A-test: procena funkcionalnog oporavka tokom rane rehabilitacije bolesnika na ortopedskom odeljenju – validnost sadržaja, kriterijuma i konstrukcije

  • 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
Ključne reči: hip prosthesis||, ||kuk, proteza, orthopedic procedures||, ||ortopedske procedure, postoperative period||, ||postoperativni period, physical therapy||, ||fizikalna terapija, recovery of function||, ||funkcija, povratak, predictive value of the tests||, ||testovi, prognostička vrednost,

Sažetak


Uvod/Cilj. A-test je dizajniran za procenu funkcionalnog oporavka bolesnika na ortopedskom odeljenju. Ovaj performance-based test sastoji se od 10 stavki za procenu 10 bazičnih aktivnosti uz pomoć šestostepene ordinalne skale (0–5). Ukupni skor je u opsegu od 0 do 50, tj. od nesposobnosti bolesnika da izvede bilo koju osnovnu aktivnost uprkos pomoći fizioterapeuta do potpune samostalnosti i sigurnosti pri izvođenju svih osnovnih aktivnosti.  Cilj ove studije bio je da se ispita validnost A-testa. Metode. Ova prospektivna studija sprovedena je na ortopedskom odeljenju i obuhvatila je 120 bolesnika (60 bolesnika sa osteoartritisom kuka kojima je učinjena artroplastika kuka i 60 hirurški lečenih bolesnika sa prelomom kuka) tokom rane rehabilitacije (1–5. dan). Validnost A-testa bila je ispitana kroz 3 aspekta: validnost sadržaja – efekat poda i plafona (floor and ceiling effect), opseg, asimetrija distribucije rezultata; validnost kriterijuma – konkurentna validnost [korelacija sa skalom The University of Iowa Level of Assistance Scale (ILAS) za bolesnike sa osteoartritisom kuka i sa skalom The Cumulated Ambulation Score (CAS) za bolesnike sa prelomom kuka, Spearman-ova rank korelacija] i prediktivna validnost [The New Mobility Score (NMS) 4 nedelje nakon operacije, Mann-Whitney U-test); validnost konstrukcije – ispitane su 4 hipoteze: 1) 5. dana rehabilitacije kod bolesnika kojima je urađena artroplastika zbog osteoartritisa kuka rezultati A-testa biće u jačoj korelaciji nego sa Harris hip skorom; 2) kod bolesnika sa prelomom kuka rezultati A-testa biće značajno bolji kod onih kojima je dozvoljen oslonac na operisanu nogu toikom hoda nego kod onih kojima to nije dozvoljeno; 3) rezultat A-testa biće značajno bolji kod bolesnika sa osteoartritisom kuka nego kod onih sa prelomom kuka; 4) rezultati A-testa biće značajno bolji kod bolesnika mlađih od 65 godina nego kod onih koji imaju ≥ 65 godina. Rezultati. Ustanovljen je nizak pod (1%) i plafon (2%) efekt, opseg 0–50, koeficijent asimetrije 0,57, kao i snažna korelacija sa ILAS-om za bolesnike sa osteoartritisom kuka (r = -0,97, p = 0,000) i sa CAS-om za bolesnike sa prelomom kuka (r = 0,91, p = 0,000). Bolesnici koji su imali skor A-testa veći od 35, petog dana nakon operacije (n = 46, Md = 4) imali su značajno veći NMS skor 4 nedelje nakon operacije od bolesnika sa skorom A-testa manjim od 35 (n = 59, Md = 2), (U = 379, z = -6.47, p = 0,000, r = 0,63). Sve četiri hipoteze su potvrđene. Zaključak. A-test je jednostavan i validan instrument za svakodnevno praćenje brzine i stepena funkcionalnog oporavka tokom rane rehabilitacije hirurški lečenih ortopedskih bolesnika.

Biografije autora

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

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Objavljeno
2015/04/23
Broj časopisa
Vol. 71 Br. 8 (2014)
Rubrika
Originalni članak