AB1000 Reliability and Validity of the Cone Evasion Walk Test in Patients With Total Knee Arthroplasty: A Pilot Study

Abstract

BackgroundTotal knee arthroplasty (TKA) is the gold-standard procedure for end-stage knee osteoarthritis, however, some residuel problems may still continue and cause a variety of dysfunctions, such as impaired strength, proprioception, gait, balance, postural instability, and, impaired ability to avoid obstacles while walking. Tripping over an obstacle is the most frequent cause of falls 1 and falls can limit daily activities and induce post-fall syndromes, such as dependence, loss of autonomy, immobilization, and depression 2. The Cone Evasion Walk test (CEW) to assess fall risk by the ability to evade obstacles, (ICF-code d455), which requires attentional, perceptual, and several neuromusculoskeletal and movement related functions 3. However, there is no study investigating the reliability and validity of the CEW in TKA patients.ObjectivesThe aim of the study is to investigate the reliability and validity of the CEW in patients with TKA.MethodsTwenty patients with TKA included in the study. The CEW, the Timed Up And Go Test (TUG) and the Hospital for Special Surgery (HSS) Knee Score administered to the patients. Patients rested between the tests for an hour.ResultsMean age was 68.1 ± 2.59 years and the mean HSS Knee Score was 85.43± 3.47. The relative (ICC coefficient) and absolute (SEM and SRD95) reliability values were 0.98, 1.01, and 2.75 respectively. The Spearman correlation coefficient of the CEW with the TUG was 0.72.ConclusionBased on the current findings, the CEW has excellent reliability, high validity and responsiveness in evaluating dynamic balance and obstacle avoidance in patients with TKA. The minimal clinically important difference of CEW in TKA patients is 2.75 and it may be concluded that the fact that this value is low, indicates the sensitivity of the test. Therefore, the CEW can identify even small alterations in the functional status, can be reliably used for post-operative surveillance of TKA to observe patient results, and the usage of the CEW for assessing the fall risk and mobility in the community may be a better predictor of the patients’ current condition.