To develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA).
Prospective cohort study.
Inpatients in a tertiary care hospital.
A sample of patients (N=2300) who underwent primary TKA in 2016-2017.
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.
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.
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.
List of abbreviations:c-index (concordance index), CI (confidence interval), TKA (total knee arthroplasty)
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- Feasibility of outpatient total hip and knee arthroplasty in unselected patients.Acta Orthop. 2017; 88: 516-521
- A prediction model for length of stay after total and unicompartmental knee replacement.Bone Joint J. 2013; 95-B: 1490-1496
- Predicting patient discharge disposition after total joint arthroplasty in the United States.J Arthroplasty. 2010; 25: 885-892
- Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty.J Arthroplasty. 2003; 18: 775-779
- Determinants and outcomes of inpatient versus home based rehabilitation following elective hip and knee replacement.J Rheumatol. 2000; 27: 1753-1758
- Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD).Ann Intern Med. 2015; 162: 735-736
- Development of a prognostic nomogram for predicting the probability of nonresponse to total knee arthroplasty 1 year after surgery.J Arthroplasty. 2016; 31: 1654-1660
- Use of large-scale HRQoL datasets to generate individualised predictions and inform patients about the likely benefit of surgery.Qual Life Res. 2017; 26: 2497-2505
- A new prediction model for patient satisfaction after total knee arthroplasty.J Arthroplasty. 2016; 31: 2660-2667
- Rationale of the knee society clinical rating system.Clin Orthop Relat Res. 1989; : 13-14
- Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty.J Arthroplasty. 1995; 10: 133-140
- The effectiveness of very short scales for depression screening in elderly medical patients.Int J Geriatr Psychiatry. 2001; 16: 321-326
- Reliability of the knee examination in osteoarthritis: effect of standardization.Arthritis Rheum. 2004; 50: 458-468
- Questionnaire on the perceptions of patients about total knee replacement.J Bone Joint Surg Br. 1998; 80: 63-69
- The added value of ordinal analysis in clinical trials: an example in traumatic brain injury.Crit Care. 2011; 15: R127
- Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis.Springer, New York2015
- Flexible regression models with cubic splines.Stat Med. 1989; 8: 551-561
- Using the outcome for imputation of missing predictor values was preferred.J Clin Epidemiol. 2006; 59: 1092-1101
- Regression with missing Ys: An improved strategy for analyzing multiply imputed data.Sociological Methodology. 2007; 37: 83-117
- Penalized maximum likelihood estimation to directly adjust diagnostic and prognostic prediction models for overoptimism: a clinical example.J Clin Epidemiol. 2004; 57: 1262-1270
- Simplifying a prognostic model: a simulation study based on clinical data.Stat Med. 2002; 21: 3803-3822
- Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models.Stat Methods Med Res. 2017; 26: 796-808
- ROCR: visualizing classifier performance in R.Bioinformatics. 2005; 21: 3940-3941
- ggplot2: elegant graphics for data analysis.Springer, New York2009
- Predictive risk factors for stiff knees in total knee arthroplasty.J Arthroplasty. 2006; 21: 46-52
- Are there prognostic factors for one-year outcome after total knee arthroplasty? A systematic review.J Arthroplasty. 2017; 32: 3840-3853
- Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis.Br J Anaesth. 2015; 114: 551-561
- Development and validation of a clinical prediction model for patient-reported pain and function after primary total knee replacement surgery.Sci Rep. 2018; 8: 3381
- Modelling knee range of motion post arthroplasty: clinical applications.Physiother Can. 2010; 62: 378-387
- The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature.BMC Musculoskelet Disord. 2012; 13: 250
- Hospital volume affects outcome after total knee arthroplasty.Acta Orthop. 2015; 86: 41-47
- Patient vs provider characteristics impacting hospital lengths of stay after total knee or hip arthroplasty.J Arthroplasty. 2011; 26: 1418-1426
- Lack of diversity in orthopaedic trials conducted in the United States.J Bone Joint Surg Am. 2014; 96: e56
- Ethnic differences in pain perception and patient-controlled analgesia usage for postoperative pain.J Pain. 2008; 9: 849-855
- Ethnic differences in pain and pain management.Pain Manag. 2012; 2: 219-230
Published online: May 29, 2019
© 2019 by the American Congress of Rehabilitation Medicine