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Impairments in Postural Control and Retest Reliability of Dynamic Posturographic Measures After Lung Transplantation

Ebenbichler, Gerold, MD; Doblhammer, Stephan, MD; Pachner, Melanie, MD; Habenicht, Richard, MS; Kienbacher, Thomas, MD; Mair, Patrick, PhD; Zemková, Erika, PhD; Hirjaková, Zuzana, PhD; Jaksch, Peter, MD; Klepetko, Walter, MD

American Journal of Physical Medicine & Rehabilitation: May 2019 - Volume 98 - Issue 5 - p 353–359
doi: 10.1097/PHM.0000000000001095
Original Research Articles

Objectives The aims of the study were to classify impairments in postural control using computerized posturography in lung transplant recipients undergoing subacute rehabilitation and to examine the retest reliability of these measures.

Methods In a prospective repeated-measures study, 50 lung transplant recipients underwent clinical and quantitative posturographic testing (SMART EquiTest), which included the sensory organization test, motor control test, and limits of stability test. Testing was repeated after 1 to 2 days and upon completion of rehabilitation, 2 mos later. Main outcome measures were the following: sensory organization test–composite score, motor control test–latency and amplitude scaling, limits of stability test–movement velocity, and endpoint excursion/maximum excursion.

Results At the beginning of rehabilitation, the mean sensory organization test–composite score and limits of stability test, but not the motor control test scores, were below normative reference values and and did not return to normal after rehabilitation. Intraclass correlation coefficients(2,1) yielded excellent relative reliability for all posturographic tests. The smallest detectable differences observed for the sensory organization test and limits of stability test exceeded the mean changes observed upon completion of rehabilitation.

Conclusions Impairments in sensory and anticipatory postural control were insufficiently restored after subacute lung transplantation rehabilitation. The little sensitivity of the sensory organization test-composite score or limits of stability test scores to detect a minimal change in performance due to rehabilitation limits the clinical applicability of these tests as objective outcome measures in lung transplantation rehabilitation.

From the Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna Medical University, Vienna, Austria (GE, SD, MP); Karl Landsteiner Institute of Outpatient Rehabilitation Research, Vienna, Austria (RH, TK); Department of Psychology, Harvard University, Cambridge, Massachusetts (PM); Department of Sports Kinanthropology, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia (EZ); Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia (ZH); and Department of Thoracic Surgery, Vienna Medical University, Vienna, Austria (PJ, WK).

All correspondence should be addressed to: Gerold Ebenbichler, MD, Department of Physical Medicine, Rehabilitation & Occupational Medicine, Vienna Medical University, General Hospital of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria.

Part of this work was supported by the Slovak Research and Development Agency under the Contract Number SK-AT-2015-0031.

This study was the master thesis of Stephan Doblhammer, MD, and Melanie Pachner, MD, who both published major findings of this research as master theses.

No party having a direct interest in the results of this research has or will confer a benefit on us or on any organization with which we are associated.

Stephan Doblhammer, Melanie Pachner, and Richard Habenicht are in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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