Bel ağrısı olan hastalarda Zamanlı Kalk Yürü, Tek Ayak Üzerinde Durma ve 30 Saniye Otur Kalk Testlerinin tele-değerlendirmesinin güvenirliği

Öz

Amaç: Bu çalışmanın amacı, bel ağrısı olan bireylerde Zamanlı Kalk-Yürü (Timed Up and Go; TUG), Tek Ayak Üzerinde Durma (Single Leg Standing; SLS) ve 30 Saniye Otur-Kalk (30-Second Sit-to-Stand; 30STS) testlerinin, hem aynı değerlendirici hem de farklı değerlendiriciler arasında, yüz yüze ve tele-değerlendirme yöntemleriyle güvenirliğini incelemekti. Yöntem: Çalışmaya, bel ağrısı tanısı almış ve dahil edilme kriterlerini karşılayan 50 birey katıldı. Katılımcıların yaş, cinsiyet ve beden kitle indeksi (BKİ) gibi ayrıntılı demografik verileri kaydedildi. Fonksiyonel testler hem geleneksel yüz yüze ortamda hem de senkron (eş zamanlı) ve asenkron (farklı zamanlı) tele-değerlendirme koşullarında uygulandı. Bulgular: Yüz yüze ve tele-değerlendirme yöntemleri arasında farklı değerlendiriciler arası (inter-değerlendirici) güvenirlik çok yüksek bulundu (TUG: ICC=0,999; SLS: ICC=0,998; 30STS: ICC=0,996). İki tele-değerlendirme oturumu arasındaki farklı değerlendiriciler arası (inter-değerlendirici) güvenirlik de oldukça yüksekti (TUG: 0,997; SLS: 0,999; 30STS: 0,999). Aynı değerlendirici tarafından yapılan tekrar ölçümler arasındaki (intra-değerlendirici) güvenirlik, senkron tele-değerlendirmede TUG, SLS ve 30STS için sırasıyla 0,997, 0,925 ve 0,924 olarak bulundu. Sonuç: TUG, SLS ve 30STS testleri, bel ağrısı olan bireylerde tele-değerlendirme uygulamaları açısından yüksek düzeyde güvenirlik sergilemiştir. Bu bulgular, söz konusu testlerin fonksiyonel kapasitenin ev ortamında uzaktan, güvenli ve standardize bir biçimde değerlendirilmesi için geçerli, uygulanabilir ve klinik olarak yararlı araçlar olduğunu göstermektedir.

Anahtar Kelimeler

• Bel ağrısı
• Tele-tıp
• Tele-rehabilitasyon
• Güvenirlik.

Reliability of tele-evaluation of Timed Up and Go, Single Leg Stand, and 30 s Sit to Stand Tests in patients with low back pain

Öz

Purpose: This study aimed to examine the reliability of the Timed Up and Go (TUG), Single Leg Standing (SLS), and 30-Second Sit-to-Stand (30STS) tests, both between different raters (inter-rater) and within the same rater (intra-rater), when administered through face-to-face and tele-evaluation methods in individuals with low back pain (LBP). Methods: Fifty individuals diagnosed with LBP and meeting the inclusion criteria participated in the study. Detailed demographic characteristics, including age, sex, and body mass index (BMI), were recorded. Functional tests were conducted both in a traditional face-to-face setting and under synchronous (real-time) and asynchronous (recorded) tele-evaluation conditions. Results: Inter-rater reliability between face-to-face and tele-evaluation methods was found to be very high (TUG: ICC=0.999; SLS: ICC=0.998; 30STS: ICC=0.996). Similarly, inter-rater reliability between two tele-evaluation sessions was also excellent (TUG: 0.997; SLS: 0.999; 30STS: 0.999). Intra-rater reliability, representing repeated measurements by the same rater, was also high in synchronous tele-evaluations, with ICC values of 0.997, 0.925, and 0.924 for TUG, SLS, and 30STS, respectively. Conclusions: The TUG, SLS, and 30STS tests demonstrated high reliability in tele-evaluation applications among individuals with LBP. These findings indicate that the tests are valid, feasible, and clinically useful tools for standardized, safe, and remote evaluation of functional capacity in a home environment.

Anahtar Kelimeler

• Low back pain
• Telemedicine
• Telerehabilitation
• Reliability.

Kaynakça

1. Andersson GBJ. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581- 585.
2. Truter P, Russell T, Fisher A. The feasibility of a novel telerehabilitation system for orthopaedic rehabilitation. Physiotherapy. 2014;100:233- 238.
3. Dario AB, Cabral AM, Macedo LC, et al. Effectiveness of telerehabilitation on pain and disability patients with chronic low-back pain: A systematic review and meta-analysis. Eur J Pain. 2017;21:1880-1889.
4. Palacín-Marín F, Esteban-Morenilla J, Carrasco MJ, et al. Reliability of clinical tests for lumbar instability and motor control in patients with chronic low back pain. Eur Spine J. 2013;22:305- 312.
5. Chen J, Jin W, Zhang XX, et al. Telerehabilitation approaches for stroke patients: Systematic review and meta-analysis. Stroke. 2015;46:347-352.
6. Russell T, Buttrum P, Wootton R, Jull G, et al. Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: A randomized controlled trial. J Bone Joint Surg Am. 2011;93:113-120.
7. Simmonds MJ, Olshen RA, Bove EA, et al. Assessment of functional mobility in low-back-pain patients: Timed Up and Go test reliability. Spine. 1998;23:1155-1160.
8. Podsiadlo D, Richardson S. The Timed Up and Go: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142- 148.

