLINICALTRIAL GOV: NCT05657054.
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Affiliation(s)
- Martin Bækgaard Stisen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Alma Becic Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Troels Kjeldsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Public Health, Section of Sports, Aarhus University, Aarhus, Denmark
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Robbins SM, Tyrpenou E, Lee S, Ippersiel P, Antoniou J. Impact of combined lumbar spine fusion and total hip arthroplasty on spine, pelvis, and hip kinematics during a sit to stand task. J Electromyogr Kinesiol 2024; 75:102871. [PMID: 38460219 DOI: 10.1016/j.jelekin.2024.102871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
Lumbar fusion is a risk factor for hip dislocation following total hip arthroplasty (THA). The objective was to compare joint/segment angles during sit-stand-sit in participants that had a THA with and without a lumbar fusion. The secondary objective was to compare pain, physical function, disability, and quality of life. This cross-sectional study includes participants that had THA and lumbar fusion (THA-fusion; n = 12) or THA only (THA-only; n = 12). Participants completed sit-stand-sit trials. Joint/segment angles were measured using electromagnetic motion capture. Angle characteristics were determined using principal component analysis. Hierarchical linear models examined relationships between angle characteristics and groups. Pain, physical function, and disability were compared using Mann-Whitney U tests. Upper lumbar spine was more extended during sit-stand-sit in the THA-fusion group (b = 42.41, P = 0.04). The pelvis was more posteriorly and anteriorly tilted during down and end sit-stand-sit phases, respectively, in the THA-fusion group (b = 12.21, P = 0.03). There were no significant associations between group and other angles. THA-fusion group had worse pain, physical function, disability, and quality of life. Although differences in spine joint, pelvis segment, and hip joint angles existed, these findings are unlikely to account for the increased incidence of hip dislocation after total hip arthroplasty in patients that had spine fusion.
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Affiliation(s)
- Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
| | - Evangelos Tyrpenou
- Division of Orthopaedic Surgery, SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Soomin Lee
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Patrick Ippersiel
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - John Antoniou
- Division of Orthopaedic Surgery, SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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Murao M, Nankaku M, Kawano T, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Reproducibility, criterion-related validity, and minimal clinically important difference of the stair negotiation test after total Hip arthroplasty. Physiother Theory Pract 2023; 39:2438-2445. [PMID: 35581533 DOI: 10.1080/09593985.2022.2078255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA). METHODS Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC1,1) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method. RESULTS The ICC1,1 of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p < .05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds. CONCLUSION The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability.
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Affiliation(s)
- Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Waiteman MC, Garcia MC, Briani RV, Norte G, Glaviano NR, De Azevedo FM, Bazett-Jones DM. Can Clinicians Trust Objective Measures of Hip Muscle Strength From Portable Dynamometers? A Systematic Review With Meta-analysis and Evidence Gap Map of 107 Studies of Reliability and Criterion Validity Using the COSMIN Methodology. J Orthop Sports Phys Ther 2023; 53:655-672. [PMID: 37787581 DOI: 10.2519/jospt.2023.12045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
OBJECTIVE: To summarize the evidence on reliability and criterion validity of hip muscle strength testing using portable dynamometers. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from inception to March 2023. STUDY SELECTION CRITERIA: We included studies investigating reliability or criterion validity of hip flexor, extensor, abductor, adductor, or internal/external rotator strength testing with portable dynamometers in injury-free individuals or those with pelvic/lower limb musculoskeletal disorders. DATA SYNTHESIS: We performed meta-analyses for each muscle group, position, and method of fixation. We rated pooled results as sufficient (>75% of studies with correlations ≥0.70), insufficient (>75% of studies with correlations <0.70), or inconsistent (sufficient/insufficient results). We assessed the quality of evidence, created evidence gap maps, and made clinical recommendations. RESULTS: We included a total of 107 studies (reliability 103, validity 14). The intrarater and interrater reliability for hip muscle strength testing across different positions and methods of fixation was sufficient (intraclass correlation coefficient = 0.78-0.96) with low- to high-quality evidence. Criterion validity was less investigated and mostly inconsistent (very low-to moderate-quality evidence) with a wide range of correlations (r = 0.40-0.93). CONCLUSION: Hip muscle strength testing using portable dynamometers is reliable. The use of portable dynamometers as clinical surrogates for measuring strength using an isokinetic dynamometer requires further investigation. Clinicians testing hip muscle strength with portable dynamometers should use external fixation seated for hip flexors, prone or supine for hip extensors, side-lying or supine for abductors and adductors, and prone and seated for internal and external rotators. J Orthop Sports Phys Ther 2023;53(11):655-672. Epub 3 October 2023. doi:10.2519/jospt.2023.12045.
