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SUMMARY: questionnaire for level of activity

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  • SUMMARY: questionnaire for level of activity

    Dear All:
    thanks a lot to those who replied to my
    question reported here below on the assessment of
    the level of activity. the detailed list of
    replies is attached as usual. In brief summary,
    it appears there is too little or too much,
    depending how you see it. It seems nothing is
    exactly what I was looking for, but there is a
    lot of stuff (maybe too much) with similar

    A very specific questionnaire is the Hip Outcome
    Score(HOS). unfortunately, it does not try to
    assess the frequency of the most sever loading
    conditions. but only if the patient can perform

    Some suggest to use a wearable monitor instead of
    questionnaire. Being an engineer I do not need
    to be convinced that measurements are always
    better than opinions, whenever possible.
    However, the organizational impact of
    questionnaires is minimal compared to wearable
    monitors, so I guess the comparison is unfair.



    ***********ORIGINAL QUESTION********
    In the orthopaedics clinical practice it is
    common to assess the health status and the
    clinical outcome of certain procedures such as
    joint replacement by means of questionnaires to
    be filled by the doctor or by the patient
    directly. Typical examples are the Harris hip
    score or the Womac.

    many of these questionnaires have questions
    related to the physical activity of the patient,
    but all aims to assess the level of disability
    the patient is experiencing, through questions
    such as "are you able to climb a fly of stairs?".

    While this is perfectly appropriate for elder
    patients, the indications of joint replacements
    are constantly expanding, and we are now dealing
    with younger patients, many of which return to a
    physically active life after the operation. This
    opens new scenarios for the biomechanics research
    of prosthetic devices, which are now exposed to
    much heavier load histories than in less active
    patients. It is thus essential to assess,
    possibly with a questionnaire, if the patient
    enjoys a physically active life, and and how
    intensive is the loading he or she impose to the
    prosthetic joint.

    Is anybody aware if there is a questionnaire
    already validated that aims to assess the level
    of activity, rather than the level of disability,
    even in slightly different clinical contexts?

    If nothing is already available, do you think it
    would make sense to try to develop and validate
    one, possibly through a consensus process within
    our community?


    You may want to look at the International Physical Activity Questionnaire.

    It has several questions to get at overall
    physical activity, has been validated, and comes
    in several languages. I am planning on using this
    instrument for a study I am conducting, but have
    not done so yet. If you find a better one, please
    let me know. Thank you, laura

    Laura Frey Law, PT, PhD
    Assistant Professor
    Physical Therapy and Rehabilitation Science The University of Iowa
    1-252 Medical Education Bldg
    Iowa City, IA 52242
    (319) 335-9804


    Instead of a questionnaire, it might be
    beneficial to measure the activity level.
    Attached is a study describing an activity
    monitor. They're really easy to use, and tough
    for patients to give misleading results.

    Coleman KL, Smith DG, Boone DA, Joseph AW, del Aguila MA.
    Step activity monitor: long-term, continuous recording of ambulatory function.
    J Rehabil Res Dev. 1999 Jan;36(1):8-18.

    Best of luck,

    Brian Glaister
    Research Assistant
    University of Washington Department of Mechanical Engineering
    Center of Excellence for Limb Loss Prevention and
    Prosthetic Engineering VA Puget Sound Health Care

    I have developed a questionnaire that assesses
    higher level activity for individuals with
    musculoskeletal related hip pathology: The Hip
    Outcome Score(HOS).
    We have evidence of validity based on its
    relation to the SF-36 and are currently analyzing
    data related to responsiveness and test retest
    It can currently be found at:

    References are as follows:

    Schenker ML, Martin RL, Weiland DE, Philippon MJ:
    Current trends in hip arthroscopy: A review of
    injury diagnosis, surgical techniques, and
    outcome scoring. Current Opinion in Orthopaedics.
    16: 89-94: 2005.

    Martin RL. Hip arthroscopy and outcome
    assessment. Operative Techniques in Orthopaedics.
    15(3): 290-296:2005.

