TY - JOUR
T1 - Predicting Mobility Limitations in Patients With Total Knee Arthroplasty in the Inpatient Setting
AU - Chew, Eleanor Shu Xian
AU - Yeo, Seng Jin
AU - Haines, Terry
AU - Thumboo, Julian
AU - Clark, Ross Allan
AU - Chong, Hwei Chi
AU - Poon, Cheryl Lian Li
AU - Seah, Felicia Jie Ting
AU - Tay, Darren Keng Jin
AU - Pang, Nee Hee
AU - Tan, Celia Ia Choo
AU - Pua, Yong Hao
PY - 2019/11
Y1 - 2019/11
N2 - 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 patients (N=2300) 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 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. 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% 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. 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.
AB - 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 patients (N=2300) 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 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. 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% 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. 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.
KW - Knee
KW - Models
KW - Prognosis
KW - Rehabilitation
KW - Risk
KW - Statistical
UR - http://www.scopus.com/inward/record.url?scp=85067948402&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2019.04.018
DO - 10.1016/j.apmr.2019.04.018
M3 - Article
C2 - 31152704
AN - SCOPUS:85067948402
VL - 100
SP - 2106
EP - 2112
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
IS - 11
ER -