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Foldager F, Jørgensen PB, Tønning LU, Petersen ET, Jakobsen SS, Vainorius D, Homilius M, Hansen TB, Stilling M, Mechlenburg I. The relationship between muscle power, functional performance, accelerometer-based measurement of physical activity and patient-reported outcomes in patients with hip osteoarthritis: A cross-sectional study. Musculoskelet Sci Pract 2022; 62:102678. [PMID: 36335851 DOI: 10.1016/j.msksp.2022.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with unilateral hip osteoarthritis appear to have between-leg differences in leg extension power (LEP). The Nottingham Leg Extensor Power Rig provides reliable and valid results but requires sensitive equipment. It would be relevant to identify measures closely associated with this test. OBJECTIVE (i) To investigate if LEP is lower in the affected leg compared to the non-affected leg. Furthermore, to investigate the associations between LEP and the measures: (ii) Functional performance, (iii) accelerometer-based measurement of physical activity and (iv) patient-reported outcome measures (PROM). DESIGN Cross-sectional study including 60 patients (30 men, 30 women) with hip osteoarthritis scheduled for hip replacement. METHOD The counter movement jump and 10-m sprint tests were used to determine functional performance, accelerometer-sensors were used to determine physical activity and the Copenhagen Hip and Groin Outcome Score (HAGOS) was used to determine PROM. RESULTS (i) LEP in the affected leg corresponded to 79% [95% CI 74%; 85%] of the non-affected leg, (ii) LEP was positively associated with functional performance tests (β 0.63 to 0.78, p < 0.05), (iii) positively associated although non-significantly with physical activity (β 0.16 to 0.23, p > 0.05) and (iv) positively associated with the six HAGOS subscales (β 0.25 to 0.54, p < 0.05). CONCLUSION Functional performance tests may be used as feasible, inexpensive and fast ways to assess LEP in clinical settings. These results may suggest that interventions aimed at improving LEP can improve functional performance and PROM, but not physical activity. Future research is needed to confirm the causality of these cross-sectional findings. THE CLINICAL TRIAL REGISTRATION NUMBERS Danish Data Protection Agency (1-16-02-640-14), ClinicalTrials.gov (NTC02301182) and approved by the Danish Biomedical Research Ethics Committee (1-10-72- 343-14) prior to data collection.
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Affiliation(s)
- Frederik Foldager
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark.
| | - Peter Bo Jørgensen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark
| | - Lisa Urup Tønning
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark
| | - Emil Toft Petersen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark
| | - Dovydas Vainorius
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Morten Homilius
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Bieler T, Magnusson SP, Siersma V, Rinaldo M, Schmiegelow MT, Beck T, Krifa AM, Kjær BH, Palm H, Midtgaard J. Effectiveness of promotion and support for physical activity maintenance post total hip arthroplasty-study protocol for a pragmatic, assessor-blinded, randomized controlled trial (the PANORAMA trial). Trials 2022; 23:647. [PMID: 35964101 PMCID: PMC9375375 DOI: 10.1186/s13063-022-06610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Total hip arthroplasty is considered an efficacious procedure for relieving pain and disability, but despite that objectively measured physical activity level remains unchanged compared to pre-surgery and is still considerably lower than that of a healthy age- and sex-matched population 6–12 months post-surgery. Since there is a graded relationship between physical activity level and functional performance, increasing physical activity may enhance the outcome of the procedure. This study aims to investigate whether promotion and support of physical activity initiated 3 months after total hip arthroplasty complementary to usual rehabilitation care can increase objective measured physical activity 6 months post-surgery. Methods The trial is designed as a pragmatic, parallel group, two-arm, assessor-blinded, superiority, randomized (1:1), controlled trial with post intervention follow-up 6 and 12 months after total hip arthroplasty. Home-dwelling, independent, and self-reliant patients with hip osteoarthritis are provisionally enrolled prior to surgery and re-screened about 2–3 months post-surgery to confirm eligibility. Baseline assessment is conducted 3 months post-surgery. Subsequently, patients (n=200) are randomized to either a 3-month, multimodal physical activity promotion/education intervention or control (no further attention). The intervention consists of face-to-face and telephone counselling, patient education material, pedometer, and step-counting journal. The primary outcome is objectively measured physical activity, specifically the proportion of patients that complete on average ≥8000 steps per day 6 months post-surgery. Secondary outcomes include core outcomes (i.e., physical function, pain, and patient global assessment) and health-related quality of life. Furthermore, we will explore the effect of the intervention on self-efficacy and outcome expectations (i.e., tertiary outcomes). Discussion By investigating the effectiveness of a pedometer-driven, face-to-face, and telephone-assisted counselling, behavior change intervention in complementary to usual rehabilitation, we hope to deliver applicable and generalizable knowledge to support physical activity after total hip arthroplasty and potentially enhance the outcome of the procedure. Trial registration www.clinicaltrials.govNCT04471532. Registered on July 15, 2020.
