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OBJECTIVE: This systematic review aimed to identify the existing patient-reported outcome measures (PROMs) used in hip or knee arthroplasty for adults with osteoarthritis and assess their content validity using the modified International Classification of Functioning, Disability and Health (ICF) core set for osteoarthritis (OA). METHOD: Four databases were systematically searched to identify disease or joint-specific PROMs evaluating function after hip or knee arthroplasty. Two reviewers independently evaluated the content of PROMs based on established ICF linking rules. RESULTS: From 449 studies included in this review, 50 PROMs were identified. The mobility chapter of activities and participation was the most common component, followed by sensory function and pain chapter of body function and structure. The most frequent ICF activity and participation categories were d451:going up and down stairs, d4701:using private motorized transportation, d4104:standing, and d4154:maintaining a standing position. However, 11 ICF categories of the modified OA coreset were not captured in any PROMs. This ICF-based content analysis of PROMs revealed that included activity and participation categories vary widely, with little overlap between PROMs. The Knee injury and Osteoarthritis Outcome Score and Hip disability and Osteoarthritis Outcome Score had the most coverage for activity and participation (36.7%). CONCLUSION: Even though our search identified 50 specific PROMs, there remain gaps in content related to activity and participation coverage. By providing a content analysis of the PROMs used after hip or knee arthroplasty, this study may help clinicians select PROMs based on covered categories and relevant clinical objectives.

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PURPOSE: To develop a self-report questionnaire evaluating functional priorities after hip or knee arthroplasty and evaluate patients' understanding of its items and conceptual relevance. METHODS: A self-report questionnaire was first developed based on the International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis (OA). In the second stage, two research physiotherapists thoroughly reviewed and refined the questionnaire, and another physiotherapist conducted cognitive think-aloud interviews with 18 patients to assess the face and content validity of the questionnaire. RESULTS: All categories and corresponding activities of ICF core set for OA were used to develop the questionnaire. Several questionnaire issues were identified and addressed. Most challenges were related to comprehension, followed by item ordering and visual elements. Patients identified ambiguous wording which we subsequently simplified. Ten activities of the core set were excluded due to lack of face validity, two activities were added, and four activities were modified. CONCLUSION: The findings suggest that the ICF core set for OA needs to be adjusted for patients undergoing hip or knee arthroplasty and highlight the feasibility of applying a modified core set to assess functional priorities after hip or knee arthroplasty.

The questionnaire developed in this study can be used to assess patients' functional priorities after hip or knee arthroplasty for osteoarthritis.Several activities that comprise the International Classification of Functioning, Disability and Health (ICF) core set for osteoarthritis could be used to assess functional priorities after hip or knee arthroplasty.Some categories need to be removed or modified within this core set based on feedback from patients during the think-aloud sessions in our study.Using our questionnaire to determine postoperative patient priorities can help identify appropriate patient-centered outcome measures to use after hip or knee arthroplasty.

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PURPOSE: Although hip or knee arthroplasty is generally a successful intervention, it is documented that 15%-30% of patients undergoing arthroplasty report suboptimal outcomes. This narrative review aims to provide an overview of the key findings concerning the management of poorer outcomes after hip or knee arthroplasty. METHOD: A comprehensive search of articles was conducted up to November 2023 across three electronic databases. Only studies written in English were included, with no limitations applied regarding study design and time. RESULT: Efficiently addressing poorer outcomes after arthroplasty necessitates a thorough exploration of appropriate methods for assessing recovery following hip or knee arthroplasty, ensuring accurate identification of patients at risk or experiencing poorer recovery. When selecting appropriate outcome measure tools, various factors should be taken into consideration, including understanding patients' priorities throughout the recovery process, assessing psychometric properties of outcome measure tools at different time points after arthroplasty, understanding how to combine/reconcile provider-assessed and patient-reported outcome measures, and determining the appropriate methods to interpret outcome measure scores. However, further research in these areas is warranted. In addition, the identification of key modifiable factors affecting outcomes and the development of interventions to manage these factors are needed. CONCLUSION: There is growing attention paid to delivering interventions for patients at risk or not optimally recovering following hip or knee arthroplasty. To achieve this, it is essential to identify the most appropriate outcome measure tools, factors associated with poorer recovery and management of these factors.

