Journal article
Predicting mobility limitations in patients with total knee arthroplasty in the inpatient setting
Archives of Physical Medicine and Rehabilitation, Vol.100(11), pp.2106-2112
2019
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.
Details
- Title
- Predicting mobility limitations in patients with total knee arthroplasty in the inpatient setting
- Authors
- Eleanor Chew Shu-Xian (Author)Seng-Jin Yeo (Author)Terry Haines (Author)Julian Thumboo (Author)Ross Clark (Author) - University of the Sunshine CoastHwei-Chi Chong (Author)Cheryl Lian-Li Poon (Author)Felicia Jie-Ting Seah (Author)Darren Tay Keng Jin (Author)Pang Nee Hee (Author)Celia Tan Ia Choo (Author)Yong-Hao Pua (Author) - Singapore General Hospital
- Publication details
- Archives of Physical Medicine and Rehabilitation, Vol.100(11), pp.2106-2112
- Publisher
- W.B. Saunders Co.
- Date published
- 2019
- DOI
- 10.1016/j.apmr.2019.04.018
- ISSN
- 0003-9993
- Organisation Unit
- University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; School of Health and Behavioural Sciences - Legacy; School of Health - Public Health
- Language
- English
- Record Identifier
- 99450794502621
- Output Type
- Journal article
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