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Affiliation(s)
- Theresa Bieler
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.,Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 8, Building 8, 2400, Copenhagen, NV, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, building 24, entrance R, 1353, Copenhagen K, Denmark
| | - Mie Rinaldo
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Morten Torrild Schmiegelow
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Torben Beck
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | | | - Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Nordstjernevej 41, 2600, Glostrup, Denmark
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Fernandes L, Holm CE, Villadsen A, Sørensen MS, Zebis MK, Petersen MM. Clinically Important Reductions in Physical Function and Quality of Life in Adults with Tumor Prostheses in the Hip and Knee: A Cross-sectional Study. Clin Orthop Relat Res 2021; 479:2306-2319. [PMID: 33974591 PMCID: PMC8445557 DOI: 10.1097/corr.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with a bone sarcoma who undergo limb-sparing surgery and reconstruction with a tumor prosthesis in the lower extremity have been shown to have reduced self-reported physical function and quality of life (QoL). To provide patients facing these operations with better expectations of future physical function and to better evaluate and improve upon postoperative interventions, data from objectively measured physical function have been suggested. QUESTIONS/PURPOSES We sought to explore different aspects of physical function, using the International Classification of Functioning, Disability, and Health (ICF) as a framework, by asking: (1) What are the differences between patients 2 to 12 years after a bone resection and reconstruction surgery of the hip and knee following resection of a bone sarcoma or giant cell tumor of bone and age-matched controls without walking limitations in ICF body functions (ROM, muscle strength, pain), ICF activity and participation (walking, getting up from a chair, daily tasks), and QoL? (2) Within the patient group, do ICF body functions and ICF activity and participation outcome scores correlate with QoL? METHODS Between 2006 and 2016, we treated 72 patients for bone sarcoma or giant cell tumor of bone resulting in bone resection and reconstruction with a tumor prosthesis of the hip or knee. At the timepoint for inclusion, 47 patients were alive. Of those, 6% (3 of 47) had undergone amputation in the lower limb and were excluded. A further 32% (14 of 44) were excluded because of being younger than 18 years of age, pregnant, having long transportation, palliative care, or declining participation, leaving 68% (30 of 44) for analysis. Thus, 30 patients and 30 controls with a mean age of 51 ± 18 years and 52 ± 17 years, respectively, were included in this cross-sectional study. Included patients had been treated with either a proximal femoral (40% [12 of 30]), distal femoral (47% [14 of 30]), or proximal tibia (13% [4 of 30]) reconstruction. The patients were assessed 2 to 12 years (mean 7 ± 3 years) after the resection-reconstruction. The controls were matched on gender and age (± 4 years) and included if they considered their walking capacity to be normal and had no pain in the lower extremity. Included outcome measures were: passive ROM of hip flexion, extension, and abduction and knee flexion and extension; isometric muscle strength of knee flexion, knee extension and hip abduction using a hand-held dynamometer; pain intensity (numeric rating scale; NRS) and distribution (pain drawing); the 6-minute walk test (6MWT); the 30-second chair-stand test (CST); the Toronto Extremity Salvage Score (TESS), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The TESS and the EORTC QLQ-C30 were normalized to 0 to 100 points. Higher scoring represents better status for TESS and EORTC global health and physical functioning scales. Minimum clinically important difference for muscle strength is 20% to 25%, NRS 2 points, 6MWT 14 to 31 meters, CST 2 repetitions, TESS 12 to 15 points, and EORTC QLQ-C30 5 to 20 points. RESULTS Compared with controls, the patients had less knee extension and hip abduction strength in both the surgical and nonsurgical limbs and regardless of reconstruction site. Mean knee extension strength in patients versus controls were: surgical limb 0.9 ± 0.5 Nm/kg versus 2.1 ± 0.6 Nm/kg (mean difference -1.3 Nm/kg [95% CI -1.5 to -1.0]; p < 0.001) and nonsurgical limb 1.7 ± 0.6 Nm/kg versus 2.2 ± 0.6 Nm/kg (mean difference -0.5 Nm/kg [95% CI -0.8 to -0.2]; p = 0.003). Mean hip abduction strength in patients versus controls were: surgical limb 1.1 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (mean difference -0.7 Nm/kg [95% CI -1.0 to -0.5]; p < 0.001) and nonsurgical limb 1.5 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (-0.4 Nm/kg [95% CI -0.6 to -0.2]; p = 0.001). Mean hip flexion ROM in patients with proximal femoral reconstructions was 113° ± 18° compared with controls 130° ± 11° (mean difference -17°; p = 0.006). Mean knee flexion ROM in patients with distal femoral reconstructions was 113° ± 29° compared with patients in the control group 146° ± 9° (mean difference -34°; p = 0.002). Eighty-seven percent (26 of 30) of the patients reported pain, predominantly in the knee, anterior thigh, and gluteal area. The patients showed poorer walking and chair-stand capacity and had lower TESS scores than patients in the control group. Mean 6MWT was 499 ± 100 meters versus 607 ± 68 meters (mean difference -108 meters; p < 0.001), mean CST was 12 ± 5 repetitions versus 18 ± 5 repetitions (mean difference -7 repetitions; p < 0.001), and median (interquartile range) TESS score was 78 (21) points versus 100 (10) points (p < 0.001) in patients and controls, respectively. Higher pain scores correlated to lower physical functioning of the EORTC QLQ-C30 (Rho -0.40 to -0.54; all p values < 0.05). Less muscle strength in knee extension, knee flexion, and hip abduction correlated to lower physical functioning of the EORTC QLQ-C30 (Rho 0.40 to 0.51; all p values < 0.05). CONCLUSION This patient group demonstrated clinically important muscle weaknesses not only in resected muscles but also in the contralateral limb. Many patients reported pain, and they showed reductions in walking and chair-stand capacity comparable to elderly people. The results are relevant for information before surgery, and assessments of objective physical function are advisable in postoperative monitoring. Prospective studies evaluating the course of physical function and which include assessments of objectively measured physical function are warranted. Studies following this patient group with repetitive measures over about 5 years could provide information about the course of physical function, enable comparisons with population norms, and lead to better-designed, targeted, and timely postoperative interventions. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Linda Fernandes
- Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Christina Enciso Holm
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Allan Villadsen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Michala Skovlund Sørensen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mette Kreutzfeldt Zebis
- Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Coleman G, Dobson F, Hinman RS, Bennell K, White DK. Measures of Physical Performance. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:452-485. [PMID: 33091270 DOI: 10.1002/acr.24373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Fiona Dobson
- University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Bennell
- University of Melbourne, Melbourne, Victoria, Australia
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Larsen JB, Skou ST, Arendt-Nielsen L, Simonsen O, Madeleine P. Neuromuscular exercise and pain neuroscience education compared with pain neuroscience education alone in patients with chronic pain after primary total knee arthroplasty: study protocol for the NEPNEP randomized controlled trial. Trials 2020; 21:218. [PMID: 32197629 PMCID: PMC7083002 DOI: 10.1186/s13063-020-4126-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/31/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is considered an effective treatment for pain relief and improved physical performances in end-stage knee osteoarthritis. However, several studies have reported less favorable outcomes after TKA with chronic pain rates of approximately 20%. Exercise might be an effective treatment strategy for chronic pain following TKA, but no randomized controlled trials have evaluated its effect. Therefore, the purpose of this randomized controlled trial is to investigate whether a 12-week neuromuscular exercise (NEuroMuscular EXercise training program for patients with knee or hip osteoarthritis