Test-Retest Reliability of Modified Thai Lower Extremity Functional Scale (Modified Thai LEFS) and correlation to Thai version of Knee Osteoarthritis Outcome Scores (Thai KOOS), Self-Pace Walk test (SPWT), and Timed Up and Go test (TUG) in Thais with knee osteoarthritis
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Published:
Sep 25, 2018
Keywords:
LEFS knee osteoarthritis functional scale physical function self-report outcome measure
Main Article Content
Abstract
Background: Six millions of elderly citizens in Thailand have been reported to have knee osteoarthritis (OA). Thai version of self-report functional measures could be benefit to evaluate functional level of knee OA.
Objective: To examine test-retest reliability and validity of Modified Lower Extremity Functional Scale (Modified Thai LEFS) to Thai version of Knee Osteoarthritis Outcome Score (KOOS) and to functional performance tests including 40m-Self Pace Walk Test (40m-SPWT) and Timed Up and Go test (TUG) in participants with knee OA.
Method: Thirty participants with knee OA (27 females, aged 65±8) were included in this study. Forward/backward translation and Indexes of Objective Congruence (IOC) were used with respect to original version. Each participant completed the Modified Thai LEFS at first visit and within one week for test-retest reliability. Concurrent validity of Modified Thai LEFS comparing to Thai version of Knee Osteoarthritis Outcome Score (KOOS; pain, activity daily living and sport and recreation), 40m-Self Pace Walking Test (40m-SPWT), and Timed Up and Go test (TUG) were investigated using Pearson correlation coefficient.
Result: Results showed that Modified Thai LEFS had high congruence (IOC=0.8). The study also found high test-retest reliability(ICC=0.83, p<.001) and medium to high concurrent validity as indicated by moderate correlations to KOOS daily living (r=0.59, p<.001), KOOS pain (r=0.4, p<.05), 40m-SPWT (r=-0.48, p<.001) and TUG (r=-0.46, p<.001) and strong correlation to KOOS sport and recreation(r=0.72, p<.001).
Conclusion: Modified Thai LEFS was found to be a highly reliable and moderately valid tool for self-reported functional level in participants with knee OA.
Article Details
How to Cite
1.
Chaipinyo K, Khoprasert W, Likhitphithak W, Pareepon A. Test-Retest Reliability of Modified Thai Lower Extremity Functional Scale (Modified Thai LEFS) and correlation to Thai version of Knee Osteoarthritis Outcome Scores (Thai KOOS), Self-Pace Walk test (SPWT), and Timed Up and Go test (TUG) in Thais with knee osteoarthritis. Thai J Phys Ther [internet]. 2018 Sep. 25 [cited 2025 Dec. 30];40(3):134-45. available from: https://he02.tci-thaijo.org/index.php/tjpt/article/view/147309
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Research Articles
References
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14. Stasi S, Papathanasiou G, Anagnostou M, et al. Lower Extremity Functional Scale (LEFS): Cross-Cultural Adaption into Greek and Reliability Properties of the Instrument. Health Science Journal. 2012;6(4):750-73.
15. Cacchio A, De Blasis E, Necozione S, et al. The Italian version of the Lower Extremity Functional Scale was reliable, valid, and responsive. J Clin Epidemiol.. 2010 May; 63(5):550-7.
16. Pereira LM, Dias JM, Mazuquin BF, Castanhas LG, Menacho MO, Cardoso JR. Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL. Braz J PhysTher. 2013 May-Jun; 17(3):272-80.
17. Metsavaht L, Leporace G, Riberto M, et al. Translation and cross-cultural adaptation of the lower extremity functional scale into a Brazilian Portuguese version and validation on patients with knee injuries. J Orthop Sports PhysTher. 2012 Nov; 42(11):932-9.
18. Hou WH, Yeh TS, Liang HW. Reliability and validity of the Taiwan Chinese version of the Lower Extremity Functional Scale. J Formos Med Assoc. 2012 May;113(5):313-20.
