Single-step test for unilateral limb ability following total knee arthroplasty

J Orthop Sports Phys Ther. 2013 Feb;43(2):66-73. doi: 10.2519/jospt.2013.4372. Epub 2012 Nov 16.


Study design: Secondary analysis of a cohort enrolled in a prospective, randomized, longitudinal clinical trial.

Objectives: The single-step test (SST) was evaluated to assess its intertester reliability, validity as a test of activity limitation, and responsiveness to change for patients after unilateral total knee arthroplasty (TKA). The SST was also examined to determine whether it could differentiate between the surgical and nonsurgical lower limbs of patients after unilateral TKA and between the surgical limbs of patients after TKA and the limbs of healthy controls.

Background: Tests of functional ability for patients recovering from TKA cannot differentiate the contribution of each limb to performance outcome. A test of unilateral limb ability would provide a metric for assessing the surgical lower extremity, without the confounder of the status of the contralateral lower extremity.

Methods: Intertester reliability was assessed between clinicians and between a clinician and a switch mat. Patients who underwent unilateral TKA were tested at initial outpatient physical therapy evaluation, at 3 months after TKA, and at 1 year after TKA.

Results: The assessment of function with the SST was determined to be reliable between testers when using a stopwatch. SST times were significantly correlated with other measures of lower extremity functional performance, providing evidence of its validity in patients after TKA. The SST was responsive to treatment in patients after TKA, with improvements in time for test completion. Performance on the SST also differed between limbs of patients after TKA and when comparing the limbs of healthy controls to those of patients after TKA.

Conclusion: The SST is a reliable measure between testers and a valid and responsive test of activity limitations when assessing unilateral lower extremity impairments in patients after TKA.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Exercise Test*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Range of Motion, Articular
  • Recovery of Function
  • Reproducibility of Results
  • Treatment Outcome