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Improved walking distance and range of motion predict patient satisfaction after TKA

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Abstract
Purposes: The focus in the evaluation of total knee arthroplasty has shifted from objective measures of implant position and knee function, to patient-reported outcome measures (PROMs). The relation between these two measures was investigated and the possibility of prediction of the patient satisfaction level was evaluated by defining thresholds for improvement of (1) range of motion (ROM), (2) 6-min walk test (6MWT), (3) sit-to-stand test (STS) and (4) quadriceps force after TKA? Methods: Fifty-seven patients were prospectively tested at preoperative and 6 months postoperative intervals. The ROM, 6MWT, STS-test and quadriceps force were evaluated. Two clusters were created based on the postoperative KOOS, OKS and the satisfaction subscore of the new KSS, cluster 1 consisted of patients with good to excellent PROMs, cluster 2 of patients with poorer PROMs. Patients in each cluster were more similar to each other than to those in the other cluster. Receiver operating characteristic (ROC)-curve analysis was used to identify thresholds for the functional outcomes that established cluster allocation. Multiple logistic regression was used to define a model to predict cluster allocation. Results: Patients with high postoperative PROMs (cluster 1 allocation) showed higher postoperative functional outcomes (p < 0.05). Thresholds for the improvement of ROM (>= 5 degrees, OR 6.3, 95% CI 1.23-31.84), 6MWT (>= 50 m, OR 8.2, 95% CI 1.61-42.18) STS (>= 1.05 s, OR 3, 95% CI 0.56-16.07) and normalized Q4 force (>= 1.5 N/BMI, OR 2.5, 95% CI 0.49-12.89) were found to be predictors of cluster allocation. A model to predict the cluster allocation contained gender, ROM improvement and 6MWT improvement (sensitivity 91.1%, specificity 75%). Conclusions: Thresholds for improvement of functional parameters can predict the patient satisfaction cluster. Patients, who are male, improve on the 6-min walk test with 50 m or more and have an increased range of motion of 5 degrees or more, compared to the preoperative situation, are 6-8 times more likely of being satisfied after TKA. These tests are easy to use in clinical practice and can predict the level of patient satisfaction after TKA.
Keywords
Total knee arthroplasty, Functional rehabilitation, Patient-reported outcome measures, Patient satisfaction, Prediction model, TOTAL KNEE ARTHROPLASTY, TOTAL CONDYLAR PROSTHESIS, QUALITY-OF-LIFE, QUADRICEPS STRENGTH, REPLACEMENT, SOCIETY, QUESTIONNAIRE, TRANSLATION, RELIABILITY, VALIDATION

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Chicago
Van Onsem, Stefaan, Matthias Verstraete, Sebastiaan Dhont, Bert Zwaenepoel, Catherine Van Der Straeten, and Jan Victor. 2018. “Improved Walking Distance and Range of Motion Predict Patient Satisfaction After TKA.” Knee Surgery Sports Traumatology Arthroscopy 26 (11): 3272–3279.
APA
Van Onsem, S., Verstraete, M., Dhont, S., Zwaenepoel, B., Van Der Straeten, C., & Victor, J. (2018). Improved walking distance and range of motion predict patient satisfaction after TKA. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 26(11), 3272–3279.
Vancouver
1.
Van Onsem S, Verstraete M, Dhont S, Zwaenepoel B, Van Der Straeten C, Victor J. Improved walking distance and range of motion predict patient satisfaction after TKA. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2018;26(11):3272–9.
MLA
Van Onsem, Stefaan, Matthias Verstraete, Sebastiaan Dhont, et al. “Improved Walking Distance and Range of Motion Predict Patient Satisfaction After TKA.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 26.11 (2018): 3272–3279. Print.
@article{8551647,
  abstract     = {Purposes: The focus in the evaluation of total knee arthroplasty has shifted from objective measures of implant position and knee function, to patient-reported outcome measures (PROMs). The relation between these two measures was investigated and the possibility of prediction of the patient satisfaction level was evaluated by defining thresholds for improvement of (1) range of motion (ROM), (2) 6-min walk test (6MWT), (3) sit-to-stand test (STS) and (4) quadriceps force after TKA? 
Methods: Fifty-seven patients were prospectively tested at preoperative and 6 months postoperative intervals. The ROM, 6MWT, STS-test and quadriceps force were evaluated. Two clusters were created based on the postoperative KOOS, OKS and the satisfaction subscore of the new KSS, cluster 1 consisted of patients with good to excellent PROMs, cluster 2 of patients with poorer PROMs. Patients in each cluster were more similar to each other than to those in the other cluster. Receiver operating characteristic (ROC)-curve analysis was used to identify thresholds for the functional outcomes that established cluster allocation. Multiple logistic regression was used to define a model to predict cluster allocation. 
Results: Patients with high postoperative PROMs (cluster 1 allocation) showed higher postoperative functional outcomes (p < 0.05). Thresholds for the improvement of ROM (>= 5 degrees, OR 6.3, 95% CI 1.23-31.84), 6MWT (>= 50 m, OR 8.2, 95% CI 1.61-42.18) STS (>= 1.05 s, OR 3, 95% CI 0.56-16.07) and normalized Q4 force (>= 1.5 N/BMI, OR 2.5, 95% CI 0.49-12.89) were found to be predictors of cluster allocation. A model to predict the cluster allocation contained gender, ROM improvement and 6MWT improvement (sensitivity 91.1%, specificity 75%). 
Conclusions: Thresholds for improvement of functional parameters can predict the patient satisfaction cluster. Patients, who are male, improve on the 6-min walk test with 50 m or more and have an increased range of motion of 5 degrees or more, compared to the preoperative situation, are 6-8 times more likely of being satisfied after TKA. These tests are easy to use in clinical practice and can predict the level of patient satisfaction after TKA.},
  author       = {Van Onsem, Stefaan and Verstraete, Matthias and Dhont, Sebastiaan and Zwaenepoel, Bert and Van Der Straeten, Catherine and Victor, Jan},
  issn         = {0942-2056},
  journal      = {KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY},
  keywords     = {Total knee arthroplasty,Functional rehabilitation,Patient-reported outcome measures,Patient satisfaction,Prediction model,TOTAL KNEE ARTHROPLASTY,TOTAL CONDYLAR PROSTHESIS,QUALITY-OF-LIFE,QUADRICEPS STRENGTH,REPLACEMENT,SOCIETY,QUESTIONNAIRE,TRANSLATION,RELIABILITY,VALIDATION},
  language     = {eng},
  number       = {11},
  pages        = {3272--3279},
  title        = {Improved walking distance and range of motion predict patient satisfaction after TKA},
  url          = {http://dx.doi.org/10.1007/s00167-018-4856-z},
  volume       = {26},
  year         = {2018},
}

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