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BACKGROUND: Workplace mild traumatic brain injuries are frequently associated with persistent symptoms, leading to a reduction in productivity at work or even disability. People who sustain workplace injuries frequently need rehabilitation and support, and the challenges of delivering these services was heightened during the COVID-19 pandemic as injured workers had to be cared for remotely. Currently, clinicians are conducting both in-person and virtual (remote) concussion assessments; however, the measures that are being used to complete these assessments have undocumented psychometric properties. OBJECTIVE: This study will document the psychometric properties of the clinical measures that are being used remotely and their ability to produce similar results to in-person assessments. Specifically, through this method-comparison study, we aim to (1) evaluate the sensitivity of the measures included in a virtual assessment toolkit when compared to an in-person assessment and (2) determine the interrater and intrarater reliabilities of the measures included in a virtual assessment toolkit. METHODS: Patient participants (people living with acquired brain injuries) will attend two assessments (in person and virtual) at the Ottawa Hospital. The two assessments will be identical, consisting of the measures included in our previously developed virtual concussion assessment toolkit, which includes finger-to-nose testing, the Vestibular/Ocular Motor Screening tool, balance testing, cervical spine range of motion, saccades testing, and evaluation of effort. All virtual assessments will occur using the Microsoft Teams platform and will be audio/video-recorded. The clinician assessor and patient participant will complete a feedback form following completion of the assessments. A different clinician will also document the findings on observed videos of the virtual assessment shortly after completion of both in-person and virtual assessments and approximately 1 month later. Interrater reliability will be assessed by comparing the second clinician's observation with the first clinician's initial virtual assessment. Intrarater reliability will be evaluated by comparing the second clinician's observation with their own assessment approximately 1 month later. Sensitivity will be documented by comparing the findings (identification of abnormality) of the in-person assessment completed by the initial clinician assessor with those of the second clinician assessor on the observation of the recording of the virtual assessment. RESULTS: As of May 2024, we have recruited 7 clinician assessors and completed study assessments with 39 patient participants. The study recruitment is expected to be completed by September 2024. CONCLUSIONS: Currently, it is unknown if completing concussion assessments virtually produces similar results to the in-person assessment. This work will serve as a first step to determining the similarity of the virtual assessment to the matching in-person assessment and will provide information on the reliability of the virtual assessment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57663.

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Objective: Total knee (TKA) and hip arthroplasty (THA) are successful procedures in treating end-stage osteoarthritis when nonoperative treatments fail. However, a growing body of literature has been reporting suboptimal outcomes following TKA and THA. While pre- and post-operative rehabilitation is imperative to recovery, little is known about their effectiveness for patients at risk of poor outcomes. In the 2 systematic reviews with identical methodology, we aim to evaluate the effectiveness of (a) pre-operative and (b) post-operative rehabilitation interventions for patients at risk of poor outcomes following TKA and THA. Methods: The 2 systematic reviews will follow the principles and recommendations outlined in the Cochrane Handbook. Only randomized controlled trials (RCTs) and pilot RCTs will be searched in 6 databases: CINAHL, MEDLINE, Embase, Web of Science, Pedro, and OTseeker. Eligible studies including patients at risk of poor outcomes and evaluating rehabilitation interventions following and preceding arthroplasty will be considered for inclusion. Primary outcomes will include performance-based tests and functional patient-reported outcome measures, and secondary outcomes will include health-related quality of life and pain. The quality of eligible RCTs will be evaluated using the Cochrane's risk of bias tool, and the strength of evidence will be assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Discussion: These reviews will synthesize the evidence regarding the effectiveness of pre-and post-operative rehabilitation interventions for patients at risk of poor outcomes, which in turn may inform practitioners and patients in planning and implementing the most optimal rehabilitation programs to achieve the best outcomes after arthroplasty. Systematic Review Registration: PROSPERO CRD42022355574.

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CONTEXT: Contralateral training in the early stages after surgery can improve the balance of the reconstructed knee, which is impaired following anterior cruciate ligament reconstruction (ACLR). However, little is known about the neuromuscular cross exercise after ACLR. OBJECTIVE: To investigate the effects of an 8-week cross exercise on balance and function of the reconstructed knee following ACLR. DESIGN: A single-blind randomized clinical trial. PARTICIPANTS: Thirty athletic males who underwent ACLR were randomly divided into intervention (n = 15) and control groups (n = 15). INTERVENTION: The intervention and control groups received a routine physiotherapy program. In addition, the intervention group performed neuromuscular exercises on the nonoperated limb. OUTCOME MEASURES: Before and 9 weeks after ACLR, dynamic and static balance, function, and pain in the reconstructed knee were measured by Star Excursion Balance Test (SEBT), stork balance stand test, balance error scoring system (BESS), Lysholm questionnaire, and visual analog scale. Data were analyzed by SPSS using 2-independent sample t test, paired t test, and analysis of covariance. RESULTS: Between-group comparison showed that, contralateral knee neuromuscular exercises significantly increased in the reaching distance in SEBT in the anterior (P < .001), posterior (P < .001), posteromedial (P = .010), and posterolateral directions (P = .007), decreased the number of errors in 4 stance positions of BESS including single stance on the firm (P ≤ .001) and foam surface (P ≤ .001), and tandem stance on the firm (P = .028) and foam surface (P ≤ .001). It also increased the time of standing of the stork stand test (P = .044) and decreased the pain intensity (P = .014). CONCLUSION: Neuromuscular exercise of the nonsurgical knee could improve the dynamic and static balance, and pain in the early stages following ACLR in the surgical leg. These findings may be potentially valuable for current rehabilitation protocols.

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