Reliability of the Modified Four-Square Step Test in Revision Total Knee Arthroplasty: A Cross-Sectional Study

Abstract

Background The modified four-square step test (mFSST) assesses dynamic balance by rapid stepping in different directions. This study aimed to evaluate the reliability of the mFSST in patients who had undergone revision total knee artroplasty (rTKA).

Methods The study was designed as a cross-sectional study. The mFSST was administered on 22 patients with a history of rTKA. Two trials were performed and the patients rested between trials to avoid fatigue.

Results The intraclass correlation coefficient (ICC) for the mFSST was 0.83. The standard error of measurement and the smallest real difference (95%. confidence level) were 0.67 and 1.85 respectively.

Conclusion The mFSST showed good reliability in patients who had undergone rTKA. The mFSST is a reliable measure for the assessment of gait variability, dynamic balance, walking skills and mobility. It can easily detect changes in rTKA patients with simple equipment.

Zusammenfassung

Fragestellung und Hintergrund Der modifizierte Four-Square-Step-Test (mFSST) prüft das dynamische Gleichgewicht mittels schneller Ausführung von 5 Schritten in verschiedene Richtungen. Ziel der Studie war es, die Zuverlässigkeit des mFSST bei Patienten nach erfolgter Knie-Totalendoprothesen-Revision (Knie-TEP-Wechsel) zu untersuchen.

Patienten und Methodik Die Studie war als Querschnittsstudie angelegt. Der mFSST wurde bei 22 Patienten mit Knie-TEP-Wechsel in der Vorgeschichte durchgeführt. Es erfolgten zwei Versuche, wobei die Patienten sich zwischen den Versuchen ausruhen konnten, um Ermüdung zu vermeiden.

Ergebnisse Der Intraklassen-Korrelationskoeffizient (ICC) für den mFSST betrug 0,83. Der Standardfehler der Messung und der kleinster tatsächlicher Unterschied (Smallest Real Difference, SRD) (Konfidenz-Niveau von 95%) betrugen 0,67 bzw. 1,85.

Schlussfolgerung Für den mFSST fand sich eine gute Zuverlässigkeit bei Patienten nach Knie-TEP-Wechsel. Der mFSST ist ein zuverlässiges Maß für die Beurteilung von Gangvariabilität, dynamischem Gleichgewicht, Gehfähigkeit und Mobilität. Der Test kann mit einfacher Ausrüstung Veränderungen bei Patienten nach Knie-TEP-Wechsel nachweisen.

Key words

Mobility - dynamic balance - arthroplasty - reliability - total knee artroplasty - modified four-square step test

Schlüsselwörter

Mobilität - dynamisches Gleichgewicht - Endoprothese - Zuverlässigkeit - Knie-Totalendoprothese - modifizierter Four-Square-Step-Test

