Abstract
Objective
To investigate preoperative predictors of instrumental activities of daily living
(IADL) disability in older adults six months after knee arthroplasty (KA).
Design
Prospective cohort study
Setting
General hospital with an orthopedic surgery department
Participants
Two hundred twenty (N = 220) patients 65 years old with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty
(UKA)
Interventions
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.
Results
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.
Conclusion
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.
Keywords
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)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 8,
2023
Received in revised form:
December 22,
2022
Received:
July 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
