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Preoperative predictors of instrumental activities of daily living disability in older adults six months after knee arthroplasty

Published:February 28, 2023DOI:



      To investigate preoperative predictors of instrumental activities of daily living (IADL) disability in older adults six months after knee arthroplasty (KA).


      Prospective cohort study


      General hospital with an orthopedic surgery department


      Two hundred twenty (N = 220) patients 65 years old with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA)


      Not applicable

      Main Outcome Measure

      IADL status was evaluated for six activities. Participants chose “able,” “need help,” or “unable” according to their capacity of executing these IADL activities. If they chose “need help” or “unable” for one or more items, they were defined as “disabled.” Their usual gait speed (UGS), range of motion for the knee, isometric knee extension strength (IKES), pain status, depressive symptoms, pain catastrophizing, and self-efficacy were evaluated as predictors. Baseline and follow-up assessments were conducted one month before and six months after KA, respectively. Logistic regression analyses with IADL status as the dependent variable were performed at follow-up. All models were adjusted using age, sex, severity of the knee deformity, operation type (TKA or UKA), and preoperative IADL status as covariates.


      In total, 166 patients completed the follow-up assessment, and 83 (50.0%) reported IADL disability six months after KA. Preoperative UGS, IKES on the non-operated side, and self-efficacy were statistically significantly different between those with a disability at follow-up and those who did not and were therefore included in logistic regression models as independent variables. UGS (odds ratio = 3.22, 95% confidence interval = 1.38–7.56, p = 0.007) was determined as a significant independent variable.


      The present study demonstrated the importance of evaluating preoperative gait speed to predict the presence of IADL disability in older adults six months after KA. Patients with poorer preoperative mobility should be provided careful postoperative care and treatment.


      List of abbreviations:

      BADL (basic activities of daily living), GDS-15 (fifteen-item Geriatric Depression Scale), IADL (instrumental activities of daily living), IKES (isometric knee extension strength), KA (knee arthroplasty), KL-score (Kellgren–Lawllence score), KOOS-pain (pain subscale of the knee injury and osteoarthritis outcome score), PCS-6 (six-item short form of the pain catastrophizing scale), PSEQ-4 (four-item short form of the pain self-efficacy questionnaire), ROC curve (receiver characteristic operating curve), TKA (total knee arthroplasty), UGS (usual gait speed), UKA (unicompartmental knee arthroplasty)
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