Pua Yong-Hao, Poon Cheryl Lian-Li, Seah Felicia Jie-Ting, Tan John Wei-Ming, Woon Ee-Lin, Chong Hwei-Chi, Thumboo Julian, Clark Ross Allan, Yeo Seng-Jin
From the Department of Physiotherapy, Singapore General Hospital, Singapore (Y-HP, CL-LP, JW-MT, E-LW); Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore (Y-HP, JT); Department of Physiotherapy, Sengkang General Hospital, Singapore (FJ-TS); Department of Physiotherapy, Changi General Hospital, Singapore (H-CC); Department of Rheumatology and Immunology, Singapore General Hospital, Singapore (JT); Health Services Research and Evaluation, Singhealth Office of Regional Health, Singapore (JT); Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia (RAC); and Department of Orthopaedic Surgery, Singapore General Hospital, Singapore (S-JY).
Am J Phys Med Rehabil. 2023 May 1;102(5):389-395. doi: 10.1097/PHM.0000000000002176. Epub 2022 Dec 30.
After a total knee arthroplasty, physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function.
A sample of 2624 patients with primary total knee arthroplasty participated in this retrospective longitudinal study. Monthly, for 4 mos after surgery, quadriceps strength and gait speed were quantified. At the month-6 time point, self-reported walking and stair climbing function was measured.
All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher month-6 self-reported walking and stair climbing function ( P < 0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P < 0.001). Among female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 wks after total knee arthroplasty.
By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Upon completion of this article, the reader should be able to: (1) Understand how self-reported walking and stair climbing abilities improved from baseline before total knee arthroplasty (total knee arthroplasty) to 6 mos postoperatively; (2) Describe the time course of the 2 performance-based measures of quadriceps strength and walking speed after a total knee arthroplasty; and (3) Relate the trajectories of post-total knee arthroplasty quadriceps strength and walking speed measurements across distinct levels of self-reported walking and stair climbing function.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
全膝关节置换术后，康复过程中常对股四头肌力量和步态速度进行身体评估。我们的研究旨在通过检查自我报告的步行和爬楼梯功能水平的轨迹曲线来提高其临床可解释性。
2624例初次全膝关节置换患者的样本参与了这项回顾性纵向研究。术后4个月内每月对股四头肌力量和步态速度进行量化。在第6个月时间点，测量自我报告的步行和爬楼梯功能。
所有身体指标随时间呈非线性改善。在混合效应模型中，随着时间推移，股四头肌力量和步态速度增强与术后6个月自我报告的步行和爬楼梯功能更好相关（P<0.001）。股四头肌力量和步态速度更快的提升与更高水平的步行和爬楼梯功能相关（交互作用P<0.001）。在爬楼梯和行走有很大困难的女性患者中，全膝关节置换术后8周后股四头肌力量轨迹曲线趋于平稳。
通过在临床可解释的功能水平上分层轨迹曲线，我们的研究结果可能为患者和临床医生提供一种更好地解释连续量表化的股四头肌力量和步态速度值的方法。在让患者参与共同决策和设定期望时，这些信息可能很有价值。
索取CME学分：在http://www.physiatry.org/JournalCME在线完成自我评估活动和评价。
CME目标：阅读本文后，读者应能够：（1）了解自我报告的步行和爬楼梯能力从全膝关节置换术前基线到术后6个月如何改善；（2）描述全膝关节置换术后基于表现的股四头肌力量和步行速度两项测量指标的时间进程；（3）将全膝关节置换术后股四头肌力量和步行速度测量的轨迹与自我报告的不同步行和爬楼梯功能水平相关联。
高级。
学术物理医学与康复医师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理医学与康复医师协会将此基于期刊的CME活动指定为最多1.0个美国医学协会（AMA）PRA第1类学分™。医生应仅根据其参与活动的程度索取学分。
