Amano Tetsuya, Tanaka Ryo, Tanaka Shigeharu
Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University.
Graduate School of Humanities and Social Sciences, Hiroshima University.
Phys Ther Res. 2020 Sep 28;23(2):202-208. doi: 10.1298/ptr.E10044. eCollection 2020.
To derive a clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty.
This prospective cohort study evaluated the data of 273 individuals undergoing primary total knee arthroplasty. The individual factors, the physical and motor function data were assessed preoperatively upon admission as a baseline survey. The knee joint extension angle and knee joint flexion angle were re-evaluated on postoperative day 14 as a follow-up. The recovery group comprised individuals with a knee joint extension angle of more than -5 degrees and knee joint flexion angle of more than 110 degrees on postoperative day 14. The other patients constituted the non-recovery group. Multivariate logistic regression analysis was used for deriving a clinical prediction rule.
The results indicated that the use of a cane, knee joint extension and flexion angles, and Timed Up and Go test time were significant factors for predicting early recovery of knee range of motion after total knee arthroplasty. Furthermore, a clinical prediction rule was derived and included the use of a cane, knee joint extension angle ≥ -15 degrees, knee joint flexion angle ≥ 125 degrees, and a Timed Up and Go test time < 11.2 s. A total clinical prediction rule score ≥ 8 indicated a positive likelihood ratio of more than 10 for a successful outcome and the post-test probability was approximately 95%.
The derived clinical prediction rule might be a useful screening tool for proper postoperative goal setting and the establishment of individualized physical therapy programs.
推导全膝关节置换术后膝关节活动范围早期恢复的临床预测规则。
这项前瞻性队列研究评估了273例行初次全膝关节置换术患者的数据。入院术前评估个体因素、身体和运动功能数据作为基线调查。术后第14天重新评估膝关节伸展角度和膝关节屈曲角度作为随访。恢复组包括术后第14天膝关节伸展角度大于-5度且膝关节屈曲角度大于110度的患者。其他患者构成未恢复组。采用多因素逻辑回归分析推导临床预测规则。
结果表明，使用手杖、膝关节伸展和屈曲角度以及计时起立行走测试时间是预测全膝关节置换术后膝关节活动范围早期恢复的重要因素。此外，推导了一个临床预测规则，包括使用手杖、膝关节伸展角度≥-15度、膝关节屈曲角度≥125度以及计时起立行走测试时间<11.2秒。总临床预测规则评分≥8表明成功结果的阳性似然比大于10，检验后概率约为95%。
推导的临床预测规则可能是一个有用的筛查工具，用于适当的术后目标设定和制定个体化物理治疗方案。
