title: Factors for Assessing the Effectiveness of Early Rehabilitation after Minimally Invasive Total Knee Arthroplasty: A Prospective Cohort Study.
abstract: The effectiveness of current rehabilitation programs is supported by high-level evidence from the results of randomized controlled trials, but an increasing number of patients are not discharged from the hospital because of the schedule of the critical path (CP). The present study aimed to determine which factors can be used to assess the effectiveness of early rehabilitation. We enrolled 123 patients with medial knee osteoarthritis (OA) who had undergone unilateral minimally invasive total knee arthroplasty for the first time. The following factors were assessed preoperatively: the maximum isometric muscle strength of the knee extensors and flexors, maximum knee and hip joint angle, pain, 5-m maximum walking speed, sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side (bilateral or unilateral knee OA), and functional independence measure. We re-evaluated physical function (i.e., muscle strength, joint angle, and pain) and motor function (5-m maximum walking speed) 14 days postoperatively. Changes in physical function, motor function (5-m maximum walking speed), and number of days to independent walking were used as explanatory variables. The postoperative duration of hospitalization (in days) was used as the dependent variable in multivariate analyses. These analyses were adjusted for sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side, and functional independence measure. The duration of hospitalization was significantly affected by the number of days to independent walking (p < 0.001, β = 0.507) and a change in the 5-m maximum walking speed (p = 0.016, β = -0.262). Multiple regression analysis showed that the radiographic knee grade (p = 0.029, β = 0.239) was a significant confounding factor. Independent walking and walking speed recovery were considered to reduce the duration of hospitalization. Therefore, these indices can be used to assess the effectiveness of early rehabilitation.
authors.affiliation: Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, Japan.|Graduate School of Health Science, KIBI International University, Takahashi, Okayama, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
authors.affiliation: JICA Guatemala Office, Zona, Calle, Guatemala.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Tamari
authors.affiliation: Department of Physical Therapy, Kawasaki Junior College of Rehabilitation, Kurashiki, Okayama, Japan.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Hiroshima, Japan.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Uchida
authors.affiliation: Department of Physical Therapy, Yamaguchi Allied Health College, Yamaguchi, Yamaguchi, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Rehabilitation, Hohsyasen Daiichi Hospital, Imabari, Ehime, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Morikawa
authors.affiliation: Graduate School of Health Science, KIBI International University, Takahashi, Okayama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawamura
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000534:rehabilitation*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000534:rehabilitation*; D053580:Muscle Strength / Q000502:physiology; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D016138:Walking / Q000502:physiology