Predicting Mobility Limitations in Patients With Total Knee Arthroplasty in the Inpatient Setting |
| |
| Affiliation: | 1. Department of Physiotherapy, Singapore General Hospital, Singapore;2. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore;3. School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia;4. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore;5. Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia;6. Department of Physiotherapy, Sengkang General Hospital, Singapore;7. SingHealth Group Allied Health, Singapore;1. Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts;2. University of Washington, Seattle, Washington;3. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;4. Brigham and Women’s Hospital, Boston, Massachusetts;5. University of Texas Medical Branch, Shriners Hospitals for Children-Galveston, Galveston, Texas;6. Harborview Medical Center, University of Washington, Seattle, Washington;7. University of Texas Southwestern Medical Center, Dallas, Texas;8. Shriners Hospitals for Children-Boston, Boston, Massachusetts;1. Systems and Cognitive Neuroscience Division, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium;2. Unit of Neurology, University Hospital of Parakou, Parakou, Benin;3. Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin;4. National Center of Reference in Physical Therapy and Rehabilitation, University Hospital Roi Khaled, Bujumbura, Burundi;5. Arsalis SPRL, Glabais, Belgium;1. New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA;2. Harvard Medical School, Boston, MA;3. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA;4. College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA;5. Heller School for Social Policy and Management, Brandeis University, Waltham, MA;6. Department of Medicine, Brigham and Women’s Hospital, Boston, MA;7. Bloomsburg University of Pennsylvania, Bloomsburg, PA;1. Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience, Maastricht, The Netherlands;2. Limburg Brain Injury Centre, Maastricht, The Netherlands;3. Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia;4. Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia;5. St. Vincent’s Hospital, Melbourne, Fitzroy, Australia;6. Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO;7. Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands;8. University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands;9. Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht, the Netherlands;1. Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois;2. Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada;3. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;1. School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC;2. Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC;3. Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC;4. Sport Medicine Department, Orthopedic Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC;5. Medical School, National Yang-Ming University Taipei, Taiwan, ROC;6. Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC;7. College of Medicine, National Taiwan University, Taipei, Taiwan, ROC;8. Department of Orthopaedics, Clintec, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden |
| |
| Abstract: | ObjectiveTo develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA).DesignProspective cohort study.SettingInpatients in a tertiary care hospital.ParticipantsA sample of patients (N=2300) who underwent primary TKA in 2016-2017.InterventionsNot applicable.Main Outcome MeasureCandidate 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 determined a priori 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.ResultsOn 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% confidence interval, 0.68-0.75) 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 body mass index, non-Chinese race, and greater self-reported walking limitations preoperatively.ConclusionWe 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. |
| |
| Keywords: | Knee Models Prognosis Rehabilitation Risk Statistical c-index" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" concordance index CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" confidence interval TKA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" total knee arthroplasty |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
