Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Geert Grooteplein Zuid 21, 6525, EZ, Nijmegen, the Netherlands.
FysioHolland Twente, Geessinkbrink 7, 7544, CW, Enschede, the Netherlands.
BMC Musculoskelet Disord. 2021 Feb 13;22(1):179. doi: 10.1186/s12891-021-04037-7.
Recovery trajectories differ between individual patients and it is hypothesizes that they can be used to predict if an individual patient is likely to recover earlier or later. Primary aim of this study was to determine if it is possible to identify recovery trajectories for physical functioning and pain during the first six weeks in patients after TKA. Secondary aim was to explore the association of these trajectories with one-year outcomes.
Prospective cohort study of 218 patients with the following measurement time points: preoperative, and at three days, two weeks, six weeks, and one year post-surgery (no missings). Outcome measures were performance-based physical functioning (Timed Up and Go [TUG]), self-reported physical functioning (Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS-ADL]), and pain (Visual Analogue Scale [VAS]). Latent Class Analysis was used to distinguish classes based on recovery trajectories over the first six weeks postoperatively. Multivariable regression analyses were used to identify associations between classes and one year outcomes.
TUG showed three classes: "gain group" (n = 203), "moderate gain group" (n = 8) and "slow gain group" (n = 7), KOOS showed two classes: "gain group" (n = 86) and "moderate gain group" (n = 132), and VAS-pain three classes: "no/very little pain" (n = 151), "normal decrease of pain" (n = 48) and "sustained pain" (n = 19). The" low gain group" scored 3.31 [95% CI 1.52, 5.09] seconds less on the TUG than the "moderate gain group" and the KOOS "gain group" scored 11.97 [95% CI 8.62, 15.33] points better than the "moderate gain group" after one year. Patients who had an early trajectory of "sustained pain" had less chance to become free of pain at one year than those who reported "no or little pain" (odds ratio 0.11 [95% CI 0.03,0.42].
The findings of this study indicate that different recovery trajectories can be detected. These recovery trajectories can distinguish outcome after one year.
个体患者的康复轨迹存在差异，有人假设这些轨迹可用于预测个体患者是否有可能更早或更晚康复。本研究的主要目的是确定是否可以在 TKA 后最初六周内识别出患者的身体功能和疼痛的康复轨迹。次要目的是探讨这些轨迹与一年结果的关联。
这是一项前瞻性队列研究，共纳入 218 名患者，在以下时间点进行测量：术前和术后 3 天、2 周、6 周和 1 年（无缺失）。主要结果为基于轨迹的术后 6 周内表现性身体功能（计时起立行走测试[TUG]）、自我报告的身体功能（膝关节损伤和骨关节炎结果评分-日常生活活动[KOOS-ADL]）和疼痛（视觉模拟量表[VAS]）。采用潜在类别分析根据术后最初 6 周的恢复轨迹区分类别。采用多变量回归分析确定类别的一年结果之间的关联。
TUG 显示了 3 个类别：“获益组”（n=203）、“中度获益组”（n=8）和“获益缓慢组”（n=7），KOOS 显示了 2 个类别：“获益组”（n=86）和“中度获益组”（n=132），VAS 疼痛显示了 3 个类别：“无/很少疼痛”（n=151）、“疼痛正常下降”（n=48）和“持续疼痛”（n=19）。与“中度获益组”相比，“获益缓慢组”在 TUG 上的得分少 3.31 秒[95%置信区间（CI）为 1.52，5.09]，与“中度获益组”相比，KOOS“获益组”一年后得分高出 11.97 分[95% CI 为 8.62，15.33]。在最初轨迹为“持续疼痛”的患者中，一年后无疼痛的可能性比报告“无或很少疼痛”的患者小（比值比 0.11[95% CI 为 0.03，0.42]）。
本研究结果表明，可以检测到不同的恢复轨迹。这些恢复轨迹可以区分一年后的结果。