19. Williams VJ, Piva SR, Irrgang JJ, Crossley C, Fitzgerald GK. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports PhysTher. 2012 Aug;42(8):716-23.
20. Bennell K, Dobson F, Hinman R. Measures of physical performance assessments: Self-Paced Walk Test (SPWT), Stair Climb Test (SCT), Six-Minute Walk Test (6MWT), Chair Stand Test (CST), Timed Up & Go (TUG), Sock Test, Lift and Carry Test (LCT), and Car Task. Arthritis Care Res (Hoboken). 2011 Nov; 63(11):350-70.
21. Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL. Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage. Dec; 20(12):1548-62.
22. Dobson F, Hinman RS, Roos EM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage. 2013 Aug; 21(8):1042-52.
23. Elboim-Gabyzon M, Rozen N, Laufer Y. Gender differences in pain perception and functional ability in subjects with knee osteoarthritis. ISRN Orthop 2012:413105.
24. Mansournia MA, Danaei G, Forouzanfar MH, et al. Effect of physical activity on functional performance and knee pain in patients with osteoarthritis : analysis with marginal structural models. Epidemiology. Jul;23(4):631-40.
25. Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL. Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage. Dec; 20(12):1548-62.
26. Stasi S, Papathanasiou G, Korres N, et al. Validation of the Lower Extremity Functional Scale in community-dwelling elderly people (LEFS-Greek); determination of functional status cut-off points using TUG test. Eur Geriatr Med. 2013 Sep;4(4): 237-41.
27. Stratford PW, Kennedy D, Pagura SM, Gollish JD. The relationship between self-report and performance-related measures: questioning the content validity of timed tests. Arthritis Rheum. 2003 Aug; 49(4):535-40.
28. Chirawattanakul A.Statistics for health science research. First edition Bangkok: Wittayapat. 2013:312
29. Stratford PW, Kennedy DM, Hanna SE. Condition-specific Western Ontario McMaster Osteoarthritis Index was not superior to region-specific Lower Extremity Functional Scale at detecting change. J Clin Epidemiol. 2004 Oct;57(10):1025-32.
30. Naal FD, Impellizzeri FM, Torka S, Wellauer V, Leunig M, von Eisenhart-Rothe R. The German Lower Extremity Functional Scale (LEFS) is reliable, valid and responsive in patients undergoing hip or knee replacement. Qual Life Res. 2014 Aug.
2. Prasartritha T.Knee Osteoarthritis.1st ed. Bangkok: Reungpanya; 2010.
3. Thanerat T, Warongchayakul C, Phakaihran W, et al. A study of acupressure on range of knee joint movement in osteoarthritis. Chula Med J. 2013;57(5).
4. Howe TE, Dawson LJ, Syme G, Duncan L, Reid J. Evaluation of outcome measures for use in clinical practice for adults with musculoskeletal conditions of the knee: a systematic review. Man Ther. 2011 Apr;17(2):100-18.
5. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. PhysTher. 1999 Apr;79(4):371-83.
6. Maly MR, Costigan PA, Olney SJ. Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil. 2006 Jan;87(1):96-104.
7. Committee AR. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). 2012 [cited 2017September]; Available from: https://www.rheumatology.org/Practice/Clinical/Clinicianresearchers/Outcomes_Instrumentation/Western_Ontario_and_McMaster_Universities_Osteoarthritis_Index_(WOMAC)/.
8. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998 Aug; 28(2):88-96.
9. Veenhof C, Bijlsma JW, van den Ende CH, van Dijk GM, Pisters MF, Dekker J. Psychometric evaluation of osteoarthritis questionnaires: a systematic review of the literature. Arthritis Rheum. 2006 Jun; 55(3):480-92.
10. Pua YH, Cowan SM, Wrigley TV, Bennell KL. The Lower Extremity Functional Scale could be an alternative to the Western Ontario and McMaster Universities Osteoarthritis Index physical function scale. J Clin Epidemiol. 2009 Oct;62(10):1103-11.
11. Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. 2003;1:17.
12. Chaipinyo K.Test-Retest Reliability and Construct Validity of the Thai Version of Knee Osteoarthritis Outcome Score (KOOS). Thai J of PhysTher. 2009; 31(2): 67-76
13. Hoogeboom TJ, de Bie RA, den Broeder AA, van den Ende CH. The Dutch Lower Extremity Functional Scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study. BMC MusculoskeletDisord. 2012;13:117.
14. Stasi S, Papathanasiou G, Anagnostou M, et al. Lower Extremity Functional Scale (LEFS): Cross-Cultural Adaption into Greek and Reliability Properties of the Instrument. Health Science Journal. 2012;6(4):750-73.
15. Cacchio A, De Blasis E, Necozione S, et al. The Italian version of the Lower Extremity Functional Scale was reliable, valid, and responsive. J Clin Epidemiol.. 2010 May; 63(5):550-7.
16. Pereira LM, Dias JM, Mazuquin BF, Castanhas LG, Menacho MO, Cardoso JR. Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL. Braz J PhysTher. 2013 May-Jun; 17(3):272-80.
17. Metsavaht L, Leporace G, Riberto M, et al. Translation and cross-cultural adaptation of the lower extremity functional scale into a Brazilian Portuguese version and validation on patients with knee injuries. J Orthop Sports PhysTher. 2012 Nov; 42(11):932-9.
18. Hou WH, Yeh TS, Liang HW. Reliability and validity of the Taiwan Chinese version of the Lower Extremity Functional Scale. J Formos Med Assoc. 2012 May;113(5):313-20.
19. Williams VJ, Piva SR, Irrgang JJ, Crossley C, Fitzgerald GK. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports PhysTher. 2012 Aug;42(8):716-23.
20. Bennell K, Dobson F, Hinman R. Measures of physical performance assessments: Self-Paced Walk Test (SPWT), Stair Climb Test (SCT), Six-Minute Walk Test (6MWT), Chair Stand Test (CST), Timed Up & Go (TUG), Sock Test, Lift and Carry Test (LCT), and Car Task. Arthritis Care Res (Hoboken). 2011 Nov; 63(11):350-70.
21. Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL. Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage. Dec; 20(12):1548-62.
22. Dobson F, Hinman RS, Roos EM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage. 2013 Aug; 21(8):1042-52.
23. Elboim-Gabyzon M, Rozen N, Laufer Y. Gender differences in pain perception and functional ability in subjects with knee osteoarthritis. ISRN Orthop 2012:413105.
24. Mansournia MA, Danaei G, Forouzanfar MH, et al. Effect of physical activity on functional performance and knee pain in patients with osteoarthritis : analysis with marginal structural models. Epidemiology. Jul;23(4):631-40.
25. Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL. Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage. Dec; 20(12):1548-62.
26. Stasi S, Papathanasiou G, Korres N, et al. Validation of the Lower Extremity Functional Scale in community-dwelling elderly people (LEFS-Greek); determination of functional status cut-off points using TUG test. Eur Geriatr Med. 2013 Sep;4(4): 237-41.
27. Stratford PW, Kennedy D, Pagura SM, Gollish JD. The relationship between self-report and performance-related measures: questioning the content validity of timed tests. Arthritis Rheum. 2003 Aug; 49(4):535-40.
28. Chirawattanakul A.Statistics for health science research. First edition Bangkok: Wittayapat. 2013:312
29. Stratford PW, Kennedy DM, Hanna SE. Condition-specific Western Ontario McMaster Osteoarthritis Index was not superior to region-specific Lower Extremity Functional Scale at detecting change. J Clin Epidemiol. 2004 Oct;57(10):1025-32.
30. Naal FD, Impellizzeri FM, Torka S, Wellauer V, Leunig M, von Eisenhart-Rothe R. The German Lower Extremity Functional Scale (LEFS) is reliable, valid and responsive in patients undergoing hip or knee replacement. Qual Life Res. 2014 Aug.
