Functional recovery following total ankle arthroplasty (TAA) is assessed with patient-reported metrics, but physical performance tests may allow for a more accurate assessment of patient function. We quantified correlations between patient-reported measures and physical performance tests in patients after TAA to determine the usefulness of physical performance tests in post-TAA assessment.
Methods:
In total, 140 patients with end-stage ankle osteoarthritis were assessed prior to TAA and again at 12 and 24 months postoperatively. At each time point, the visual analog scale (VAS), Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS), Short Musculoskeletal Function Assessment (SMFA), and Short-Form 36 (SF-36) scores were collected, as well as walking speed, Four-Square Step Test (FSST) times, and Short Physical Performance Battery (SPPB) balance scores.
Results:
All but 1 (SF-36 general health component) of the patient-reported outcomes improved significantly from preoperative assessment to both 1 and 2 years postoperatively (P < .001 in all cases). Walking speed, FSST times, and balance scores improved significantly across time (P < .001 in all cases). Walking speed was moderately correlated with total SF-36 scores at both 1 and 2 years postoperatively (P < .001 in both cases), both components of the SMFA at 1 year postoperatively (P < .001 in both cases), and total AOFAS scores at 2 years postoperatively (P = .001).
Conclusion:
The lack of strong correlations between the 2 sets of metrics indicates that they provide different information about a patient’s recovery following TAA. Therefore, it is important to include both sets of metrics in post-TAA assessments to better understand operative success and functional recovery.
AdamsSBJrDemetracopoulosCAQueenRMEarly to mid-term results of fixed-bearing total ankle arthroplasty with a modular intramedullary tibial component. J Bone Joint Surg Am. 2014;9(23):1983-1989.
2.
AfilaloJEisenbergMJMorinJFGait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56(20):1668-1676.
3.
AlleyDEHicksGEShardellMMeaningful improvement in gait speed in hip fracture recovery. J Am Geriatr Soc. 2011;59(9):1650-1657.
4.
BarthulyAMBohannonRWGorackW.Gait speed is a responsive measure of physical performance for patients undergoing short-term rehabilitation. Gait Posture. 2012;36(1):61-64.
5.
BeyaertCSirveauxFPaysantJMoleDAndreJM.The effect of tibio-talar arthrodesis on foot kinematics and ground reaction force progression during walking. Gait Posture. 2004;20(1):84-91.
6.
BohannonRW.Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing. 1997;26(1):15-19.
7.
ChoiJHColemanSCTenenbaumSPoloFEBrodskyJW.Prospective study of the effect on gait of a two-component total ankle replacement. Foot Ankle Int. 2013;34(11):1472-1478.
8.
CressMESchechtmanKBMulrowCDRelationship between physical performance and self-perceived physical function. J Am Geriatr Soc. 1995;43(2):93-101.
9.
DattaniRSlobogeanGPO’BrienPJPsychometric analysis of measuring functional outcomes in tibial plateau fractures using the Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires. Injury. 2013;44(6):825-829.
10.
DawsonJDollHCoffeyJJenkinsonC.Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus. Osteoarthritis Cartilage. 2007;15(8):918-931.
11.
DetrembleurCLeemrijseT.The effects of total ankle replacement on gait disability: analysis of energetic and mechanical variables. Gait Posture. 2009;29(2):270-274.
12.
DiteWTempleVA.A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. 2002;83(11):1566-1571.
13.
DoetsHCBrandRNelissenRG.Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg Am. 2006;88(6):1272-1284.
14.
DoetsHCvan MiddelkoopMHoudijkHNelissenRGVeegerHE.Gait analysis after successful mobile bearing total ankle replacement. Foot Ankle Int. 2007;28(3):313-322.
15.
DyrbyCChouLBAndriacchiTPMannRA.Functional evaluation of the Scandinavian total ankle replacement. Foot Ankle Int. 2004;25(6):377-381.
16.
FeigenbaumLASteinlaufSDCarlstonMReturn to sport following a spring ligament reconstruction in a Division I collegiate jumper: a case report. Remed Open Access. 2016;1(1002):1-6.
17.
FlavinRColemanSCTenenbaumSBrodskyJW.Comparison of gait after total ankle arthroplasty and ankle arthrodesis. Foot Ankle Int. 2013;34(10):1340-1348.
18.
FreireANGuerraROAlvaradoBGuralnikJMZunzuneguiMV.Validity and reliability of the short physical performance battery in two diverse older adult populations in Quebec and Brazil. J Aging Health. 2012;24(5):863-878.
19.
GohEYChuaSYHongSJNgSS.Reliability and concurrent validity of four square step test scores in subjects with chronic stroke: a pilot study. Arch Phys Med Rehabil. 2013;94(7):1306-1311.
20.
GuralnikJMSimonsickEMFerrucciLA short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85-M94.
21.
GuralnikJMFerrucciLSimonsickEMSaliveMEWallaceRB.Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556-561.
22.
HaleSAHertelS.Reliability and sensitivity of the foot and ankle disability index in subjects with chronic ankle instability. J Athl Train. 2005;40(1):35-40.
23.
HawkerGAMianSKendzerskaTFrenchM.Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63(11):S240-S252.
24.
HintermannBKnuppMZwickyLBargA.Total ankle replacement for treatment of end-stage osteoarthritis in elderly patients. J Aging Res. 2012;2012:345237.
25.
HoeymansNFeskensEJvan den BosGAKromhoutD.Measuring functional status: cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990-1993). J Clin Epidemiol. 1996;49(10):1103-1110.
26.
