The objective of this study was to compare the responsiveness of two self-report measures and three physical performance measures of function following physiotherapy for osteoarthritis of the knee. Patients referred for physiotherapy with osteoarthritis of the knee were recruited. The Western Ontario and McMaster Universities (WOMAC), Lequesne Algofunctional Index (LAI), timed-up-and-go test (TUGT), timed-stand test (TST) and six-minute walk test (6MWT) were administered at first and final physiotherapy visits. Wilcoxon Signed Rank tests were used to determine the effect of physiotherapy on each outcome. Responsiveness was calculated using effect size, standardised response mean and a median-based measure of responsiveness due to some outlying data. Thirty-nine patients with a mean age of 65.3 (standard deviation 6.9) years were investigated before and after a course of exercise-based physiotherapy. There was a significant improvement in all outcomes except the WOMAC scores. All measures demonstrated small effect sizes for all statistics (<0.50), except the 6MWT which was in the moderate range for one of the indices (standardised response mean 0.54). The LAI was more responsive than the WOMAC total score and the WOMAC physical function subscale for all responsiveness statistics, whilst the 6MWT was more responsive than the TST and the TUGT. The median-based effect size index produced the smallest effect sizes for all measures (0.1 to 0.43).
These results can be used to guide decision making about which physical function outcome measures should be used to evaluate effectiveness of rehabilitation of people with osteoarthritis of the knee at group level in a clinical setting.
Helen P. French, Martina Fitzpatrick, Oliver FitzGerald. Responsiveness of physical function outcomes following physiotherapy intervention for osteoarthritis of the knee: an outcome comparison study.
Physiotherapy, 4 May 2010, online article ahead of print