Predictors of multidimensional functional outcomes after total knee arthroplasty
Predictors of multidimensional functional outcomes after total knee arthroplasty
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DOI：
10.1002/jor.23596
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发表时间：
2017-12-01
影响因子：
2.8
通讯作者：
Sluka, Kathleen A.
中科院分区：
文献类型：
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作者：
Cooper, Nicholas A.;Rakel, Barbara A.;Sluka, Kathleen A.
全膝关节置换术(TKA)后，临床上使用多种评估方法，包括自我报告、执行任务和体力活动水平。目前尚不清楚这些不同的功能评估是否可以互换，或者它们是否衡量不同的结构。本研究的目的是描述人工全膝关节置换术前后不同的功能测量方法。我们通过感知功能(Koos ADL)、体能(步速)和日常活动(通过加速计测量步数/天)来表征TKA前后的功能；比较TKA患者和年龄匹配的健康对照组的功能；并检查TKA患者的特征，以寻找潜在的术后功能预测因素。在全膝关节置换术之前，参与者的所有三项功能评估都显著低于健康对照组，而且术后参与者的每一项评估都低于对照组。所有三种功能评估在术后一段时间内都有不同的发展。每一种功能结果都有一套独特的预测因子。知觉功能主要受焦虑和抑郁的预测，体能表现受年龄的影响最大，日常活动主要受体重指数的预测。压力痛阈值在所有模型中都是一个共同的预测因子。与健康对照组相比，接受全膝关节置换术的患者在术前存在功能限制，并且在术后的不同措施中持续存在。全膝关节置换术后的功能结果取决于所使用的功能测量方法，这意味着每种测量方法的基础结构都不同。应评估多种功能措施，以便更全面地评估TKA术后的功能。进一步的工作应该评估旨在治疗术后TKA功能的可修改预测指标的干预措施的影响。(三)2017年骨科研究会。由Wiley期刊公司出版，J Orthop Res 35：2790-2798,2017。
Multiple assessments are used clinically after total knee arthroplasty (TKA) including self-report, performance tasks, and physical activity levels. It is unclear if these different functional assessments are interchangeable or if they measure different constructs. The objective of this study was to characterize different functional measures before and after TKA. We characterized function before and after TKA using perceived function (KOOS ADL), physical performance (gait speed), and daily activity (steps/day via accelerometry); compared function in people undergoing TKA to age-matched healthy controls; and examined characteristics of those undergoing TKA for potential predictors of postoperative function. Prior to TKA, all three functional assessments were significantly lower for participants than those of healthy controls and each measure remained lower for participants than for controls postoperatively. All three functional assessments developed differently over time postoperatively. Each functional outcome had a unique set of predictors. Perceived function was predicted primarily by anxiety and depression, physical performance was most strongly predicted by age, and daily activity was chiefly predicted by BMI. Pressure pain threshold was a common predictor across all models. Functional limitations exist preoperatively and persist postoperatively across different measures in people undergoing TKA when compared to those measures in healthy controls. Functional outcomes after TKA are different depending on the functional measure utilized, implying that different constructs underlie each measure. Multiple functional measures should be assessed to provide a more comprehensive assessment of function after TKA. Further work should assess the impact of interventions designed to treat modifiable predictors of postoperative TKA function. (c) 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2790-2798, 2017.