The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee.
OBJECTIVE
The aggregated locomotor function (ALF) score, a simple measure of observed locomotor function, using timed walking, stairs and transfers, was developed and evaluated for intra-tester reliability, criterion-related validity and responsiveness in a sample of patients with knee osteoarthritis.


METHODS
Patients with knee osteoarthritis (n = 214) were recruited for inclusion in a randomized controlled trial investigating two methods of exercise provision. Before treatment, patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 health survey (SF-36) questionnaires and were timed whilst performing an 8 m walk, ascending and descending a set of gymnasium stairs and completing a test of transferring in and out of a chair. A group of 15 patients also undertook a replicate test-retest reliability study of the above outcome measures. Standardized response means were calculated for the ALF, WOMAC and SF-36 from data from the clinical trial.


RESULTS
The ALF takes 10 min to administer and demonstrated excellent intra-tester reliability, with excellent intra-class correlation coefficient (ICC) statistics (ICC(2,k) 0.99; 95% CI 0.98-0.99), and low standard error of measurement (0.86 s) and smallest detectable difference (9.5%) values. Criterion-related validity with the physical function dimensions of the WOMAC and SF-36 was good, with correlation coefficients of 0.59 and - 0.53 respectively. Standardized response means were higher for the ALF (0.49) than for both the WOMAC (0.39) and the SF-36 (0.12).


CONCLUSIONS
This work has demonstrated that the ALF can be used as a measure of physical function status and as a means of quantifying treatment response. The measure offers a simple and convenient outcome in the assessment and treatment of locomotor dysfunction. The ALF score is a reliable, valid and responsive outcome measure over 12 months and can be recommended for use in the evaluation of patients with knee osteoarthritis.
McCarthy
C J
CJ
Centre for Rehabilitation Science, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. christopher.j.mccarthy@man.ac.uk
Oldham
J A
JA
D000368:Aged; D004185:Disability Evaluation; D006801:Humans; D008124:Locomotion; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome