Pre-operative functional mobility as an independent determinant of inpatient functional recovery after total knee arthroplasty during three periods that coincided with changes in clinical pathways
2017
Aims To investigate whether pre-operative functional mobility is a
determinant of delayed inpatient recovery of activities (IRoA) after
total knee arthroplasty (TKA) in three periods that coincided with
changes in the clinical pathway. Patients and Methods All patients (n = 682, 73% women, mean age 70 years, standard
deviation 9) scheduled for TKA between 2009 and 2015 were pre-operatively
screened for functional mobility by the Timed-up-and-Go test (TUG)
and De Morton mobility index (DEMMI). The cut-off point for delayed
IRoA was set on the day that 70% of the patients were recovered,
according to the Modified Iowa Levels of Assistance Scale (mILAS)
(a 5-item activity scale). In a multivariable logistic regression
analysis, we added either the TUG or the DEMMI to a reference model
including established determinants. Results Both the TUG (Odds Ratio (OR) 1.10 per second, 95% confidence
intervals (CI) 1.06 to 1.15) and the DEMMI (OR 0.96 per point on
the 100-point scale, 95% CI 0.95 to 0.98) were statistically significant
determinants of delayed IRoA in a model that also included age,
BMI, ASA score and ISAR score. These associations did not depend
on the time period during which the TKA took place, as assessed
by tests for interaction. Conclusion Functional mobility, as assessed pre-operatively by the TUG and
DEMMI, is an independent and stable determinant of delayed inpatient
recovery of activities after TKA. Future research, focusing on improvement
of pre-operative functional mobility through tailored physiotherapy
intervention, should indicate whether such intervention enhances
post-operative recovery among high-risk patients. Cite this article: Bone Joint J 2017;99-B:211–17.
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