Department of Rehabilitation, Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care, Wakayama, Japan.
Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
PLoS One. 2021 Apr 14;16(4):e0249564. doi: 10.1371/journal.pone.0249564. eCollection 2021.
In patients with knee osteoarthritis (KOA) undergoing knee arthroplasty (KA), lower-limb motor function tests are commonly measured during peri-surgical rehabilitation. To clarify their sources of variation and determine reference intervals (RIs), a multicenter study was performed in Japan.
We enrolled 545 KOA patients (127 men; 418 women; mean age 74.2 years) who underwent KA and followed a normal recovery course. The surgical modes included total KA (TKA), minimally invasive TKA (MIS-TKA), and unicompartmental KA (UKA). Motor functions measured twice before and two weeks after surgery included timed up-and-go (TUG), maximum walking speed (MWS), extensor and flexor muscle strength (MS), and knee range of motion (ROM). Multiple regression analysis was performed to evaluate their sources of variation including sex, age, BMI, and surgical mode. Magnitude of between-subgroup differences was expressed as SD ratio (SDR) based on 3-level nested ANOVA. SDR≥0.4 was set as the threshold for requiring RIs specific for each subgroup.
Before surgery, age-related changes exceeding the threshold were observed for TUG and MWS. Between-sex difference was noted for extensor and flexor MS, but extension and flexion ROMs were not influenced by sex or age. After surgery, in addition to similar influences of sex and age on test results, surgical modes of UKA and MIS-TKA generally had a favorable influence on MWS, extensor MS, and flexion ROM. All motor function test results showed a variable degree of skewness in distribution, and thus RIs were basically derived by the parametric method after Gaussian transformation of test results.
This is the first study to determine RIs for knee motor functions specific to KOA patients after careful consideration of their sources of variation and distribution shapes. These RIs facilitate objective implementation of peri-surgical rehabilitation and allow detection of patients who deviate from the normal course of recovery.
在接受膝关节置换术（KA）的膝骨关节炎（KOA）患者中，围手术期康复期间通常会测量下肢运动功能测试。为了阐明其变异源并确定参考区间（RI），在日本进行了一项多中心研究。
我们招募了 545 名接受 KA 且恢复正常的 KOA 患者（男性 127 名；女性 418 名；平均年龄 74.2 岁）。手术方式包括全膝关节置换术（TKA）、微创 TKA（MIS-TKA）和单髁膝关节置换术（UKA）。术前和术后两周测量两次的运动功能包括起立行走测试（TUG）、最大步行速度（MWS）、伸肌和屈肌力量（MS）以及膝关节活动度（ROM）。采用多元回归分析评估包括性别、年龄、BMI 和手术方式在内的变异源。基于 3 级嵌套 ANOVA，用标准差比（SDR）表示亚组间差异的幅度。SDR≥0.4 被设定为需要为每个亚组特定的 RI 的阈值。
术前，TUG 和 MWS 出现了超过阈值的与年龄相关的变化。伸肌和屈肌 MS 存在性别差异，但伸展和屈曲 ROM 不受性别或年龄的影响。术后，除了性别和年龄对测试结果的类似影响外，UKA 和 MIS-TKA 的手术方式通常对 MWS、伸肌 MS 和屈曲 ROM 有良好的影响。所有运动功能测试结果的分布均存在不同程度的偏度，因此 RI 基本上是通过对测试结果进行高斯变换后的参数方法得出的。
这是第一项在仔细考虑变异源和分布形状后，确定 KOA 患者术后膝关节运动功能特定 RI 的研究。这些 RI 有助于客观实施围手术期康复，并能够发现偏离正常恢复过程的患者。
