Performance-based outcome measures are becoming increasingly important in health care. The 2-minute walk test (2MWT) and the Timed Up and Go test (TUG) are frequently used in clinical trials as performance-based tests in many diseases including osteoarthritis. The purposes of this study were: (1) to determine test-retest reliability of data for the 2MWT and the TUG; (2) to determine minimal detectable change (MDC) scores for the TUG and 2MWT in patients with total hip arthroplasty (THA).
Methods:
37 patients, who had undergone primary THA, were included. Patients twice performed trials for the 2MWT and TUG on the same day. In addition to demographic data of patients, the Harris Hip Score, 2MWT and TUG scores were recorded.
Results:
The TUG and 2MWT showed excellent test-retest reliability. The Intraclass correlation coefficient ICC (2,1), Standard error of measurement (SEM) and minimal detectable chance at the 95% CI (MDC95) for TUG were 0.96, 0.59 seconds and 1.62 seconds respectively. The ICC (2,1), SEM and MDC95 for 2MWT were 0.96, 6.37 m and 17.56 m respectively.
Conclusion:
Clinicians and researchers can be confident that greater changes than 1.62 seconds for TUG and 17.56 m for the 2MWT over time represent a real clinical change in rehabilitation process in patients with THA. Both the 2MWT and TUG may assist in early identification of patients who may need additional rehabilitation to reduce the potential for poor outcomes after THA. Therefore, both of these tests can be used in a clinical setting with a small measurement error.
HarrisWHSledgeCB.Total hip and total knee replacement (1). N Engl J Med1990; 323: 725–731.
2.
HarrisWHSledgeCB.Total hip and total knee replacement (2). N Engl J Med1990; 323: 801–807.
3.
Di MonacoMValleroFTapperoR, et al. Rehabilitation after total hip arthroplasty: a systematic review of controlled trials on physical exercise programs. Eur J Phys Rehabil Med2009; 45: 303–317.
4.
KurtzSOngKLauE, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am2007; 89: 780–785.
5.
DobsonFHinmanRSRoosEM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage2013; 21: 1042–1052.
6.
UnverBKalkanSYukselE, et al. Reliability of the 50-foot walk test and 30-sec chair stand test in total knee arthroplasty. Acta Ortop Bras2015; 23: 184–187.
7.
GillSMcBurneyH.Reliability of performance-based measures in people awaiting joint replacement surgery of the hip or knee. Physiother Res Int2008; 13: 141–152.
8.
WeissJMNoblePCCondittMA, et al. What functional activities are important to patients with knee replacements?Clin Orthop Relat Res2002; (404): 172–188.
9.
MiznerRLPettersonSCClementsKE, et al. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments. A longitudinal analysis of outcomes. J Arthroplasty2011; 26: 728–737.
10.
StratfordPWKennedyDMWoodhouseLJ.Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Phys Ther2006; 86: 1489–1496.
11.
BrooksDParsonsJHunterJP, et al. The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation. Arch Phys Med Rehabil2001; 82: 1478–1483.
12.
UnverBKahramanTKalkanS, et al. Reliability of the six-minute walk test after total hip arthroplasty. Hip Int2013; 23: 541–545.
13.
YukselEKalkanSCekmeceS, et al. Assessing minimal detectable changes and test-retest reliability of the timed up and go test and the 2-minute walk test in patients with total knee arthroplasty. J Arthroplasty2017; 32: 426–430.
14.
PinTW.Psychometric properties of 2-minute walk test: a systematic review. Arch Phys Med Rehabil2014; 95: 1759–1775.
15.
YeungTSWesselJStratfordPW, et al. The timed up and go test for use on an inpatient orthopaedic rehabilitation ward. J Orthop Sports Phys Ther2008; 38: 410–417.
16.
PodsiadloDRichardsonS.The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc1991; 39: 142–148.
17.
MillerPAMorelandJStevensonTJ.Measurement properties of a standardized version of the two-minute walk test for individuals with neurological dysfunction. Physiother Can2002; 54: 241–248.
18.
ConnellyDMThomasBKCliffeSJ, et al. Clinical utility of the 2-minute walk test for older adults living in long-term care. Physiother Can2009; 61: 78–87.
19.
ResnikLBorgiaM.Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error. Phys Ther2011; 91: 555–565.
20.
UnnanuntanaARuangsomboonPKeesukpuntW.Validity and responsiveness of the two-minute walk test for measuring functional recovery after total knee arthroplasty. J Arthroplasty2018; 33: 1737–1744.
21.
FlansbjerUBHolmbäckAMDownhamD, et al. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med2005; 37: 75–82.
22.
