ArticleThe timed “up and go” test: Reliability and validity in persons with unilateral lower limb amputation☆,☆☆
Abstract
Objective: To determine the interrater and intrarater reliability and the validity of the Timed “up and go” test as a measure for physical mobility in elderly patients with an amputation of the lower extremity.
Design: To test interrater reliability, the test was performed for two observers at different times of the same day in an alternating order. To test intrarater reliability, the patients performed the test for one observer on two consecutive visits with an interval of 2 weeks. To test validity, the results of the Timed “up and go” test were compared with the results on the Sickness Impact Profile, 68-item version (SIP68), and the Groningen Activity Restriction Scale (GARS).
Patients: Thirty-two patients, age 60yrs or older, with unilateral transtibial or transfemoral amputation because of peripheral vascular disease.
Results: The Timed “up and go” test showed good intrarater and interrater reliability (r = .93 and .96, respectively). A moderate relationship exists between the Timed “up and go” test and the GARS, a good relationship exists with the “physical subscales” of the SIP68, and there is no relationship with the “mental subscales” of the SIP68.
Conclusions: The Timed “up and go” test is a reliable instrument with adequate concurrent validity to measure the physical mobility of patients with an amputation of the lower extremity.
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Cited by (289)
Clinimetrics of performance-based functional outcome measures for vascular amputees: A systematic review
2023, Annals of Physical and Rehabilitation MedicineObjective physical performance-based outcome measures (PerBOMs) are essential tools for the holistic management of people who have had an amputation due to vascular disease. These people are often non-ambulatory, however it is currently unclear which PerBOMs are high quality and appropriate for those who are either ambulatory or non-ambulatory.
Which PerBOMs have appropriate clinimetric properties to be recommended for those who have had amputations due to vascular disease (‘vascular amputee’)?
MEDLINE, CINAHL, EMBASE, EMCARE, the Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched for the terms: “physical performance” or “function”, “clinimetric properties”, “reliability”, “validity”, “amputee” and “peripheral vascular disease” or “diabetes”.
A systematic review of PerBOMs for vascular amputees was performed following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology and PRISMA guidelines. The quality of studies and individual PerBOMs was assessed using COSMIN risk of bias and good measurement properties. Overall PerBOM quality was evaluated with a modified GRADE rating. Key clinimetric properties evaluated were reliability, validity, predictive validity and responsiveness.
A total of 15,259 records were screened. Forty-eight studies (2650 participants) were included: 7 exclusively included vascular amputees only, 35 investigated validity, 20 studied predictive validity, 23 investigated reliability or internal consistency and 7 assessed responsiveness. Meta-analysis was neither possible nor appropriate for this systematic review in accordance with COSMIN guidelines, due to heterogeneity of the data. Thirty-four different PerBOMs were identified of which only 4 are suitable for non-ambulatory vascular amputees. The Amputee Mobility Predictor no Prosthesis (AMPnoPro) and Transfemoral Fitting Predictor (TFP) predict prosthesis use only. PerBOMs available for assessing physical performance are the One-Leg Balance Test (OLBT) and Basic Amputee Mobility Score (BAMS).
At present, few PerBOMs can be recommended for vascular amputees. Only 4 are available for non-ambulatory individuals: AMPnoPro, TFP, OLBT and BAMS.
Transcutaneous osseointegration for amputees (TOFA) surgically implants a prosthetic anchor into the residual limb’s bone, enabling direct skeletal connection to a prosthetic limb and eliminating the socket. TOFA has demonstrated significant mobility and quality of life benefits for most amputees, but concerns regarding its safety for patients with burned skin have limited its use. This is the first report of the use of TOFA for burned amputees.
Retrospective chart review was performed of five patients (eight limbs) with a history of burn trauma and subsequent osseointegration. The primary outcome was adverse events such as infection and additional surgery. Secondary outcomes included mobility and quality of life changes.
The five patients (eight limbs) had an average follow-up time of 3.8 ± 1.7 (range 2.1–6.6) years. We found no issues of skin compatibility or pain associated with the TOFA implant. Three patients underwent subsequent surgical debridement, one of whom had both implants removed and eventually reimplanted. K-level mobility improved (K2 +, 0/5 vs 4/5). Other mobility and quality of life outcomes comparisons are limited by available data.
