Ist die ILOAS ein geeignetes Messinstrument zur Erfassung des funktionellen Status von Patienten mit Kniegelenkersatz während der stationären Rehabilitation?

Zusammenfassung

Hintergrund: Die Iowa Level of Assistance Scale (ILOAS) ist ein Messinstrument zur Erfassung des funktionellen Status nach Kniegelenkersatz. Da sie verschiedene Aktivitäten vereint, wäre sie auch als Funktionsparameter für die Rehabilitation nach Kniegelenkersatz geeignet.

Ziel: Die vorliegende Studie untersuchte die Reproduzierbarkeit, konkurrente Validität und Responsivität der ILOAS.

Methode: Unter Verwendung des Western Ontario und McMaster Universities Arthroseindex (WOMAC) als Referenztest erfolgte die Prüfung der ILOAS an verschiedenen Tagen der stationären Rehabilitation. Reproduzierbarkeit, konkurrente Validität und Responsivität der ILOAS wurden berechnet.

Ergebnisse: An der Studie nahmen 32 Patienten teil. Die Intertester-Reliabilität erreichte r_s = 0,757 (p = 0,01); ICC = 0,789 (95 %-CI = 0,518 – 0,902), die kleinste erkennbare Veränderung (SDD) 4,7 Punkte (95 %-LA = –3,7, 6,1), die Korrelation zwischen WOMAC und ILOAS r_s = 0,439 (p = 0,014), die durch die ILOAS ermittelte Effektstärke (ES) 1,51 (95 %-CI = 0,92 – 2,07), die des WOMAC 1,27 (95 %-CI = 0,62 – 1,89). Der Gesamt-Score der ILOAS veränderte sich im Durchschnitt um 5 Punkte (erlaubte Vollbelastung 7, vorgeschriebene Teilbelastung 2 Punkte).

Schlussfolgerungen: Die Intertester-Reliabilität und die Intertester-Übereinstimmung waren moderat bis gut. WOMAC und ILOAS zeigten eine moderate Korrelation. Die Veränderung zwischen den beiden Messzeitpunkten (Tag 1 und 14) ist aufgrund der SDD nur bei den Patienten mit erlaubter Vollbelastung klinisch signifikant.

Abstract

Background: The Iowa Level of Assistance Scale (ILOAS) is an assessment for functional status evaluation after total knee replacement. Since the ILOAS is a multi-activity test it may also be a suitable useful parameter for measuring functional status in rehabilitation after total knee replacement.

Objective: This study investigated whether the ILOAS is a suitable assessment tool for functional status evaluation after total knee replacement during inpatient rehabilitation.

Method: Using the Western Ontario and McMaster Universities Arthroseindex (WOMAC) as reference tests the ILOAS was measured on different days during inpatient rehabilitation. The ILOAS’ reproducibility, concurrent validity and responsiveness were measured.

Results: 32 patients participated in this study. The intertester reliability was r_s = 0.757 (p = 0.01); ICC = 0.789 (95 % CI = 0.518 – 0.902), the smallest detectable difference (SDD) was 4.7 points (95 % LA = –3.7, 6.1), correlation between WOMAC and ILOAS was r_s = 0.439 (p = 0.014), effect size (ES) of the ILOAS was 1.51 (95 % CI = 0.92 – 2.07) and of the WOMAC 1.27 (95 % CI = 0.62 – 1.89). The ILOAS total score varied altered by 5 points on average (7 points for full impact, 2 for partial impact).

Conclusion: Intertester reliability as well as intertester correlation were moderate to good. WOMAC and ILOAS correlated moderately. Due to the SDD the change between the 2 test intervals (day 1 and day 14) was clinically significant only in patients with permitted full impact.

Kniegelenkersatz - stationäre Rehabilitation - Assessment - Physiotherapie - Validität

total knee replacement - inpatient rehabilitation - assessment - physiotherapy - validity

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