Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China.
Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong, China.
PM R. 2020 Mar;12(3):238-245. doi: 10.1002/pmrj.12226. Epub 2019 Oct 1.
Although balance is commonly assessed during the recovery of total knee arthroplasty (TKA), the minimal clinically important difference (MCID) values of frequently used balance assessment tools have not been established previously in this population.
To determine the MCID of four balance tests-ie, the Balance Evaluation Systems Test (BESTest), Mini-BESTest, Brief-BESTest, and the Berg Balance Scale (BBS)-in individuals post-TKA.
Prospective cohort.
Outpatient rehabilitation.
Inclusion criteria: (1) first primary TKA with diagnosed knee osteoarthritis; (2) aged 50-85 years.
(1) TKA due to rheumatoid arthritis of the knee or traumatic injury; (2) known medical conditions that influence balance ability. One hundred forty-six participants were recruited, and 134 of them with complete data were included in the analysis.
Participants received individualized physiotherapy, consisting of electrotherapy for pain and edema control, mobilization and strengthening exercises, and gait and balance training, once or twice per week between assessments.
Participants were assessed on the BESTest, Mini-BESTest, Brief-BESTest, BBS, and Functional Gait Assessment (FGA) 2 and 4 weeks after surgery. The FGA was used as the anchor reference measure to calculate the MCID of the other four balance tests. A distribution-based approach was also employed to derive the MCID (ie, standardized effect size of 0.5).
The BESTest (area under curve [AUC] = 0.811, 95% confidence interval [CI] 0.739-0.883) had the highest accuracy in detecting clinically important improvements on the FGA (≥4 points), followed by the Mini-BESTest (AUC = 0.782, 95% CI 0.704-0.860), Brief-BESTest (AUC = 0.701, 95% CI 0.618-0.795), and BBS (AUC = 0.586, 95% CI 0.490-0.682). The anchor- and distribution-based MCIDs were 6-8 for the BESTest, 1-2 for the Mini-BESTest, and 2-3 for the Brief-BESTest.
Improvements exceeding MCIDs established above are indicative of significant progress in balance function post-TKA. The BBS is not a recommended tool due to its low AUC value.
尽管在全膝关节置换术（TKA）康复期间通常会评估平衡，但之前尚未在该人群中确定常用平衡评估工具的最小临床重要差异（MCID）值。
确定四项平衡测试（即平衡评估系统测试（BESTest）、Mini-BESTest、Brief-BESTest 和 Berg 平衡量表（BBS））在 TKA 后个体中的 MCID。
前瞻性队列研究。
门诊康复。
纳入标准：（1）初次原发性 TKA 合并膝关节骨关节炎诊断；（2）年龄 50-85 岁。
（1）因膝关节炎或创伤性损伤所致的 TKA；（2）已知影响平衡能力的医疗状况。共招募了 146 名参与者，其中 134 名数据完整的参与者纳入分析。
参与者接受个体化物理治疗，包括电疗以控制疼痛和水肿、活动和强化锻炼以及步态和平衡训练，每周接受 1-2 次治疗。
术后 2 周和 4 周时，参与者接受 BESTest、Mini-BESTest、Brief-BESTest、BBS 和功能性步态评估（FGA）测试。使用 FGA 作为锚定参考测量值来计算其他四项平衡测试的 MCID。还采用基于分布的方法来得出 MCID（即，标准化效应量为 0.5）。
在检测 FGA（≥4 分）方面，BESTest（曲线下面积[AUC] = 0.811，95%置信区间[CI] 0.739-0.883）的准确性最高，其次是 Mini-BESTest（AUC = 0.782，95% CI 0.704-0.860）、Brief-BESTest（AUC = 0.701，95% CI 0.618-0.795）和 BBS（AUC = 0.586，95% CI 0.490-0.682）。基于锚定和分布的 MCID 分别为 BESTest 为 6-8，Mini-BESTest 为 1-2，Brief-BESTest 为 2-3。
超过上述 MCID 的改善表明 TKA 后平衡功能有显著进展。由于 AUC 值较低，BBS 不是推荐的工具。
