title: Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study.
abstract: OBJECTIVE
  In the 6 months after total knee arthroplasty (TKA), what is the pattern of pain resolution and functional recovery in people without diabetes, with diabetes that does not impact on routine activities, and with diabetes that does impact on routine activities? Is diabetes that impacts on routine activities an independent predictor of slower resolution of pain and functional recovery after TKA?
  
  
  METHODS
  Community-based prospective observational study.
  
  
  METHODS
  A consecutive cohort of 405 people undergoing primary TKA, of whom 60 (15%) had diabetes. PARTICIPANTS with diabetes were also asked preoperatively whether diabetes impacted on their routine activities. PARTICIPANTS were categorised into three groups: no diabetes (n=345), diabetes with no impact on activities (n=41), and diabetes that impacted activities (n=19).
  
  
  METHODS
  Pain and function were measured using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within the month before surgery and 1, 3 and 6 months after surgery. Demographic, medical and surgical factors were also measured, along with depression, social support and health-related quality of life.
  
  
  RESULTS
  No baseline differences in pain and function were seen among the three groups (p > 0.05). Adjusting for age, gender and contralateral joint involvement across the 6 postoperative months, participants with diabetes that impacted on routine activities had pain scores that were 8.3 points higher (indicating greater pain) and function scores that were 5.4 points higher (indicating lower function) than participants without diabetes. PARTICIPANTS with diabetes that doesn't impact on routine activities had similar recovery to those without diabetes.
  
  
  CONCLUSIONS
  People undergoing TKA who report preoperatively that diabetes impacts on their routine activities have less recovery over 6 months than those without diabetes or those with diabetes that does not impact on routine activities. Physiotherapists could institute closer monitoring within the hospital and community settings for people undergoing TKA who perceive that diabetes impacts on their routine activities. [Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA (2014) Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study.Journal of Physiotherapy60: 217-223].
authors.affiliation: Faculty of Rehabilitation Medicine, University of Alberta.
authors.forename: Nurudeen
authors.initials: N
authors.lastname: Amusat
authors.affiliation: Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta; Orthopedic Research, Capital Health.
authors.forename: Lauren
authors.initials: L
authors.lastname: Beaupre
authors.affiliation: School of Public Health, University of Alberta.
authors.forename: Gian S
authors.initials: GS
authors.lastname: Jhangri
authors.affiliation: Canadian Agency for Drugs and Technologies in Health, Ottawa.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Pohar
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada.
authors.forename: Scot
authors.initials: S
authors.lastname: Simpson
authors.affiliation: Faculty of Rehabilitation Medicine, University of Alberta.
authors.forename: Sharon
authors.initials: S
authors.lastname: Warren
authors.affiliation: Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta.
authors.forename: C Allyson
authors.initials: CA
authors.lastname: Jones
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D018771:Arthralgia / Q000453:epidemiology*; D019645:Arthroplasty, Replacement, Knee; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Diabetes; Function; Pain; Recovery; Total knee arthroplasty