Background It is important to evaluate the functional result of any orthopaedic intervention. This is commonly achieved by completing tests which evaluate function in a controlled environment under a specific set of conditions, allowing objective measures to be gathered. Alternatively patient-reported assessments may be used, which reveal the limitations that the patients experience when carrying out everyday activities in their own environment. This study investigated the association between these two methods.
Method 40 adult patients undergoing lower limb reconstruction surgery completed the Toronto Extremity Salvage Score (TESS) pre-operatively and at 6, 12 and 24 months post surgery. TESS evaluates a single domain, physical disability, based on patients’ reports of their function. It is applicable to a heterogeneous population being sensitive to change across a range of levels of disability.1 They also performed 3 timed tests of stair climbing, sit-to-stand and walking.
Results Within subjects changes were analysed using the Wicoxon matched-pairs test and associations between variables by a Spearman’s Rank Correlation Coefficient.
Subjects, on average, improved on all of the functional measures, with significant improvements from the baseline score at 12 and 24 months (P < 0.001). Changes at 6 months were not significant. There was a poor correlation between TESS and the timed function tests. To explore this further the association between specific questions in TESS and the objective performance tests were tested. This showed significant correlations between walking speed and the question about walking indoors (0.53, P < 0.003), between stair climbing and the question about going upstairs (0.64, P < 0.001) and downstairs (0.42, P < 0.025) and sit-to-stand and the question about getting out of a chair (0.41, P < 0.03).
Conclusions The association between the self-reported and observed outcome measures was not as strong as may have been expected when both purport to measure the same dimension of physical function. One explanation for this may be that the observed outcomes were all timed activities and patients’ satisfaction with their functional abilities may not be related to time. Whilst timed tests may be reliable tests of function, they may not be as valid or useful a measure as patient-reported measures.
Davis AM, Bell RS, Badley EM, et al. Evaluating functional outcome in patients with lower extremity sarcoma. Clin Orthop Relat Res. 1999;358:90–100
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