Division of Health Science, Graduate School of Health Science, Suzuka University of Medical Science, Japan; Department of Rehabilitation, Suzuka Kaisei Hospital, Japan.
Department of Rehabilitation, Mie University Hospital, Japan.
J Orthop Sci. 2024 Nov;29(6):1451-1455. doi: 10.1016/j.jos.2023.12.002. Epub 2023 Dec 18.
Total knee arthroplasty (TKA) is an effective treatment to improve mobility in patients with severe knee osteoarthritis. However, some patients continue to have poor mobility after surgery. The preoperative identification of patients with poor mobility after TKA allows for better treatment selection and appropriate goal setting. The purpose of this study was to develop a clinical prediction rule (CPR) to predict mobility after TKA.
This study included patients undergoing primary TKA. Predictors of outcome included patient characteristics, physical function, and psychological factors, which were measured preoperatively. The outcome measure was the Timed Up and Go test, which was measured at discharge. Patients with a score of ≥11 s were considered having a low-level of mobility. The classification and regression tree methodology of decision tree analysis was used for developing a CPR.
Of the 101 cases (mean age, 72.2 years; 71.3 % female), 26 (25.7 %) were classified as low-mobility. Predictors were the modified Gait Efficacy Scale, age, knee pain on the operated side, knee extension range of motion on the non-operated side, and Somatic Focus, a subscale of the Tampa Scale for Kinesiophobia (short version). The model had a sensitivity of 50.0 %, a specificity of 98.7 %, a positive predictive value of 92.9 %, a positive likelihood ratio of 37.5, and an area under the receiver operating characteristic curve of 0.853.
We have developed a CPR that, with some accuracy, predicts the mobility outcomes of patients after TKA. This CPR may be useful for predicting postoperative mobility and clinical goal setting.
全膝关节置换术（TKA）是改善严重膝骨关节炎患者活动能力的有效治疗方法。然而，一些患者在手术后仍存在活动能力差的情况。术前识别 TKA 后活动能力差的患者有助于更好地选择治疗方法和设定适当的目标。本研究旨在制定一种临床预测规则（CPR）来预测 TKA 后的活动能力。
本研究纳入了接受初次 TKA 的患者。预后预测因素包括患者特征、身体功能和心理因素，这些因素在术前进行测量。结局测量指标为计时起立行走测试（TUG），在出院时进行测量。得分≥11s 的患者被认为活动能力较低。采用决策树分析的分类回归树方法来制定 CPR。
在 101 例患者（平均年龄 72.2 岁，71.3%为女性）中，26 例（25.7%）被归类为活动能力低。预测因素为改良步态功效量表、年龄、患侧膝关节疼痛、非手术侧膝关节伸展活动度和躯体聚焦，这是运动恐惧症量表（简版）的一个亚量表。该模型的灵敏度为 50.0%，特异性为 98.7%，阳性预测值为 92.9%，阳性似然比为 37.5，受试者工作特征曲线下面积为 0.853。
我们已经制定了一种 CPR，该 CPR 可以准确预测 TKA 后患者的活动能力结局。该 CPR 可能有助于预测术后活动能力和临床目标设定。