KangHGDingwellJB.Effects of walking speed, strength and range of motion on gait stability in healthy older adults. J Biomech. 2008;41(14):2899-2905.
27.
KitaokaHBAlexanderIJAdelaarRSClinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15(7):349-353.
28.
LewisJSJrAdamsSBJrQueenRMOutcomes after total ankle replacement in association with ipsilateral hindfoot arthrodesis. Foot Ankle Int. 2014;35(6):535-542.
29.
McKeeKEHackneyME.The four square step test in individuals with Parkinson’s disease: association with executive function and comparison with older adults. NeuroRehabilitation. 2014;35(2):279-289.
30.
MerrillSSSeemanTEKaslSVBerkmanLF.Gender differences in the comparison of self-reported disability and performance measures. J Gerontol A Biol Sci Med Sci. 1997;52(1):M19-M26.
MiznerRLPettersonSCClementsKEMeasuring functional improvement after total knee arthroplasty requires both performance-based and patient-reported assessments: a longitudinal analysis of outcomes. J Arthroplasty. 2011;26(5):728-737.
33.
MundermannADyrbyCOHurwitzDESharmaLAndriacchiTP.Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. Arthritis Rheum. 2004;50(4):1172-1178.
34.
NevilleCEYoungISGilchristSEEffect of increased fruit and vegetable consumption on physical function and muscle strength in older adults. Age (Dordr). 2013;35(6):2409-2422.
35.
NilsagardYEvon KochLKNilssonMForsbergAS.Balance exercise program reduced falls in people with multiple sclerosis - a single group pretest posttest trial. Arch Phys Med Rehabil. 2014;95(12):2428-2434.
36.
NunleyJACaputoAMEasleyMECookC.Intermediate to long-term outcomes of the STAR total ankle replacement: the patient perspective. J Bone Joint Surg Am. 2012;94(1):43-48.
37.
PalombaroKMCraikRLMangioneKKTomlinsonJD.Determining meaningful changes in gait speed after hip fracture. Phys Ther. 2006;86(6):809-816.
38.
PenninxBWPahorMCesariMAnemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc. 2004;52(5):719-724.
39.
PerryJGarrettMGronleyJKMulroySJ.Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982-989.
40.
PuthoffMLSaskowskiD.Reliability and responsiveness of gait speed, five times sit to stand, and hand grip strength for patients in cardiac rehabilitation. Cardiopulm Phys Ther J. 2013;24(1):31-37.
41.
QueenRMDe BiassioJCButlerRJJ. Leonard Goldner Award 2011: changes in pain, function, and gait mechanics two years following total ankle arthroplasty performed with two modern fixed-bearing prostheses. Foot Ankle Int. 2012;33(7):535-542.
42.
QueenRMAdamsSBJrViensNADifferences in outcomes following total ankle replacement in patients with neutral alignment compared with tibiotalar joint malalignment. J Bone Joint Surg Am. 2013;95(21):1927-1934.
43.
QueenRMButlerRJAdamsSBJrBilateral differences in gait mechanics following total ankle replacement: a two year longitudinal study. Clin Biomech. 2014;29(4):418-422.
44.
QueenRMSparlingTLButlerRJPatient-reported outcomes, function, and gait mechanics after fixed and mobile-bearing total ankle replacement. J Bone Joint Surg Am. 2014;96(12):987-993.
45.
RaoSEllisSJDelandJTHillstromH.Nonmedicinal therapy in the management of ankle arthritis. Curr Opin Rheumatol. 2010;22(2):223-228.
46.
RichterMZechSGeerlingJA new foot and ankle outcome score: questionnaire based, subjective, visual-analogue-scale, validated and computerized. Foot Ankle Int. 2006;12(4):191-199.
47.
RollandYLauwers-CancesVCesariMPhysical performance measures as predictors of mortality in a cohort of community-dwelling older French women. Eur J Epidemiol. 2006;21(2):113-122.
48.
SalbachNMO’BrienKBrooksDSpeed and distance requirements for community ambulation: a systematic review. Arch Phys Med Rehabil. 2014;95(1):117-128.
49.
SaltzmanCLMannRAAhrensJEProspective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int. 2009;30(7):579-596.
50.
ShinkaiSWatanabeSKumagaiSWalking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Age Ageing. 2000;29(5):441-446.
51.
SwiontkowskiMFEngelbergRMartinDPAgelJ.Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness. J Bone Joint Surg Am. 1999;81(9):1245-1260.
52.
TrulssonARoosEMAgebergEGarwiczM.Relationships between postural orientation and self reported function, hop performance and muscle power in subjects with anterior cruciate ligament injury. BMC Musculoskelet Disord. 2010;11:143.
53.
ValderrabanoVNiggBMvon TscharnerVGait analysis in ankle osteoarthritis and total ankle replacement. Clin Biomech. 2007;22(8):894-904.
54.
ValderrabanoVNiggBMvon TscharnerVFrankCBHintermannB. J.Leonard Goldner Award 2006: total ankle replacement in ankle osteoarthritis: an analysis of muscle rehabilitation. Foot Ankle Int. 2007;28(2):281-291.
55.
VergheseJWangCHoltzerR.Relationship of clinic-based gait speed measurement to limitations in community-based activities in older adults. Arch Phys Med Rehabil. 2011;92(5):844-846.
56.
WareJEJrSherbourneCD.The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483.
57.
WhitneySLMarchettiGFMorrisLOSpartoPJ.The reliability and validity of the four square step test for people with balance deficits secondary to a vestibular disorder. Arch Phys Med Rehabil. 2007;88(1):99-104.
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