9. Lin SI, Woollacott MH. Postural control and the influence of somatosensory input in older adults: Functional performance implications. J Gerontol A Biol Sci Med Sci. 2002;57:B798-B804.
10. Jones CJ, Rikli RE, Beam WC. A 30-s chair stand test as a measure of lower-body strength in community-residing older adults. Res Q Exerc Sport. 1999;70:113-119.
11. Bohannon RW. Reference values for the five- repetition sit-to-stand test: A descriptive meta- analysis. Phys Ther. 2006;86:1128-1135.
12. Kwan MMS, Lin SI, Chen CH, et al. Validation of the 30-second chair-stand test in community- dwelling older people. Age Ageing. 2011;40:558- 563.
13. Palazón-Bru A, Tomás-Rodríguez MI, Gil- Guillén VF, et al. Reliability of physical performance tests in low back pain patients. Eur Spine J. 2017;26:97-103.
14. Denehy L, Berney S, Elliott D. Telehealth delivery of physical performance tests: A systematic review. J Telemed Telecare. 2019;25:397-407.
15. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155- 163.
16. Stratford PW, Kennedy DM, Pagura SM. The reliability of the 30-second chair-stand test in patients with hip and knee osteoarthritis. Physiother Can. 2003;55:23-29.
17. Ozsoy I, Uz AL. Reliability of tele-assessment of five-repetition sit-to-stand and Timed Up and Go tests in patients with non-specific chronic low- back pain. Discov Health Syst. 2024;3:34.
18. Bowman A, Denehy L, Benjemaa A, et al. Feasibility and safety of the 30-second sit-to- stand test delivered via telehealth: An observational study. PM R. 2023;15:31-40.
19. Karim R, Jasper A, Uy SJM, et al. Feasibility of Timed Up and Go administered via telerehabilitation in older adults: A pilot study. Top Geriatr Rehabil. 2023;39:229-234.
20. Tousignant M, Boissy P, Moffet H, et al. Patients’ satisfaction with in-home telerehabilitation after total knee arthroplasty: A randomized controlled trial. Telemed J E Health. 2011;17:422-426.
21. Cottrell MA, Hill AJ, O’Leary SP, et al. Clinical outcomes for patients receiving telehealth- delivered physical therapy: A systematic review and meta-analysis. Telemed J E Health. 2018;24:628-635. Suso-Martí L, La Touche R, Herranz-Gómez A, et al. Effectiveness of telerehabilitation in musculoskeletal disorders: Systematic review and meta-analysis. Phys Ther. 2020;100:1906- 1921.
22. Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy: Making virtual physical therapy a reality. Phys Ther. 2020;100:830-842.
23. de Vet HCW, Terwee CB, Mokkink LB, et al. Measurement in Medicine: A Practical Guide. Cambridge (UK): Cambridge University Press; 2011.
24. Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull. 1979;86:420-428.
25. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice (3rd ed.). Philadelphia (PA): F.A. Davis; 2015.
26. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327:307- 310.
27. Cottrell MA, Galea OA, O’Leary SP, et al. Real- time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: A systematic review and meta-analysis. Clin Rehabil. 2017;31:625-638.
28. W, Green H, Sikhosana N, et al. Effectiveness of telehealth cardiac rehabilitation programs on health outcomes of patients with coronary heart diseases: An umbrella review. J Cardiopulm Rehabil Prev. 2024;44:15-25.
29. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19:231-240.
30. Guralnik JM, Ferrucci L, Simonsick EM, et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332:556-561.
31. Moffet H, Tousignant M, Nadeau S, et al. In- home telerehabilitation compared with face-to- face rehabilitation after total knee arthroplasty: A non-inferiority randomized controlled trial. J Bone Joint Surg Am. 2015;97:1129-1141.
32. Pastora-Bernal JM, Martín-Valero R, Barón- López FJ, et al. Evidence of benefit of telerehabilitation after orthopedic surgery: A systematic review. J Med Internet Res. 2017;19:e142.
33. Bashshur RL, Shannon GW, Smith BR, et al. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health. 2014;20:769-800.
34. Cottrell MA, O’Leary SP, Hill AJ, et al. Service provision via telerehabilitation for patients with musculoskeletal conditions: A clinical commentary. J Orthop Sports Phys Ther. 2019;49:736-739.
35. Chen J, Cheng H, Wang Y. Factors influencing patients’ acceptance of telemedicine services: An integrative review. Int J Environ Res Public Health. 2019;16:4223.