The A-test: assessment of functional recovery during early rehabilitation of patients in an orthopedic ward – content, criterion and construct validity

Aleksandra Vukomanović; Aleksandar Djurović; Zoran Popović; Vesna Pejović

doi:10.2298/3254

Aleksandra Vukomanović Clinic for Physical Medicine and Rehabilitation, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Aleksandar Djurović Clinic for Physical Medicine and Rehabilitation, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Zoran Popović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia
Vesna Pejović Clinic for Physical Medicine and Rehabilitation, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/3254

Keywords: hip prosthesis, orthopedic procedures, postoperative period, physical therapy, recovery of function, predictive value of the tests,

Abstract

Background/Aim. The A-test was designed for assessment of functional recovery during early rehabilitation of patients in an orthopedic ward. This performance-based test consists of 10 items for assessing basic activities by a six level ordinal scale (0–5). Total scores can range from 0 to 50, i.e. from inability to perform any activity despite the help of therapists to complete independence and safety in performing all activities. The aim of this study was to examine the A-test validity. Methods. This prospective study was conducted in an orthopedic ward and included 120 patients [60 patients with hip osteoarthritis that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF)] during early inpatient rehabilitation (1st–5th day). Validity was examined through 3 aspects: content validity – floor and ceiling effect, range, skewness; criterion validity – concurrent validity [correlation with the University of Iowa Level of Assistance Scale (ILAS) for patients with hip osteoarthritis, and with the Cumulated Ambulation Score (CAS) for patients with HF, Spearman rank correlation] and predictive validity [the New Mobility Score (NMS) 4 weeks after surgery, Mann-Whitney U test]; construct validity – 4 hypotheses: 1) on the fifth day of rehabilitation in patients underwent arthroplasty due to hip osteoarthritis, the A-test results will strongly correlate with those of ILAS, while the correlation with the Harris hip score will be less strong; 2) in patients with HF, the A-test results will be significantly better in those with allowed weight bearing as compared to patients whom weight bearing is not allowed while walking; 3) results of the A-test will be significantly better in patients with hip osetoarthritis than in those with HF; 4) the A-test results will be significantly better in patients younger than 65 years than in those aged 65 years and older. Results. The obtained results were: low floor (1%) and ceiling (2%) effect, range 0–50, skewness 0.57, strong correlation with ILAS for the patients with hip osteoarthritis (r = -0.97, p = 0.000) and with CAS for the patients with hip fracture (r = 0.91, p = 0.000) The patients with the A-test score 35 and more on the fifth day of rehabilitation (n = 46, Md = 4) had significantly higher NMS rank 4 weeks after surgery than the patients with the A-test score less than 35 (n = 59, Md = 2), (U = 379, z = -6.47, p = 0.000, r = 0.63). All 4 hypotheses were confirmed. Conclusion. The A-test is simple and valid instrument for everyday evaluation of pace and degree of functional recovery during early rehabilitation of patients surgically treated in an orthopedic ward.

Author Biographies

Aleksandra Vukomanović, Clinic for Physical Medicine and Rehabilitation, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Asistent na Medicinskom fakultetu Univerziteta odbrane u Beogradu, spefijalista fizikalne medicine i rehabilitacije u Klinici za fizikalnu medicinu i rehabilitaciju VMA

Aleksandar Djurović, Clinic for Physical Medicine and Rehabilitation, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Profesor na Medicinskom fakultetu Univerziteta odbrane u Beogradu, Načelnik Klinike za fizikalnu medicinu i rehabilitaciju VMA

Zoran Popović, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia

Profesor na Medicinskom fakultetu Univerziteta odbrane u Beogradu, specijalista ortopedske hirurgije i traumatologije

Vesna Pejović, Clinic for Physical Medicine and Rehabilitation, Military Medical Academy, Belgrade, Serbia

spefijalista fizikalne medicine i rehabilitacije u Klinici za fizikalnu medicinu i rehabilitaciju VMA

References

Stucki G, Stier-Jarmer M, Grill E, Melvin J. Rationale and princi-ples of early rehabilitation care after an acute injury or illness. Disabil Rehabil 2005; 27(7−8): 353−09.

Küçükdeveci AA, Tennant A, Grimby G, Franchignoni F. Strategies for assessment and outcome measurement in physical and re-habilitation medicine: an educational review. J Rehabil Med 2011; 43(8): 661−72.

Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standard-ized outcome measures in physical therapist practice: percep-tions and applications. Phys Ther 2009; 89(2): 125−35.

Shields RK, Leo KC, Miller B, Dostal WF, Barr R. An acute care physical therapy clinical practice database for outcomes re-search. Phys Ther 1994; 74(5): 463−70.

Shields RK, Enloe LJ, Evans RE, Smith KB, Steckel SD. Reliability, validity, and responsiveness of functional tests in patients with total joint replacement. Phys Ther 1995; 75(3): 169−76.

Duke RG, Keating JL. An investigation of factors predictive of independence in transfers and ambulation after hip fracture. Arch Phys Med Rehabil 2002; 83(2): 158−64.

Foss NB, Kristensen MT, Kehlet H. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score. Clin Rehabil 2006; 20(8): 701−8.

Kristensen MT, Bandholm T, Foss NB, Ekdahl C, Kehlet H. High inter-tester reliability of the new mobility score in patients with hip fracture. J Rehabil Med 2008; 40(7): 589−91.

Kristensen MT, Andersen L, Bech-Jensen R, Moos M, Hovmand B, Ekdahl C, et al. High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture. Clin Rehabil 2009; 23(12): 1116−23.

Vukomanović A, Popović Z, Durović A, Krstić L. The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergo-ing total hip arthroplasty. Vojnosanit Pregl 2008; 65(4): 291−7.

Hodkinson HM. Evaluation of a mental test score for assess-ment of mental impairment in the elderly. Age Ageing 1972; 1(4): 233-8.

Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993; 75(5): 797−8.

Mohoney FI, Barthel DW. Functional evaluation: the Barthel In-dex. Maryland State Med J 1956; 14: 62−5.

Haris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg (Am) 1969; 51(4): 737−55.

Dawson J, Fitzpatrick R, Carr A, Murray D. Questionare on the perception of patients about total hip replacement. J Bone Surg Br 1996; 78(2): 185−90.

Jaglal S, Lakhani Z, Schatzker J. Reliability, validity, and responsiveness of the lower extremity measure for patients with a hip fracture. J Bone Joint Surg Am 2000; 82(7): 955−62.

Swiontkowski MF, Engelberg R, Martin DP, Agel J. Short muscu-loskeletal function assessment questionnaire: validity, reliability, and responsiveness. J Bone Joint Surg Am 1999; 81(9): 1245−60.

Hoang-Kim A, Schemitsch E, Bhandari M, Kulkarni AV, Beaton D. Outcome assessment in hip fracture: evaluation of the practi-cality of commonly-used outcomes in hip fracture studies. Arch Orthop Trauma Surg 2011; 131(12): 1687−95.

Norvell DC, Dettori JR, Suk M. What makes a quality outcomes instruments. In: Suk M, Hanson BP, Norvell DC, Helfet DL, edi-tors. Musculosceletal outcomes measures and instruments. New York: AO Foundation Publisching, Thieme; 2009. p. 7−25.

Terwee CB, Mokkink LB, Steultjens MP, Dekker J. Performance-based methods for measuring the physical function of patients with osteoarthritis of the hip or knee: a systematic review of measurement properties. Rheumatology 2006; 45(7): 890−902.

Mcdowell I. Measuring health. A quide to rating scales and ques-tionnaires. 3rd ed. New York: Oxford University Press; 2006.