TOFA is safe and compatible for amputees with a history of burn trauma. Rehabilitation capacity is influenced more by the patient’s overall medical and physical capacity than their specific burn injury. Judicious use of TOFA for appropriately selected burn amputees seems safe and merited.
Oxygen consumption and gait dynamics in transfemoral bone-anchored prosthesis users compared to socket-prosthesis users: A cross-sectional study
2023, Gait and PostureA transfemoral bone-anchored prosthesis (BAP) is an alternative for the conventional socket-suspended prosthesis (SSP) in persons suffering from socket-related problems. In these persons, it has been demonstrated to reduce oxygen consumption during walking, which could be related to centre of mass (CoM) and trunk dynamics. However, it remains uncertain whether the same comparative findings are found in SSP-users without any socket-related problems.
Do oxygen consumption, CoM and trunk dynamics during walking differ between satisfied transfemoral SSP- and BAP-users and able-bodied individuals (AB); and are CoM and trunk dynamics and pistoning potential determinants of oxygen consumption?
Oxygen consumption was measured while participants walked on a treadmill at preferred speed, 30 % slower, and 30 % faster. At preferred speed, we also evaluated CoM deviation, root-mean-square values (RMS) of mediolateral (ML) CoM and trunk excursions, and pistoning. In the prosthetic users, we evaluated whether oxygen consumption, CoM and trunk dynamics, and pistoning were associated.
We included BAP-users (n = 10), SSP-users (n = 10), and AB (n = 10). SSP-users demonstrated higher oxygen consumption, CoM and trunk RMS ML in comparison to AB during walking. BAP-users showed intermediate results between SSP-users and AB, yet not significantly different from either group. Greater CoM and trunk excursions were associated with higher oxygen consumption; in the SSP-users a greater degree of pistoning, in turn, was found to associate with larger trunk RMS ML.
Our results indicate that satisfied SSP-users have increased oxygen consumption compared to AB subjects and use compensatory movements during walking. An assessment of CoM and trunk dynamics, and pistoning during walking may be considered for evaluating whether an individual SSP-user could possibly benefit from a BAP, in addition to the currently used functional tests for evaluating eligibility. This might lead to a larger group of persons with a transfemoral SSP benefiting from this technology.
French translation and validation of the cross-cultural adaptation of the MSTS functional assessment questionnaire completed after tumor surgery
2023, Orthopaedics and Traumatology: Surgery and ResearchMalignant tumors of the extremities are uncommon. Their surgical treatment, whether conservative or not, may cause sequelae. Functional assessment of patients is essential for research purposes, but also follow-ups and adaptation of treatments. The Musculoskeletal Tumor Society Rating Scale (MSTS) is a disease-specific functional scoring system often used in English literature. Currently, no studies have been published on a valid French translation of the MSTS, whether for the lower or upper extremities. We, therefore, conducted a prospective study to answer the following questions: (1) Are the proposed adapted French versions of the MSTS valid? (2) Do the psychometric properties of the two versions obtained make their use relevant?
The translation and cross-cultural adaptation were carried out following the recommendations of Beaton and Guillemin to obtain two versions: one for patients who had undergone upper extremity surgery (MSTS-UE) and one for those who had undergone lower extremity surgery (MSTS-LE). A prospective multicenter cohort study was then carried out to analyze the psychometric properties of these two versions.
A total of 250 patients from 3 referral centers were enrolled in this study. A confirmatory factor analysis (CFA) demonstrated that the two French versions of the MSTS (MSTS-LE and MSTS-UE) were a good fit with a root mean square error of approximation (RMSEA) < 0.08 and a comparative fit index (CFI) > 0.90. The psychometric properties of the two versions were validated with internal consistency (Cronbach alpha > 0.7), convergent validity of each item with its score (> 0.4), and sufficient criterion validity (Pearson correlation coefficient > 0.4). The discriminant validity analysis showed that there was a significant correlation between each version and the performance status (PS) (p < 0.05).