assigned for total joint replacement; NEMEX-TJR) program combined with pain neuroscience education (PNE) provides greater pain relief and improvement in physical performances than PNE alone at 12 months follow-up in a population of patients with chronic pain after primary TKA. METHODS For this randomized controlled superiority trial, 120 patients with moderate-to-severe chronic pain after TKA are recruited from Aalborg University Hospital, Denmark. Patients are randomly assigned in a 1:1 ratio to one of two interventions: (a) NEMEX-TJR twice weekly for 12 weeks combined with two sessions of PNE or (b) two sessions of PNE given over 6 weeks. Assessment is performed at baseline before intervention and at 3, 6, and 12 months after initiation of the intervention. Outcome assessors are blinded toward group allocation. The primary outcome is the change in the Knee Injury and Osteoarthritis Outcome Score4 (KOOS4), defined as the mean score for the KOOS subscales pain, symptoms, activities of daily living, and quality of life. Secondary outcomes include all KOOS subscale scores and scores for PainDETECT, the Fear-Avoidance Beliefs Questionnaire, Global Perceived Effect, the Pain Catastrophizing Scale, pain intensities, temporal summation, conditioned pain modulation, and pressure pain thresholds. Physical performances are measured with walking, stair climbing, and chair standing tests as well as tests of muscle strength and power. DISCUSSION The findings will be useful in establishing effective treatment strategies for chronic pain after TKA. The randomized controlled trial involves rigorous scientific methods and uses clinically applicable interventions. The study interventions are conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the health care systems. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03886259. Registered 22 March 2019. Ethics committee registration: N-20180046.
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Affiliation(s)
- Jesper Bie Larsen
- Translational Pain Biomarker, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark. .,Sports Sciences - Performance and Technology, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Lars Arendt-Nielsen
- Translational Pain Biomarker, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Simonsen
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Pascal Madeleine
- Sports Sciences - Performance and Technology, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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10
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Hyytiäinen HK, Morelius M, Lappalainen AK, Bostrom AF, Lind KA, Junnila JJT, Hielm-Björkman A, Laitinen-Vapaavuori O. The Finnish Canine Stifle Index: responsiveness to change and intertester reliability. Vet Rec 2019; 186:604. [PMID: 31685656 PMCID: PMC7365560 DOI: 10.1136/vr.105030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/08/2019] [Accepted: 10/18/2019] [Indexed: 11/05/2022]
Abstract
Background The responsiveness and the intertester reliability of the Finnish Canine Stifle Index (FCSI) were tested, and a cut-off between compromised and severely compromised performance level was set. Methods Three groups of dogs were used, 29 with any stifle dysfunction (STIF), 17 with other musculoskeletal disease except stifle (OTHER) and 11 controls (CTRL). All dogs were tested with the FCSI by the same physiotherapist at three occasions, at baseline, at six weeks and 10 weeks, and once also by another physiotherapist. Results Dogs in the STIF group demonstrated significantly higher (P<0.001) FCSI scores than in OTHER or CTRL groups at baseline. Only the STIF group showed a significant (P<0.001) change in FCSI score at all time points, indicating responsiveness to change. There were no significant differences between the evaluators (P=0.736), showing good intertester reliability, supported by moderate to good (0.78) intraclass correlation coefficient (ICC). The evaluator performing the FCSI did not have a significant effect when comparing the groups of dogs (P=0.214). The 95 per cent confidence intervals of the ICC per group were 0.79 (0.60, 0.91) for STIF, 0.83 (0.53, 0.96) for OTHER 0.78 (0.64, 0.88) for all dogs. A cut-off differentiating a severely compromised from a compromised performance was set at 120, having sensitivity of 83 per cent and specificity of 89 per cent. Conclusion The FCSI is a recommendable measure of dogs’ stifle functionality.
