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.
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.



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.



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.



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.
CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands and Nij Smellinghe Hospital Drachten, Department of Physical Therapy, Compagnonsplein 1, 9202 NN Drachten, The Netherlands.
G
G
van der Sluis
R A
RA
Goldbohm
Diakonessenhuis Hospital Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
J E
JE
Elings
Radboud University Medical Center, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands.
M W
MW
Nijhuis-van der Sanden
Radboud University Medical Center, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands.
R P
RP
Akkermans
Nij Smellinghe Hospital Drachten, Compagnonsplein 1, 9202 NN Drachten, The Netherlands.
R
R
Bimmel
Radboud University Medical Center, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands.
T J
TJ
Hoogeboom
Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
N L
NL
van Meeteren
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D019091:Critical Pathways; D015444:Exercise; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000601:surgery*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D020127:Recovery of Function
Care pathway; Clinical prediction; Functional mobility; Recovery of activities; Total knee arthroplasty