Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan.
Mod Rheumatol. 2020 Jan;30(1):197-203. doi: 10.1080/14397595.2018.1553228. Epub 2019 Jan 3.
: The purpose of this study was to compare the recovery of mobility and self-efficacy following total knee arthroplasty (TKA) between the 5-day and the 28-day protocol. This prospective cohort study was carried out at two hospitals.: In total, 104 patients who underwent TKA were enrolled. The primary outcomes measured were Life Space Assessment (LSA) for mobility and modified-Gait Efficacy Scale (mGES) for self-efficacy. Knee Society Score (KSS) was used to estimate the functional outcomes. These assessments were performed in all patients preoperatively, and at 1, 3, and 6 months postoperatively. After calculating the propensity score using covariates, such as patient characteristics, LSA, mGES, and KSS at baseline, propensity score-adjusted multivariate analysis of covariance (MANCOVA) was performed.: MANCOVA revealed significant differences in LSA and mGES, but not in KSS, between the two protocols. The adjusted means of LSA and mGES in the 28-day protocol were significantly greater than those in the 5-day protocol in all the postoperative assessments.: Mobility and self-efficacy were greater following the 28-day protocol than the 5-day protocol after TKA. Our findings suggest that the modified treatment procedure for improving mobility and self-efficacy is necessary to introduce the early discharge protocol in Japan.
: 本研究旨在比较全膝关节置换术(TKA)后 5 天和 28 天方案在移动能力和自我效能恢复方面的差异。这是一项前瞻性队列研究,在两家医院进行。
: 共纳入 104 例接受 TKA 的患者。主要结局指标为移动能力的生活空间评估(LSA)和自我效能的改良步态功效量表(mGES)。膝关节学会评分(KSS)用于评估功能结局。所有患者在术前以及术后 1、3 和 6 个月进行这些评估。在使用协变量(如患者特征、基线时的 LSA、mGES 和 KSS)计算倾向评分后,进行了倾向评分调整的多元协方差分析(MANCOVA)。
: MANCOVA 显示,两种方案在 LSA 和 mGES 方面存在显著差异,但在 KSS 方面没有差异。在所有术后评估中,28 天方案的 LSA 和 mGES 的调整平均值均显著大于 5 天方案。
: TKA 后,28 天方案的移动能力和自我效能均高于 5 天方案。我们的研究结果表明,需要引入一种改良的治疗方案,以提高移动能力和自我效能,从而在日本引入早期出院方案。