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 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.
Keywords
List of abbreviations:
c-index (concordance index), CI (confidence interval), TKA (total knee arthroplasty)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 29, 2019
Footnotes
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