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Affiliation(s)
- Heli K Hyytiäinen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Mikael Morelius
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Anu K Lappalainen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Anna F Bostrom
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Kirsti A Lind
- Veterinary Teaching Hospital, University of Helsinki, Helsinki, Finland
| | | | - Anna Hielm-Björkman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Outi Laitinen-Vapaavuori
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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11
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Mikkelsen LR, Madsen MN, Rathleff MS, Thorborg K, Rossen CB, Kallemose T, Bandholm T. Pragmatic Home-Based Exercise after Total Hip Arthroplasty - Silkeborg: Protocol for a prospective cohort study (PHETHAS-1). F1000Res 2019; 8:965. [PMID: 31448107 PMCID: PMC6694449 DOI: 10.12688/f1000research.19570.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: Rehabilitation exercises are offered to patients after total hip arthroplasty (THA); however, the effectiveness and optimal type and dose of exercise remains unknown. The primary objective of this trial is to indicate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA, based on the relationship between the performed exercise dose and the change in performance-based function (gait speed) from 3 (start of intervention) to 10 weeks (end of intervention) after surgery. The secondary objective is to investigate if a dose-response relationship exists between the performed exercise dose and changes in: hip-related disability, lower-extremity functional performance, and hip muscle strength Methods: In this prospective cohort study, patients scheduled for THA will be consecutively included until 88 have completed the intervention period from 3 to 10 weeks postoperatively. Participants perform the standard rehabilitation program with elastic band exercises. Exercise dose (exposure) will be objectively quantified using a sensor attached to the elastic band. The primary outcome is gait speed measured by the 40-m fast-paced walk test. Secondary outcomes include: patient reported hip disability (Hip disability and Osteoarthritis Outcome Score (HOOS)), hip muscle strength (hand-held dynamometry) and lower extremity function (30-s chair stand test). Discussion: This trial will add knowledge concerning the relationship between performed exercise dose and post-operative outcomes after THA. The protocol paper describes the study design and methods in detail, including the statistical analysis plan. Trial registration: Pre-registered on March 27, 2017 at ClinicalTrails.gov (ID: NCT03109821).
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Affiliation(s)
- Lone Ramer Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Michael Skovdal Rathleff
- Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Occupational and Physical Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | | | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Occupational and Physical Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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12
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Mikkelsen LR, Madsen MN, Rathleff MS, Thorborg K, Rossen CB, Kallemose T, Bandholm T. Pragmatic Home-Based Exercise after Total Hip Arthroplasty - Silkeborg: Protocol for a prospective cohort study (PHETHAS-1). F1000Res 2019; 8:965. [PMID: 31448107 PMCID: PMC6694449 DOI: 10.12688/f1000research.19570.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 07/20/2023] Open
Abstract
Introduction: Rehabilitation exercises are offered to patients after total hip arthroplasty (THA); however, the effectiveness and optimal type and dose of exercise remains unknown. The primary objective of this trial is to indicate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA, based on the relationship between the performed exercise dose and the change in performance-based function (gait speed) from 3 (start of intervention) to 10 weeks (end of intervention) after surgery. The secondary objective is to investigate if a dose-response relationship exists between the performed exercise dose and changes in: hip-related disability, lower-extremity functional performance, and hip muscle strength Methods: In this prospective cohort study, patients scheduled for THA will be consecutively included until 88 have completed the intervention period from 3 to 10 weeks postoperatively. Participants perform the standard rehabilitation program with elastic band exercises. Exercise dose (exposure) will be objectively quantified using a sensor attached to the elastic band. The primary outcome is gait speed measured by the 40-m fast-paced walk test. Secondary outcomes include: patient reported hip disability (Hip disability and Osteoarthritis Outcome Score (HOOS)), hip muscle strength (hand-held dynamometry) and lower extremity function (30-s chair stand test). Discussion: This trial will add knowledge concerning the relationship between performed exercise dose and post-operative outcomes after THA. The protocol paper describes the study design and methods in detail, including the statistical analysis plan. Trial registration: Pre-registered on March 27, 2017 at ClinicalTrails.gov (ID: NCT03109821).
