Advocacy for use of the modified Iowa Level of Assistance Scale for clinical use in patients after hip replacement: an observational study

J. Elings*, S. Zoethout, P. M. ten Klooster, G. van der Sluis, S. M. van Gaalen, N. L. U. van Meeteren, T. J. Hoogeboom

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives To test the internal consistency and item difficulty of the modified Iowa Level of Assistance Scale (mILAS).

Design Retrospective observational study.

Setting Two orthopaedic wards of two general hospitals.

Participants Following elective primary unilateral total hip replacement surgery, all participants performed mILAS activities that were scored daily to assess their recovery of activities during hospitalisation.

Main outcome measures The internal consistency and the level of assistance needed by the patient (item difficulty) of the mILAS were calculated using data from Deventer Hospital, Deventer, the Netherlands (n= 255). A cross-validation was performed using data from Nij Smellinghe Hospital, Drachten, the Netherlands (n= 224).

Results The internal consistency of the mILAS was acceptable on all three postoperative days (alpha = 0.84 to 0.97). Cronbach's alpha and Rasch analysis revealed a misfit of stair climbing with the other items of the mILAS. The item difficulty of the mILAS items changed over the first two postoperative days. During the first three postoperative days, the sit to supine transfer was generally the most difficult item to achieve, and the sit to stand transfer was the least difficult item to achieve as rated by physiotherapists. The cross-validation analysis revealed similar results.

Conclusions The mILAS is a clinically sound measurement tool to assess the ability of patients to perform five functional tasks safely during hospitalisation. Stair climbing appears to be the easiest item to complete, and the sit to supine transfer is generally the most difficult after surgery. (C) 2018 Published by Elsevier Ltd on behalf of Chartered Society of Physiotherapy.

Original languageEnglish
Pages (from-to)108-113
Number of pages6
Issue number1
Publication statusPublished - Mar 2019


  • Total hip replacement
  • Inpatients
  • Activities of daily living
  • Recovery of activities
  • Clinimetrics

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