title: Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2.
abstract: OBJECTIVE
  Knee range of motion (ROM) at discharge from acute care is used as a clinical indicator following total knee replacement (TKR) surgery. This study aimed to assess the clinical relevance of this indicator by determining whether discharge knee ROM predicts longer-term knee ROM and patient-reported knee pain and function.
  
  
  METHODS
  A total of 176 TKR recipients were prospectively followed after discharge from acute care. Outcomes assessed included knee ROM and Oxford knee score post rehabilitation and 1 year post surgery. Discharge ROM and other patient factors were identified a priori as potential predictors in multiple linear regression modelling.
  
  
  RESULTS
  A total of 133 (76%) and 141 (80%) patients were available for follow-up post rehabilitation [mean postoperative week 8.1 (SD 2.7)] and at 1 year [mean postoperative month 12.1 (SD 1.4)], respectively. Greater discharge knee flexion was a significant (P < 0.001) predictor of greater post-rehabilitation flexion but not 1-year knee flexion (P < 0.083). Better discharge knee extension was a significant predictor of better post-rehabilitation (P = 0.001) and 1-year knee extension (P = 0.013). Preoperative Oxford score and post-rehabilitation knee flexion independently predicted post-rehabilitation Oxford score, and gender predicted 1-year Oxford score. Discharge ROM did not significantly predict Oxford score in either model.
  
  
  CONCLUSIONS
  The finding that early knee range predicts longer-term range provides clinical evidence favouring the relevance of discharge knee ROM as a clinical indicator. Although longer-term patient-reported knee pain and function were not directly associated with discharge knee ROM, they were associated with ROM when measured concurrently in the sub-acute phase. No causal effect has been demonstrated, but the findings suggest it may be important for physiotherapists to maximize range in the early and sub-acute periods.
authors.affiliation: South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia. justine.naylor@sswahs.nsw.gov.au
authors.forename: Justine M
authors.initials: JM
authors.lastname: Naylor
authors.forename: Victoria
authors.initials: V
authors.lastname: Ko
authors.forename: Steve
authors.initials: S
authors.lastname: Rougellis
authors.forename: Nick
authors.initials: N
authors.lastname: Green
authors.forename: Rajat
authors.initials: R
authors.lastname: Mittal
authors.forename: Rob
authors.initials: R
authors.lastname: Heard
authors.forename: Anthony E T
authors.initials: AE
authors.lastname: Yeo
authors.forename: Anne
authors.initials: A
authors.lastname: Barnett
authors.forename: Danella
authors.initials: D
authors.lastname: Hackett
authors.forename: Chris
authors.initials: C
authors.lastname: Saliba
authors.forename: Nicole
authors.initials: N
authors.lastname: Smith
authors.forename: Martin
authors.initials: M
authors.lastname: Mackey
authors.forename: Alison
authors.initials: A
authors.lastname: Harmer
authors.forename: Ian A
authors.initials: IA
authors.lastname: Harris
authors.forename: Sam
authors.initials: S
authors.lastname: Adie
authors.forename: Lynette
authors.initials: L
authors.lastname: McEvoy
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000502:physiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011184:Postoperative Period; D016059:Range of Motion, Articular; D020127:Recovery of Function