    Martin RL, Kelly BT, Philippon MJ. Evidence of
    validity for the Hip Outcome Score(HOS). Journal
    of Orthopaedic Sports Physical Therapy.35; A18:

    Please do not hesitate to contact me with further questions.

    RobRoy Martin PhD, PT, CSCS
    Duquesne University
    Department of Physical Therapy
    114 Rangos School of Health Sciences
    Pittsburgh, PA 15282

    Hi Marco

    I'm a physiotherapist working on rehabilitation
    following articular cartilage repair and I'm just
    starting a PhD looking at return to sport and
    exercise activities following ACI cartilage
    repair procedures so I've been looking at the
    outcomes measures as well. You should find the
    following of interest -

    Published studies on cartilage repair procedures
    commonly present outcomes in terms of a measure
    of change from preoperative status to a
    chronological endpoint, as opposed to individual
    goal achievement. I think this is an issue with a
    lot of the questionnaire outcome measures.

    I'd be very interested to hear what responses you
    have and how you decided to proceed.



    Karen Hambly
    Senior Lecturer - Sports Therapy London
    Metropolitan University 166-220 Holloway Road
    N7 8DB tel:
    mobile: 0207 133 2274
    07709 581265

    There was a Supplement of Medicine and Science in
    Sport and Exercise (Vol 29, No. 6 June 1997) that
    compiled Physical Activity Questionnaires for
    health related research, as of that date.

    Gordon Chalmers, Ph.D.
    Dept. of Physical Education, Health and
    Recreation Western Washington University
    516 High St.
    Bellingham, WA, U.S.A.
    Phone: 360-650-3113
    Email: Gordon-dot-Chalmers-at-wwu-dot-edu
    in above email address: replace "-dot-" with "."
    replace "-at-" with "@"

    Ciao Marco,
    hai già provato il Tegner score che si usa per
    ACL reconstruction? Magari si può adattare
    all'anca o dare idee su i livelli di prestazioni
    e l'attività propriocettiva. Ciao, sandra

    Sandra Martelli

    Hi Marco,
    this has always been a problem with clinical
    quesitonnaires and is a reason why we have been
    developing objective functional measurements and
    classification systems.

    This is also compounded by the fact that
    "recovered" younger hip/knee replacement patients
    equate more to normal joint function compared to
    elderly outcomes. So the new designs of knee that
    are supposed to bring more natural knee function
    apply to these people also.

    We have talked to various people about combining
    objective functional classifiers with subjective
    clinical and patient-led questionnaires and it is
    viewed as a useful marriage of information.

    Lets see if anyone has a useful questionnaire and
    as you know I am very keen to develop community
    approaches to joint function classification using
    collaborative-cohorts of data.


    Dr Cathy Holt
    Lecturer in Biomechanics
    School of Engineering
    Cardiff University
    Queen's Buildings
    The Parade
    Cardiff CF24 3AA
    tel 00 44 0(29) 2087 4533
    fax 00 44 0(29) 2087 4939

    An excellent one designed and validated for
    children (who are also very active!) is the
    Activity Scale for Kids (ASK), by Dr. Nancy Young
    at the Hospital for Sick Children
    ( It has been used with
    several different populations of kids. It might
    be a good starting point for developing an adult
    Development/validation of a questionnaire can
    take a couple of years - i think the community
    could contribute, but a single group would need
    to take the lead to get the validation done.
    Best of luck,
    Sheila Purkiss

    I used what I called a modified activity
    questionnaire in my dissertation which took
    scales from 2 or 3 established questionnaires in
    an attempt to quantify individual and team
    sporting activities.

    In the attached word document I copied some
    statements and tables from a paper in review with
    Journal of Motor Behavior and then copied the
    appendix containing the activity questionnaire
    from my dissertation.

    Paper is: Roncesvalles MN, Woollacott MH, Brown
    N, Jensen JL. An emerging postural response: is
    control of the hip possible in the newly walking
    J Mot Behav. 2004 Jun;36(2):147-59.

    Please let me know if you have further question about this information.


