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The 3-m backward walk test (3MBWT) is used to evaluate neuromuscular control, proprioception, protective reflexes, fall risk, and balance. The aim of the present study was to determine the test–retest reliability of the 3MBWT in patients with primary total knee arthroplasty (TKA). Twenty-eight patients with primary TKA, operated by the same surgeon, were included in this study. Patients performed trials for 3MBWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The 3MBWT showed an excellent test–retest reliability in this study. Intraclass correlation coefficient (ICC) for 3MBWT was 0.97. The standard error of measurement and smallest real difference at the 95% confidence level for 3MBWT were 1.06 and 2.94, respectively. The 3MBWT has an excellent test–retest reliability in patients with primary TKA. It is an effective and reliable tool for measuring dynamic balance and participant falls. As a clinical test, the 3MBWT is easy to score, requires little space, has no cost, needs no special equipment, and can be applied in a short time as part of the routine medical examination.

Background:Patients with TKA show impairments in standing balance up to 1 year after surgery. The impaired standing balance in TKA patients was found to be associated with falls risk and decreased functional level. Assessing of standing balance with objective and reliable assessments tools would therefore be extremely useful for determining accurate exercise program, and risks of falling, especially during the rehabilitative period when ambulation is at its most unsteady (1, 2). The stepping maneuver requires adequate strength and motor control to stabilize the body over the stance limb while the other leg is stepping, therefore the Step Test (ST) provides significant information for dynamic standing balance and lower limb motor control (3). The reliability of ST is reported in patient groups such as stroke, however, there is not any study that investigates the reliability of ST in patients with TKA in the current literature.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the ST in patients with TKA.Methods:40 patients with TKA due to knee osteoarthritis, operated by the same surgeon, were included in this study. Patients performed trials for ST twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The ST assesses an individual’s ability to place one foot onto a 7.5-cm-high step and then back down to the floor repeatedly as fast as possible for 15 seconds. The score is the number of steps completed in the 15-second period for each lower extremity. Scores for each lower extremity were recorded separately. Prior to the testing, the ST was demonstrated by the tester and all participants were allowed to a practice trial.Results:The ST showed an excellent test-retest reliability (ICC2,1=0.95) in this study. Standard error of measurement (SEM) and MDC95for ST were 0.37 and 1.02, respectively.Conclusion:This study found that the ST has an excellent test–retest reliability in patients with TKA. It is an effective and reliable tool for measuring dynamic standing balance and participant falls. As a performance-based clinical test, the ST is easy to score, can be applied in a short time as part of the routine medical examination. Therefore, inclusion of ST into a more comprehensive battery of performance-based measures of standing balance and lower limb motor control function in subjects with TKA should be considered.References:[1]Si, H. B., Zeng, Y., Zhong, J., et al. (2017). The effect of primary total knee arthroplasty on the incidence of falls and balance-related functions in patients with osteoarthritis. Scientific reports, 7(1), 1-9.[2]Moutzouri, M., Gleeson, N., Billis, E., et al. (2017). The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 25(11), 3439-3451.[3]Hill, K. D., Bernhardt, J., McGann, A. M., et al. (1996). A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiotherapy Canada, 48(4), 257-262.Disclosure of Interests:None declared

Background:Patients with total knee arthroplasty (TKA) often experience pain and reduced balance control, which may predispose them to greater fall risk. The patients with revision total knee arthrooplasty (rTKA), have more pain, stiffness and physical dysfunction and less postoperative improvement compared to the patients with TKA [1]. Falls in people with gait or balance disorders have significant consequences. Fear of falling can also predispose people to inactivity, which can lead to problems of debilitation, increased handicap, and disability by itself. Most of the falls take place in the course of movement, and the trips and slips were determined as the most common cause of elderly falls. Trips are responsible of falls between 40% to 60% and slips between 10% to 15%, showing that the capability to take a quick step would prevent many falls [2]. Literature has found stepping speed to the different directions declines with aging and are lesser for fallers than for nonfallers [3].Modified four square step test (mFSST) was developed to assessing fall risk and dynamic balance by scoring time while participants stepping in multiple directions but its reliability has not been investigated in patients undergoing rTKA.Objectives:The aims of this study were to determine the test-retest reliability and the minimal clinically important change (MCID) of the mFSST in patients with rTKAMethods:mFSST administered on 22 patients undergoing rTKA. mFSST is performed by using tapes to make one horizontal and one vertical line like a cross to create 4 quadrants. Patients’ performances were timed as patients were successfully stepping clockwise and counter-clockwise while avoid touching on tapes, turning their body or losing balance. Two trials performed and patients rested between trials and were encouraged to rest as often as they required to prevent fatigue.Results:ICC(2.1)for mFSST was 0.83. The standard error of measurement and MCID were 0.67 and 1.85 respectively (95 %. confidence level).Conclusion:The mFSST has a good test-retest reliability in patients with rTKA. It is a reliable and responsive tool for measuring fall risk, dynamic balance and mobility. The mFSST is an excellent measure of gait variability, stepping in multipl directions and dynamic balance, also can easily identify real clinically important changes in patients with rTKA in simple environments and minimal equipment.References:[1]Järvenpää J, Kettunen J, Miettinen H, Kröger H. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. International Orthopaedics 2010; 34: 649-653.[2]Cumming RG, Klineberg RJ. Fall frequency and characteristics and the risk of hip fractures. Journal of the American Geriatrics Society 1994; 42: 774-778.[3]Medell JL, Alexander NB. A clinical measure of maximal and rapid stepping in older women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2000; 55: M429-M433.Disclosure of Interests:None declared