This study produced a French version of the MSTS scoring system and validated the psychometric properties of the two versions obtained (MSTS-UE and MSTS-LE). Therefore, the French MSTS scoring system is a valid measurement that can be used in international studies.
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French translation and validation of the cross-cultural Adaptation of the MSTS functional assessment questionnaire completed after tumor surgery
2023, Revue de Chirurgie Orthopedique et TraumatologiqueLes tumeurs malignes des extrémités sont peu fréquentes. Leur traitement chirurgical qu’il soit conservateur ou non, peut être à l’origine de séquelles. L’évaluation fonctionnelle des patients est primordiale pour la recherche mais aussi pour le suivi et l’adaptation des traitements. Le score Musculoskeletal Tumor Society Rating Scale (MSTS) est un score fonctionnel spécifique fréquemment utilisé dans la littérature anglo-saxonne. Actuellement il n’existe aucune donnée concernant une traduction française valide du MSTS que ce soit pour sa version membre inférieur ou membre supérieur. Nous avons donc réalisé une étude prospective afin de répondre aux questions : (1) est-ce que les versions françaises adaptées proposées du score MSTS sont valides ? (2) est-ce que les propriétés psychométriques des deux versions obtenues rendent son utilisation pertinente ?
Un processus de traduction et d’adaptation transculturelle a été réalisé selon les recommandations de Beaton et Guillemin permettant d’obtenir une version pour les patients opérés d’un membre supérieur (MSTS MS) et après chirurgie d’un membre inférieur (MSTS MI). Une étude de cohorte prospective multicentrique a été réalisée afin d’analyser les propriétés psychométriques des deux nouvelles versions obtenues.
Au total 250 patients sur 3 centres ont été inclus. L’adéquation à une analyse factorielle confirmatoire, des deux versions françaises obtenues pour le score MSTS (MSTS MS et MSTS MI) était bonne avec un RMSEA < 0,08 et un CFI > 0,90. Les propriétés psychométriques des deux versions ont été validées, avec une cohérence interne (Cronbach > 0,7), une validité convergente de chaque item avec son score (> 0,4) et une validité de critère (Pearson > 0,4) suffisante. La validité discriminante a mis en évidence une corrélation significative entre chaque version et le Performans Status (p < 0,05).
Cette étude a permis la traduction en français du score MSTS et la validation des propriétés psychométriques des deux versions obtenues (MSTS MS et MSTS MI). Le score MSTS français est donc un score valide pouvant être utilisé notamment lors d’études internationales.
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Transtibial prosthetic alignment has small effects on whole-body angular momentum during functional tasks
2023, Journal of BiomechanicsDue to the loss of ankle function, many people with a transtibial amputation (TTA) have difficulty maintaining balance during functional tasks. Prosthetic alignment may affect how people with TTA maintain balance as it affects ground reaction forces (GRFs) and centers of pressure. We quantified the effect of prosthetic alignment on dynamic balance during several functional tasks. Ten people with TTA and 10 controls without TTA completed tasks including walking and transitioning from a chair. Participants with TTA completed all tasks with their prescribed alignment and six shifted alignments, including ±10 mm anterior/posterior, medial/lateral, and ±20 mm in the vertical direction. For each task, we quantified dynamic balance as the range of whole-body angular momentum ( and quantified trunk range of motion (ROM) and peak GRFs. Compared to controls, participants with TTA using their prescribed alignment had a greater range of in the sagittal plane during walking, in all planes during sit-to-stand, and in the transverse plane during stand-to-sit. These results were associated with GRF and trunk ROM differences between participant groups. Alignment only affected the range of in the frontal plane during walking. The larger range for the tall alignment coincided with a greater difference in vertical GRF between intact and amputated legs compared to other alignments. Our findings suggest that people with TTA can adapt to small, translational, alignment changes to maintain similar levels of dynamic balance during chair transitions. Future work should investigate alignment changes during other tasks and in lower functioning individuals.
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Supported by the Health Science Promotion Program, The Hague, The Netherlands.
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.