    Nicholas Brown, Ph.D.
    Research Assistant Professor
    University of Utah
    Department of Orthopaedics
    590 Wakara Way, Room A100
    Salt Lake City, UT. 84105
    (801) 587-5200 (phone)
    (801) 587-5211 (fax)

    From: Don Hoover


    Let me suggest a couple of resources containing a
    number of instruments that may be of use for you
    in this regard: Finch E, Brooks D, Stratford PW,
    Mayo NE. /Physical Rehabilitation Outcome
    Measures: A Guide to Clinical Decision Making
    (2^nd ed.)./ Hamilton, Ontario: Canadian
    Physiotherapy Association, 2002.

    Suk M, Hanson BP, Norvell DC, Helfet DL.
    /Musculoskeletal Outcomes Measures and
    Instruments./ New York: AO Publishing/Thieme,

    Also, Medicine and Science in Sports and Exercise
    published a compendium of such instruments in the
    late 1990s: I don't have the exact citation this
    but I think it was published as an Appendix.

    Hope all this helps,


    Ciao Marco,

    Have you taken a look at David Johnson's 2001
    paper in The Knee titled "Outcome measurement in
    the ACL deficient knee - What's the score?"
    (Johnson, D. S. and R. B. Smith (2001). "Outcome
    measurement in the ACL deficient knee : what's
    the score?" Knee 8(1): 51-57.) It may point in in
    the right direction.



    Chris Dyrby, Eng. Research Engineer
    Department of Mechanical Engineering
    Stanford University
    Durand Bldg Rm 061C
    Stanford, CA 94305-4038

    Ph: (650) 723-5793
    Fax: (650) 725-1587

    Marco, assessing patient physical activity from
    questionaiires is fraught with difficluty and it
    would be ideal to determine activity accurately
    (pedometers/data loggers etc.) with these

    You will be aware of the work of Schmalzried et
    al which assesed the activity level of patients
    with THR and TKR using pedometers.

    Silva M, Shepherd EF, Jackson WO, Dorey FJ,
    Schmalzried TP. Average patient walking activity
    approaches 2 million cycles per year: pedometers
    under-record walking activity. J Arthroplasty.
    2002 Sep;17(6):693-7.

    Weekly data was extrapolated to determine the
    yearly cycle rate of the patients. Prosthetic
    manufacturers use 1 million cycles per year for
    simulator studies.

    However, although the Harris/Oxford/WOMAC hip
    scores are all validated, it may not be accurate
    to infer a subjects activity level from a
    questionairre (see ref below)

    Kennedy D, Stratford PW, Paguara SM, Walsh M,
    Woodhouse LJ. Comparison of gender and group
    differences in self-report and physical
    performance measures in total hip and knee
    arthroplasty candidates. J Arthroplasty

    We have compared the reuslts of post-op patient
    activity sections of the hip scores with walking
    test results and found poor results, so there may
    be a better way of doing this.

    Best of luck with the work!

    Damien Bennett, PhD
    Gait Lab,
    Central Remedial Clinic,
    Vernon Avenue,
    Dublin 3,

    Phone: 00353 1 8057531
    FAX: 00353 1 8057570

    Dear Marco,
    A collegue forwarded your Biomch-L mail to me
    about questionnaires measuring level of activity.
    As far as I know, no questionnaires exist that
    validly measure level of activity. In a study in
    orthopedic patients we use the PASIPD, but this
    list is far from optimal. In that study, we also
    perform ambulatory measurements with an Activity
    Monitor (search e.g. at Bussmann JB at PubMed);
    these types of instruments are a valuable tool in
    assessing daily physical activity.
    Hans Bussmann

    J.B.J. Bussmann, PT PhD
    Senior researcher Dept. of Rehabilitation
    Medicine Erasmus MC - University Medical Centre
    Rotterdam PO Box 2040, 3000 CA Rotterdam, The
    Netherlands phone: +31-10-4633906/3190
    fax: +31-10-4633843

    Laboratorio di Tecnologia Medica tel. 39-051-6366865
    Istituti Ortopedici Rizzoli fax. 39-051-6366863
    via di barbiano 1/10, 40136 - Bologna, Italy

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