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Affiliation(s)
- Lone Ramer Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Michael Skovdal Rathleff
- Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Occupational and Physical Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | | | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Occupational and Physical Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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13
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Hansen H, Beyer N, Frølich A, Godtfredsen N, Bieler T. Intra- and inter-rater reproducibility of the 6-minute walk test and the 30-second sit-to-stand test in patients with severe and very severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3447-3457. [PMID: 30425474 PMCID: PMC6203115 DOI: 10.2147/copd.s174248] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In patients with COPD, the 6-minute walk test (6MWT) and the 30-second sit-to-stand test (30sec-STS) are widely used as clinical outcome measures of walking capacity, lower limb muscle strength, and functional ability. Due to a documented learning effect, at least two trials are recommended for assessment. The aim of our study was to investigate the intra- and inter-rater reliability and agreement of the two tests in patients with severe and very severe COPD (FEV1 <50%). Patients and methods Fifty patients (22 females; mean [SD]: age 67 [9] years, FEV1 predicted 32 [9]%) were assessed with the 6MWT and the 30sec-STS twice by the same assessor on test-day 1 (T1) and by another assessor 7–10 days later on test-day 2 (T2). Results The 6MWT intra- and inter-rater reliability (intraclass correlation coefficient, ICC1.1) was 0.98 (lower limit 95% CI: 0.94) and 0.96 (lower limit 95% CI: 0.94), respectively, and agreement (standard error of the measurement, SEM) was 14.8 and 20.5 m, respectively. The 30sec-STS intra- and inter-rater reliability and agreement results were, respectively, ICC1.1 0.94 (lower limit 95% CI: 0.90) and 0.92 (lower limit 95% CI: 0.86), with SEM of 0.97 and 1.14 repetitions. There was no difference (95% CI: −5.3; 8.1) between the 6MWT distances on T1, while the mean walking distance improved 7.9 m (0.0 m; 15.8 m) from T1 to T2. Improvement on the same test date was less likely (OR: 3.6 [95% CI: 1.1; 11.8], Fisher’s exact test, P=0.047) in patients who walked less than 350 m in the 6MWT. We found no clinically relevant learning effect in the 30sec-STS. Conclusion In patients with severe and very severe COPD the 6MWT and the 30sec-STS showed excellent intra- and inter-rater reliability and acceptable agreement. No learning effect was documented for the tests when performed on the same day. Our data suggest that in clinical practice using different assessors is acceptable, and that a single test trial may be sufficient to assess patients with severe and very severe COPD.
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Affiliation(s)
- Henrik Hansen
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark,
| | - Nina Beyer
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark,
| | - Nina Godtfredsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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14
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Correspondence: Time-based versus repetition-based sit-to-stand measures: choice of metrics matters. J Physiother 2018; 64:200-201. [PMID: 29914806 DOI: 10.1016/j.jphys.2018.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022] Open
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15
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Mikkelsen LR, Mechlenburg I, Søballe K, Jørgensen LB, Mikkelsen S, Bandholm T, Petersen AK. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations. A single-blinded randomised controlled trial. Osteoarthritis Cartilage 2014; 22:2051-8. [PMID: 25305374 DOI: 10.1016/j.joca.2014.09.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/26/2014] [Accepted: 09/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine if 2 weekly sessions of supervised progressive resistance training (PRT) in combination with 5 weekly sessions of unsupervised home-based exercise is more effective than 7 weekly sessions of unsupervised home-based exercise in improving leg-extension power of the operated leg 10 weeks after total hip replacement (THR) in patients with lower pre-operative function. METHOD A total of 73 patients scheduled for THR were randomised (1:1) to intervention group (IG, home based exercise 5 days/week and PRT 2 days/week) or control group (CG, home based exercise 7 days/week). The primary endpoint was change in leg extension power at 10 week follow up. Secondary outcomes were isometric hip muscle strength, sit-to-stand test, stair climb test, 20 m walking speed and patient-reported outcome (HOOS). RESULTS Sixty-two completed the trial (85%). Leg extension power increased from baseline to the 10 week follow up in both groups; mean [95% CI] IG: 0.29 [0.13; 0.45] and CG: 0.26 [0.10; 0.42] W/kg, with no between-group difference (primary outcome) (P = 0.79). Maximal walking speed (P = 0.008) and stair climb performance (P = 0.04) improved more in the IG compared to CG, no other between-group differences existed. CONCLUSIONS In this trial, supervised PRT twice a week in addition to 5 weekly sessions of unsupervised exercise for 10 weeks was not superior to 7 weekly sessions of unsupervised home-based exercise for 10 weeks in improving the primary outcome, leg-extension power of the operated leg, at the primary endpoint 10 weeks after surgery in THR patients with lower pre-operative function. TRIAL REGISTRATION NCT01214954.
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Affiliation(s)
- L R Mikkelsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Denmark.
| | - I Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.
| | - K Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.
| | - L B Jørgensen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
| | - S Mikkelsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark.
| | - T Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery and Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
| | - A K Petersen
- Department of Physiotherapy- and Occupational Therapy, Aarhus University Hospital, Denmark; Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University, Denmark.
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