The A-test – reliability of functional recovery assessment during early rehabilitation of patients in an orthopedic ward
Abstract
Background/Aim. There are few tests for evaluation of functional abilities of patients surgically treated for hip fractures or osteoarthritis during early rehabilition period. The aim of this study was to investigate reliability (interobserver reproducibility and internal consistency) of the A-test, an original test for functional recovery evaluation during early rehabilitation of patients in an orthopedic ward. Methods. The investigation included 105 patients (55 patients with hip osteoarthritis that underwent arthroplasty and 50 surgically treated patients with hip fracture). It was conducted in an orthopedic ward during early inpatient rehabilitation (from 1st to 5th day). For their functional recovery evaluation during early rehabilitation we used the A-test, a performance-based test with 10 items for assessing basic activities by six level ordinal scale (0–5). For internal consistency of the test the Cronbach coefficient alpha was calculated for the A-test results collected during early rehabilitation for all patients (105 patients x 5 days = 525 measures) and separately for the results of patients with hip osteoarthritis (275 measures) and hip fracture (250 measures). Values of this coefficient > 0.7 imply good internal consistency of the test. Interobserver reproducibility was estimated as follows: two physiotherapists together conducted physical therapy with the patients, and then, separately, rated the performance of each activity from the test (78 measures). The agreement between their estimations was expressed by the linear weighted kappa coefficient (for very good agreement values of kappa coefficeent have to be in the range 0.81–1). Results. The Cronbach coefficient alpha was 0.98 (the results of all the patients and the results of the patients with hip osteoarthritis) and 0.97 (the results of the patients with hip fracture). The values of kappa coefficient were in the range 0.81–0.92 for all items. Conclusion. The A-test is a reliable instrument for everyday evaluation of functional recovery during early rehabilitation of patients surgically treated in an orthopedic ward.
References
Stucki G, Stier-Jarmer M, Grill E, Melvin J. Rationale and prin-ciples of early rehabilitation care after an acute injury or illness. Disabil Rehabil 2005; 27(7−8): 353−9.
Küçükdeveci A, 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.
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 M, Bandholm T, Foss N, 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 pa-tients with hip fracture. Clin Rehabil 2009; 23(12): 1116−23.
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 responsivenees of functional tests in patients with total joint replacement. Phys Ther 1995; 75(3): 169−76, dis-cussion 176−9.
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.
Vukomanovic A, Popovic Z, Djurovic A, Krstic L. The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 under-going total hip arthroplasty. Vojnosanit Pregl 2008; 65(4): 291−7.
Vukomanović A, Luković G, Aničić S, Gavrilović D, Pejović V, Krstić LJ. Whether the type of fracture affects early rehabilitation af-ter surgical treatment of hip fractures? Balneoclimatologia 2008; 32(Suppl 1): 53−4. (Serbian)
Norvell DC, Dettori JR, Suk M. What makes a quality outcomes instruments. In: Suk M, Hanson BP, Norvell DC, Mu HD, edi-tors. Musculosceletal outcomes measures and instruments. 2nd ed. New York: Thieme; 2009. p. 7−25.
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.
Pallant J. SPPS Survival manual: A Step by Step Guide to Data Analysis Using SPPS for Windows (Version 15), 3rd ed. Syd-ney: Allen & Unwin; 2007.
Task Force on Standards for Measurement in Physical Thera-py. Standards for tests and measurements in physical therapy practice. Phys Ther 1991; 71(8): 589−622.
Sim J, Wright CC. The kappa statistics in reliability studies: use, interpretation, and sample size requirements. Phys Ther 2005; 85(3): 257−68.
Landis RJ, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics 1977; 33(1): 159−74.
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 questionnaires. New York: Oxford University Press; 2006
Vukomanovic A, Plavsic A. The interrater reliability of A-test at patients with total hip arthroplasty (abstract). Final Programme and Abstracts of the 14th European Congress of Physical and Rehabilitation Medicine; Vienna, Austria; 2004 May 12−14. Vienna: Rubidruck; 2004. p. 91
Svensson E. Guidelines to statistical evaluation of data from rat-ing scales and questionnaires. J Rehabil Med 2001; 33(1): 47−8.