Bond University, Department of Physiotherapy, Bond Institute of Health and Sport, Robina, Queensland, Australia.
Knee Research Australia, Benowa, Queensland, Australia.
J Arthroplasty. 2020 Oct;35(10):2852-2857. doi: 10.1016/j.arth.2020.05.056. Epub 2020 May 29.
The role of inpatient rehabilitation after total knee arthroplasty (TKA) remains uncertain, with evidence suggesting no better functional outcomes for those who discharge to rehabilitation to those who discharge home. The aim of this study is to develop and implement a pre-operative predictive tool, ARISE (Arthroplasty Rehabilitation Initial Screening Evaluation), that incorporated psychological, functional, and socio-demographic factors to determine discharge destination.
One week prior to TKA, the ARISE tool was administered to 100 patients, in addition to an EQ-5D-5L survey and other demographic data being recorded. The primary outcome was discharge destination. An enhanced recovery pathway, which included an anesthetic protocol designed to optimize early mobilization, was utilized. Univariable and multivariable logistic regression analysis was performed to determine the likelihood of discharge destination.
Patients in the rehabilitation group were, on average, 4.5 years older than the home group (P = .036). After multivariable regression, ARISE questions were predictive of discharge destination related to beliefs around the superiority of inpatient rehabilitation (odds ratio = 9.9 [2.6-37.9]) and post-discharge level of support (odds ratio = 6.3 [1.5-26.8]). No question around self-reported physical function was predictive.
Pre-operative patient beliefs regarding rehabilitation and future home support are highly predictive of discharge destination after primary TKA. Pre-operative patient-reported functional status and demographic variables, with the exception of increasing age, were not shown to be predictive. Predicting those that are most likely to discharge to rehabilitation allows for early, targeted interventions to optimize resources and increase likelihood of home discharge.
全膝关节置换术（TKA）后住院康复的作用仍不确定，有证据表明，对于那些出院到康复机构的患者和那些出院回家的患者，康复并不能带来更好的功能结果。本研究旨在开发和实施一种术前预测工具，ARISE（关节置换康复初始筛选评估），该工具纳入了心理、功能和社会人口统计学因素，以确定出院去向。
在 TKA 前一周，对 100 名患者进行了 ARISE 工具评估，此外还进行了 EQ-5D-5L 调查和其他人口统计学数据的记录。主要结局是出院去向。采用了一种增强康复途径，包括旨在优化早期活动的麻醉方案。进行了单变量和多变量逻辑回归分析，以确定出院去向的可能性。
康复组的患者平均比家庭组年长 4.5 岁（P =.036）。经过多变量回归，ARISE 问题预测了与对住院康复优越性的信念相关的出院去向（优势比=9.9 [2.6-37.9]）和出院后支持水平（优势比=6.3 [1.5-26.8]）。没有一个关于自我报告的身体功能的问题是预测性的。
术前患者对康复和未来家庭支持的信念高度预测了初次 TKA 后的出院去向。术前患者报告的功能状态和人口统计学变量，除了年龄增加外，都没有显示出预测性。预测那些最有可能出院到康复机构的患者，可以进行早期、有针对性的干预，以优化资源利用并提高家庭出院的可能性。