Purpose Alterations in spinal mobility lead to impaired postural control and balance, an increased risk of falls and a decrease in quality of life. The purposes of this study were to investigate the relationship between spinal mobility, postural control and balance and to compare spinal mobility and balance with a view to disease severity in patients with ankylosing spondylitis (AS). Methods 137 patients with AS were divided into 2 groups by tragus-to-wall distance (TWD): (Group I=mild AS, n=51), (Group II=moderate AS, n=86). Balance was assessed with the Single-Leg Balance Test, the Timed Up and Go Test (TUG) and the Berg Balance Scale (BBS). Spinal mobility was measured by BASMI Index [TWD, cervical rotation (CR), Modified Schober Test (MST), lumbar lateral flexion (LLF), intermalleolar distance (IMD) and thoracic expansion (TE)] and was compared between the groups. The association with balance was investigated. Results Spinal mobility and BBS scores in Group II were worse than in Group I (p<0.05). Static balance and TUG of the groups were similar (p>0.05). Dynamic balance was weakly correlated with MST, LLF and IMM and moderately correlated with CR, TE and BASMI. Static balance was weakly correlated with spinal mobility (p<0.05). There was no correlation between TWD and any balance domains (p>0.05). Conclusions In patients with AS, spinal mobility and dynamic balance worsen as the disease progresses, whereas static balance does not change. Such changes in mobility and balance can negatively affect patients’ participation in daily life and increase their risk of falls. Therefore, detailed evaluation of balance, balance training and fall prevention approaches need to be implemented in the rehabilitation programs of patients with AS.

Background:Total knee arthroplasty (TKA) is an effective treatment for patients suffering from end-stage osteoarthritis with 10- to 15-year implant survivorship rates exceeding 90%. Infection, osteolysis due to polyethylene wear, loosening, stiffness and instability may cause to implant failure and revision of the TKA (rTKA). However, up to 20% of patients continue to have postoperative pain, functional limitations and low treatment satisfaction and 24% of patients were not able to walk unaided with no limp or a slight limp after TKA [1].Falls and related traumas can produce “fracture, dislocation, crushing, and other injuries” [2]. Falls often occur due to impaired physical function which includes changes in lower knee joint angle, weakened lower limb muscles, peripheral nerve blockade, deformity of the foot limited balance and gait.Several measures of fall risk have been previously developed however, recent research has demonstrated that backwards walking is more sensitive at identifying changes in mobility and balance compared to forward walking. Backwards walking is necessary to perform such tasks as backing up to a chair, opening up a door or getting out of the way of a sudden obstacle.3-M Backwards Walk Test (3MBWT) is used to evaluate walking skills, fall risk and dynamic balance. The 3MBWT demonstrated similar or better diagnostic accuracy for falls in the past year than the most commonly used measures and found to be reliable in healthy subjects. [3] However, its reliability in rTKA has not been investigated.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal clinically important difference (MCID) of the 3MBWT in patients with rTKAMethods:Twenty-two patients with rTKA, operated on by the same surgeon, were included. For the 3MBWT, a distance of 3 meters was marked with tape and participants were asked to align their heels with the black tape. They were instructed to walk backwards as quickly. Patients performed trials for 3MBWT twice on the same day. Between the trials, patients waited for an hour on sitting position to prevent fatigue.Results:The 3MBWT showed an excellent test-retest reliability. Intraclass correlation coefficient ICC for 3MBWT was 0.97. The standard error of measurement and MCID at the 95% confidence level for 3MBWT were 1,08 and 2,99 respectively.Conclusion:The 3MBWT has an excellent test-retest reliability in patients with rTKA. It is an effective and reliable tool for measuring fall risk, dynamic balance and walking skills. As a clinical test, the 3MBWT is easy to score, has no cost, needs no special equipment and can be applied in a short time as part of the routine medical examination.References:[1]Shan L, Shan B, Suzuki A et al. Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. JBJS 2015; 97: 156-168.[2]Johnson RL, Duncan CM, Ahn KS et al. Fall-Prevention Strategies and Patient Characteristics That Impact Fall Rates After Total Knee Arthroplasty. Anesthesia & Analgesia 2014; 119: 1113-1118.[3]Carter V, Jain T, James J et al. The 3-m Backwards Walk and Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure. J Geriatr Phys Ther 2017.Disclosure of Interests:None declared

Background The modified four-square step test (mFSST) assesses dynamic balance by rapid stepping in different directions. This study aimed to evaluate the reliability of the mFSST in patients who had undergone revision total knee artroplasty (rTKA). Methods The study was designed as a cross-sectional study. The mFSST was administered on 22 patients with a history of rTKA. Two trials were performed and the patients rested between trials to avoid fatigue. Results The intraclass correlation coefficient (ICC) for the mFSST was 0.83. The standard error of measurement and the smallest real difference (95%. confidence level) were 0.67 and 1.85 respectively. Conclusion The mFSST showed good reliability in patients who had undergone rTKA. The mFSST is a reliable measure for the assessment of gait variability, dynamic balance, walking skills and mobility. It can easily detect changes in rTKA patients with simple equipment.

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