Publikationsverlauf

Eingereicht: 09. Dezember 2020

Angenommen: 25. Januar 2022

Artikel online veröffentlicht:
24. Februar 2022

• References

• 1 Greidanus NV, Peterson RC, Masri BA. et al. Quality of Life Outcomes in Revision Versus Primary Total Knee Arthroplasty. The Journal of arthroplasty 2011; 26: 615-620
• 2 Ghomrawi HM, Kane RL, Eberly LE. et al. Patterns of functional improvement after revision knee arthroplasty. JBJS 2009; 91: 2838-2845
• 3 Järvenpää J, Kettunen J, Miettinen H. et al. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. International Orthopaedics 2010; 34: 649-653
• 4 Wodowski AJ, Swigler CW, Liu H. et al. Proprioception and knee arthroplasty: a literature review. Orthopedic Clinics 2016; 47: 301-309
• 5 Pandya NK, Piotrowski GA, Pottenger L. et al. Pain relief in knee osteoarthritis reduces the propensity to trip on an obstacle. Gait & posture 2007; 25: 106-111
• 6 Levinger P, Menz HB, Morrow AD. et al. Lower limb proprioception deficits persist following knee replacement surgery despite improvements in knee extension strength. Knee Surgery, Sports Traumatology, Arthroscopy 2012; 20: 1097-1103
• 7 Deshpande N, Metter EJ, Lauretani F. et al. Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study. J Am Geriatr Soc 2008; 56: 615-620
• 8 Cumming RG, Klineberg RJ. Fall frequency and characteristics and the risk of hip fractures. J Am Geriatr Soc 1994; 42: 774-778
• 9 Medell JL, Alexander NB. A clinical measure of maximal and rapid stepping in older women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2000; 55: M429-M433
• 10 Blennerhassett JM, Jayalath VM. The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke. Archives of physical medicine and rehabilitation 2008; 89: 2156-2161
• 11 Moore M, Barker K. The validity and reliability of the four square step test in different adult populations: a systematic review. Syst Rev 2017; 6: 187
• 12 Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil 2002; 83: 1566-1571
• 13 Byrne JM, Prentice SD. Swing phase kinetics and kinematics of knee replacement patients during obstacle avoidance. Gait & posture 2003; 18: 95-104
• 14 Lu T-W, Chen H-L, Wang T-M. JG, Posture Obstacle crossing in older adults with medial compartment knee osteoarthritis. 2007; 26: 553-559
• 15 Pandya NK, Draganich LF, Mauer A. et al. Osteoarthritis of the knees increases the propensity to trip on an obstacle. Clin Orthop Relat Res 2005; 150-156
• 16 Hess RJ, Brach JS, Piva SR. et al. Walking Skill Can Be Assessed in Older Adults: Validity of the Figure-of-8 Walk Test. Physical Therapy 2010; 90: 89-99
• 17 Whitney SL, Marchetti GF, Morris LO. et al. The reliability and validity of the Four Square Step Test for people with balance deficits secondary to a vestibular disorder. Archives of physical medicine and rehabilitation 2007; 88: 99-104
• 18 Unver B, Sevik K, Yarar HA. et al. Reliability of the Modified Four Square Step Test (mFSST) in patients with primary total knee arthroplasty. Physiother Theory Pract 2021; 37: 535-539
• 19 Roos MA, Reisman DS, Hicks GE. et al. Development of the Modified Four Square Step Test and its reliability and validity in people with stroke. Journal of Rehabilitation Research & Development 2016; 53: 3
• 20 Narin S, Unver B, Bakirhan S. et al. Cross-cultural adaptation, reliability and validity of the Turkish version of the Hospital for Special Surgery (HSS) Knee Score. Acta orthopaedica et traumatologica turcica 2014; 48: 241-248
• 21 Ranawat CS, Insall J, Shine J. Duo-condylar knee arthroplasty: hospital for special surgery design. Clin Orthop Relat Res 1976; 76-82
• 22 Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain 2016; 13: 67-75
• 23 Almeida GJ, Schroeder CA, Gil AB. et al. Interrater reliability and validity of the stair ascend/descend test in subjects with total knee arthroplasty. Archives of physical medicine and rehabilitation 2010; 91: 932-938
• 24 Lee WC, Kwan YH, Chong HC. et al. The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2017; 25: 3354-3359
• 25 Lee P, Lu WS, Liu CH. et al. Test-Retest Reliability and Minimal Detectable Change of the D2 Test of Attention in Patients with Schizophrenia. Arch Clin Neuropsychol 2018; 33: 1060-1068
• 26 Bouwmans C, De Jong K, Timman R. et al. Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P). BMC Health Serv Res 2013; 13: 217
• 27 Özkeskin M, Özden F, Tuna S. The Reliability and Validity of Modified Four-Square-Step-Test and Step-Test in Older Adults. Phys Occup Ther Geriatr 2021; 1-12
• 28 Kloos AD, Fritz NE, Kostyk SK. et al. Clinimetric properties of the Tinetti Mobility Test, Four Square Step Test, Activities-specific Balance Confidence Scale, and spatiotemporal gait measures in individuals with Huntington’s disease. Gait & posture 2014; 40: 647-651
• 29 Hamacher D, Hamacher D, Müller R. et al. Exploring phase dependent functional gait variability. Hum Mov Sci 2017; 52: 191-196
• 30 Kiss RM, Bejek Z, Szendrői M. Variability of gait parameters in patients with total knee arthroplasty. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2012; 20: 1252-1260
• 31 Smith JW, Marcus RL, Tracy BL. et al. Stance time variability during stair stepping before and after total knee arthroplasty: A pilot study. Human Movement Science 2016; 45: 53-62
• 32 Choi YM, Dobson F, Martin J. et al. Interrater and Intrarater Reliability of Common Clinical Standing Balance Tests for People With Hip Osteoarthritis. Physical Therapy 2014; 94: 696-704
• 33 Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. Journal of strength and conditioning research 2005; 19: 231-240
• 34 Gibbons WJ, Fruchter N, Sloan S. et al. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil 2001; 21: 87-93
• 35 Guyatt GH, Sullivan MJ, Thompson PJ. et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 1985; 132: 919-923
• 36 Knox AJ, Morrison JF, Muers MF. Reproducibility of walking test results in chronic obstructive airways disease. Thorax 1988; 43: 388-392
• 37 Wu G, Sanderson B, Bittner V. The 6-minute walk test: how important is the learning effect?. Am Heart J 2003; 146: 129-133
• 38 Skough K, Broman L, Borg K. Test-retest reliability of the 6-min walk test in patients with postpolio syndrome. Int J Rehabil Res 2013; 36: 140-145
• 39 Jakobsen TL, Kehlet H, Bandholm T. Reliability of the 6-min walk test after total knee arthroplasty. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2013; 21: 2625-2628
• 40 Unver B, Kalkan S, Yuksel E. et al. Reliability of the 50-foot walk test and 30-sec chair stand test in total knee arthroplasty. 2015; 23: 184-187