Wagenmakers Robert, van den Akker-Scheek Inge, Groothoff Johan W, Zijlstra Wiebren, Bulstra Sjoerd K, Kootstra Johan W J, Wendel-Vos G C Wanda, van Raaij Jos J A M, Stevens Martin
Department of orthopedics, university medical center Groningen, university of Groningen, the Netherlands.
BMC Musculoskelet Disord. 2008 Oct 17;9:141. doi: 10.1186/1471-2474-9-141.
Despite recognized benefits of regular physical activity on musculoskeletal fitness as well as general health, little is known about the physical activity behavior of patients after Total Hip Arthroplasty (THA). So far, no physical activity questionnaire has been validated in this category of patients. As the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH) has been shown to be a fairly reliable and valid tool to gauge the physical activity behavior of the general Dutch adult population, we measured the reliability and relative validity of this tool in patients after THA.
44 patients (17 men and 27 women, mean age 71 +/- 8 years) completed the SQUASH twice with an in-between period of 2 to 6 weeks (mean 3.7). Reliability was determined by calculating the Spearman correlation coefficient between the activity scores of the separate questions as well as the total activity scores from both administrations. Additionally, a Bland & Altman analysis was performed for the total activity scores. Relative validity was determined using the Actigraphaccelerometer, worn by 39 patients (15 men and 24 women, mean age 70 +/- 8 years) for a 2-week period following the second questionnaire, as a criterion measure.
Spearman's correlation coefficient for overall reliability was 0.57. It varied between 0.45 and 0.90 for the separate questions. No systematic biases between readings were found. The Spearman correlation between Actigraph readings and total activity score was 0.67. It was 0.56 for total minutes of activity, 0.20 for time spent in light intensity activity, 0.40 for moderate activity and 0.35 for vigorous activity. Systematic bias was found between the SQUASH and the Actigraph.
The SQUASH can be considered to be a fairly reliable tool to assess the physical activity behavior of patients after THA. Validity was found to be comparable with those of other questionnaires, and as it is short and easy to fill in, it may prove to be a useful tool to assess physical activity in this particular subset of the population. However, the considerable systematic bias found in this study illustrates the need for further analysis of the validity of the SQUASH.
尽管人们认识到定期体育活动对肌肉骨骼健康以及总体健康有益，但对于全髋关节置换术（THA）后患者的体育活动行为知之甚少。到目前为止，尚无针对此类患者的体育活动问卷得到验证。由于简短健康增强型体育活动评估问卷（SQUASH）已被证明是评估荷兰成年普通人群体育活动行为的相当可靠且有效的工具，我们测量了该工具在THA后患者中的信度和相对效度。
44例患者（17例男性和27例女性，平均年龄71±8岁）两次完成SQUASH问卷，间隔时间为2至6周（平均3.7周）。通过计算各单独问题的活动得分之间以及两次问卷的总活动得分之间的斯皮尔曼相关系数来确定信度。此外，对总活动得分进行布兰德-奥特曼分析。使用活动记录仪作为标准测量方法，39例患者（15例男性和24例女性，平均年龄70±8岁）在第二次问卷后的2周内佩戴，以此确定相对效度。
总体信度的斯皮尔曼相关系数为0.57。各单独问题的相关系数在0.45至0.90之间。未发现读数之间存在系统偏差。活动记录仪读数与总活动得分之间的斯皮尔曼相关系数为0.67。活动总分钟数的相关系数为0.56，轻度强度活动时间的相关系数为0.20，中度活动的相关系数为0.40，剧烈活动的相关系数为0.35。发现SQUASH问卷与活动记录仪之间存在系统偏差。
SQUASH问卷可被认为是评估THA后患者体育活动行为的相当可靠的工具。发现其效度与其他问卷相当，并且由于其简短且易于填写，它可能被证明是评估这一特定人群体育活动的有用工具。然而，本研究中发现的相当大的系统偏差表明需要进一步分析SQUASH问卷的效度。
