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Reliable assessment of objective functional impairment (OFI) using five-repetition sit-to-stand testing (5R-STS) in an unsupervised, at-home setting: a prospective study in degenerative lumbar spinal patients
EANS Academy. Schröder M. 09/26/19; 275923; EP02059
Dr. Marc L. Schröder
Dr. Marc L. Schröder

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Abstract
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Background: Objective functional tests, like the five-repetition sit-to-stand test (5R-STS) can supplement an objective dimension to conventional patient-reported outcome measures (PROMs). The reliability of unsupervised obtainment of 5R-STS performance is currently unknown.
Methods: We included patients with degenerative pathologies of the lumbar spine. Patients performed the 5R-STS during the initial clinical visit (supervised), as well as at home after instruction by a physiotherapist. At home, patients were first timed by a relative (unsupervised), and subsequently produced a video recording of themselves performing the 5R-STS for digital measurement (telesupervised). Two raters independently assessed the recordings.
Results: One-hundred-twenty-one patients were recruited, of which 100 were eligible. Eighty-eight reported unsupervised results. Sixty-four returned recordings, of which 61 were ratable. Both unsupervised (r: 0.94, 95% CI: 0.91-0.96, p < 0.001) and telesupervised (r: 0.90, 95% CI: 0.83-0.94, p< 0.001) measurements demonstrated excellent correlation with clinical test times. Patients did not perform more slowly at home (p>0.05). The interrater agreement for digital judgement of the telesupervised recording was excellent (ICC: 0.996, 95% CI: 0.993-0.998, p< 0.001). We confirmed convergent validity with self-reported disability, back pain, and quality-of-life (all p< 0.05), but not with leg pain (p=0.189).
Conclusion: Unsupervised at-home assessment using the 5R-STS is highly reliable. There does not appear to be a specific need for patients to return for a supervised 5R-STS follow-up. Rather, instructions can be provided, and the test performed and rated by a partner or family member at home. This is logistically and economically advantageous for patients, clinicians, and researchers.
Background: Objective functional tests, like the five-repetition sit-to-stand test (5R-STS) can supplement an objective dimension to conventional patient-reported outcome measures (PROMs). The reliability of unsupervised obtainment of 5R-STS performance is currently unknown.
Methods: We included patients with degenerative pathologies of the lumbar spine. Patients performed the 5R-STS during the initial clinical visit (supervised), as well as at home after instruction by a physiotherapist. At home, patients were first timed by a relative (unsupervised), and subsequently produced a video recording of themselves performing the 5R-STS for digital measurement (telesupervised). Two raters independently assessed the recordings.
Results: One-hundred-twenty-one patients were recruited, of which 100 were eligible. Eighty-eight reported unsupervised results. Sixty-four returned recordings, of which 61 were ratable. Both unsupervised (r: 0.94, 95% CI: 0.91-0.96, p < 0.001) and telesupervised (r: 0.90, 95% CI: 0.83-0.94, p< 0.001) measurements demonstrated excellent correlation with clinical test times. Patients did not perform more slowly at home (p>0.05). The interrater agreement for digital judgement of the telesupervised recording was excellent (ICC: 0.996, 95% CI: 0.993-0.998, p< 0.001). We confirmed convergent validity with self-reported disability, back pain, and quality-of-life (all p< 0.05), but not with leg pain (p=0.189).
Conclusion: Unsupervised at-home assessment using the 5R-STS is highly reliable. There does not appear to be a specific need for patients to return for a supervised 5R-STS follow-up. Rather, instructions can be provided, and the test performed and rated by a partner or family member at home. This is logistically and economically advantageous for patients, clinicians, and researchers.
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