HaleySMFragala-PinkhamMA.Interpreting change scores of tests and measures used in physical therapy. Phys Ther2006; 86: 735–743.
23.
HarrisWH.Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am1969; 51: 737–755.
24.
SiggeirsdottirKJónssonBYJónssonHJr, et al. The timed ‘Up & Go’ is dependent on chair type. Clin Rehabil2002; 16: 609–616.
25.
BrooksDDavisAMNaglieG.Validity of 3 physical performance measures in inpatient geriatric rehabilitation. Arch Phys Med Rehabil2006; 87: 105–110.
26.
KirmitLKaratosunVUnverB, et al. The reliability of hip scoring systems for total hip Arthroplasty candidates: assessment by physical therapists. Clin Rehabil2005; 19: 659–661.
27.
FerrazMBQuaresmaMRAquinoLR, et al. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol1990; 17: 1022–1024.
28.
StratfordPWSpadoniG.The reliability, consistency, and clinical application of a numeric pain rating scale. Physiother Can2001; 53: 88–114.
29.
UnverBKahramanTKalkanS, et al. Test-retest reliability of the 50-foot timed walk and 30-second chair stand test in patients with total hip arthroplasty. Acta Orthop Belg2015; 81: 435–441.
30.
LiebermanJRDoreyFShekelleP, et al. Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg Am1996; 78: 835–838.
31.
SteffenTMHackerTAMollingerL.Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, Berg balance scale, timed up & go test, and gait speeds. Phys Ther2002; 82: 128–137.
32.
HeibergKEBruun-OlsenVEkelandA, et al. Effect of a walking skill training program in patients who have undergone total hip arthroplasty:follow up one year after surgery. Arthritis Care Res (Hoboken)2012; 64: 415–423.
33.
BartelsBde GrootJFTerweeCB.The six-minute walk test in chronic pediatric conditions: a systematic review of measurement properties. Phys Ther2013; 93: 529–541.
34.
BrooksDDavisAMNaglieG.The feasibility of six-minute and two-minute walk tests in in-patient geriatric rehabilitation. Can J Aging2007; 26: 159–162.
35.
ButlandRJPangJGrossER, et al. Two-, six- and 12-minutes walking tests in respiratory disease. Br Med J (Clin Res Ed)1982; 284: 1607–1608.
36.
KosakMSmithT.Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. J Rehabil Res Dev2005; 42: 103–107.
37.
HiengkaewVJitareeKChaiyawatP.Minimal detectable changes of the berg balance scale, fugl-meyer assessment scale, timed up & go test, gait speeds, and 2-minute walk testin individuals with chronic stroke with different degrees of ankle plantarflexor tone. Arch Phys Med Rehabil2012; 93: 1201–1208.
38.
LeungASChanKKSykesK, et al. Reliability, validity, and responsiveness of a 2-min walk test to assess exercise capacity of COPD patients. Chest2006; 130: 119–125.
39.
UnverBKaratosunVBakirhanS.Ability to rise independently from a chair during 6-month follow-up after unilateral and bilateral total knee replacement. J Rehabil Med2005; 37: 385–387.
40.
EriksrudOBohannonRW.Relationship of knee extension force to independence in sit-to-stand performance in patients receiving acute rehabilitation. Phys Ther2003; 83: 544–551.
41.
HughesMAMyersBSSchenkmanML.The role of strength in rising from a chair in the functionally impaired elderly. J Biomech1996; 29: 1509–1513.
42.
FreterSHFruchterN.Relationship between timed ‘up and go’ and gait time in an elderly orthopaedic rehabilitation population. Clin Rehabil2000; 14: 96–101.
43.
KennedyDMStratfordPWWesselJ, et al. Assessing stability and change offour performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord2005; 6: 3.
44.
BeckermanHRoebroeckMELankhorstGJ, et al. Smallest real difference, a link between reproducibility and responsiveness.Qual Life Res2001; 10:571–578.
45.
De VetHCTerweeCBOsteloRW, et al. Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes2006; 4: 54.
46.
McGlothlinAELewisRJ.Minimal clinically important difference: defining what really matters to patients. JAMA2014; 312: 1342–1343.
47.
BrozekJLGuyattGHSchünemannHJ.How a well-grounded minimal important difference can enhance transparency of labelling claims and improve interpretation of a patient reported outcome measure. Health Qual Life Outcomes2006; 4: 69.
48.
SteffenTSeneyM.Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with Parkinsonism. Phys Ther2008; 88: 733–746.
49.
RoachKE.Measurement of health outcomes: reliability, validity and responsiveness. J Prosthet Orthot2006; 18: 8–12.
