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J Exerc Sports Orthop. 2017;4(3). doi: 10.15226/2374-6904/4/3/00164. Epub 2017 Dec 6.

Responsiveness of Physical Activity Measures Following Exercise Programs after Total Knee Arthroplasty.

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Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh. Address: 100 Technology Dr., Suite 210. Pittsburgh, PA 15219. USA.
Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh. Address: 5017 Forbes Tower, Pittsburgh, PA 15260. USA.
Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh. Address: 3471 Fifth Ave., Suite 1010, Pittsburgh, PA 15213. USA.
Department of Health and Physical Activity, School of Education, University of Pittsburgh. Address: 128 Oak Hill Dr., Pittsburgh, PA 15213. USA.



Few instruments that measure physical activity (pa) can accurately quantify pa performed at light and moderate intensities, which is particularly relevant to older adults. Evidence for responsiveness of these instruments after an intervention is limited.


o estimate and compare the responsiveness of two activity monitors and one questionnaire in assessing PA after an intervention following total knee Arthroplasty.


This one-group pretest-posttest, repeated-measures study analyzed changes in duration of daily PA and the standardized response mean (SRM) to assess internal responsiveness that were compared across instruments. Correlations between changes in PA measured by the proposed instruments and the global rating of change were used to test external responsiveness. Agreement between PA instruments on identifying individuals who changed their PA based on measurement error was assessed using weighted-Kappa (K).


Thirty subjects, mean age 67(6) and 73% female, were analyzed. Changes in PA measured by each instrument were small (p>0.05), resulting in a small degree of responsiveness (SRM<0.30). Global rating of change scores did not correlate with changes in PA (rho=0.13-0.28, p>0.05). The activity monitors agreed on identifying changes in moderate-intensity PA (K=0.60) and number of steps (K=0.63), but did not agree with scores from questionnaire(K≤0.22).


Analyzing group-based changes in PA is challenging due to high-variability in the outcome. Investigating changes in PA at the individual-level may be a more viable alternative.


Arthroplasty; Knee; Osteoarthritis; Physical activity; Psychometrics

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