Predicting mobility limitations in patients with total knee arthroplasty in the inpatient setting

Publication date: Available online 30 May 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Eleanor Chew Shu-Xian, Seng-Jin Yeo, Terry Haines, Julian Thumboo, Ross Allan Clark, Hwei-Chi Chong, Cheryl Lian-Li Poon, Felicia Jie-Ting Seah, Darren Tay Keng Jin, Pang Nee Hee, Celia Tan Ia Choo, Yong-Hao Pua

Abstract

Objective

To develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA).

Design

Prospective cohort study

Setting

Inpatients in a tertiary care hospital.

Participants

A sample of 2300 patients who underwent primary TKA in 2016-2017.

Interventions

Not applicable

Main Outcome Measure

Candidate predictors included demographic variables and preoperative clinical and psychosocial measures. The outcome-of-interest was mobility limitations on post-TKA day 3, and this was a priori determined by an ordinal mobility outcome hierarchy based on the type of the gait aids prescribed and the level of physiotherapist assistance provided. To develop the model, we fitted a multivariable proportional odds regression model with bootstrap internal validation. We used a model approximation approach to create a simplified model that approximated predictions from the full model with 95% accuracy.

Results

On post-TKA day 3, 11% of patients required both walkers and therapist assistance to ambulate safely. Our prediction model had a concordance-index of 0.72 (95% CI, 0.68 to 0.75) when evaluating these patients. In the simplified model, predictors of greater mobility limitations included older age, greater walking aid support required preoperatively, less preoperative knee flexion range-of-movement, low-volume surgeon, contralateral knee pain, higher BMI, non-Chinese race, and greater self-reported walking limitations preoperatively.

Conclusion

We have developed a prediction model to identify patients who are at risk for mobility limitations in the inpatient setting. When used preoperatively as part of a shared-decision making process, it can potentially influence rehabilitation strategies and facilitate discharge planning.

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation http://bit.ly/30NsT78
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