RESUMO
Purpose: There is no consensus on how age and expectations influence planning for total knee arthroplasty (TKA). This study developed and evaluated a new expectation questionnaire and assessed the relationship between preoperative expectations and patient characteristics. Method: The questionnaire evaluated expectations for mobility, pain, participation, and rate of recovery after surgery. Fifty-five participants completed a 6-minute walk test and expectation questionnaire prior to TKA; 17 participants repeated the questionnaire one week later for reliability testing. Analysis of the questionnaire included intra-class correlation coefficient (ICC), homoscedasticity, skewness, kurtosis, multicollinearity, and descriptive measures. A four-step hierarchical linear regression was completed to determine the relationship of patient age, BMI, previous contralateral TKA, and 6-minute walk test scores to expectations. Results: The questionnaire showed good/high test-retest reliability (ICC 0.84; 95% CI: 0.57, 0.94; p > 0.001). The final model was significant in predicting expectation scores R2 = 0.19 (p = 0.017). Conclusions: This questionnaire reliably measures patient expectations before TKA; however, further research is needed. Although we anticipated younger age to be related to higher expectations, higher function prior to TKA appears to be more strongly associated with higher expectations.
Objectif: il n'y a pas de consensus quant à l'influence de l'âge et des attentes sur la planification d'une arthroplastie totale du genou (ATG). La présente étude a porté sur l'élaboration et l'évaluation d'un nouveau questionnaire des attentes et a évalué le lien entre les attentes préopératoires et les caractéristiques des patients. Méthodologie: le questionnaire évaluait les attentes en matière de mobilité, de douleur, de participation et de taux de rétablissement après l'opération. Au total, 55 patients ont effectué un test de marche de six minutes et ont rempli un questionnaire sur leurs attentes avant l'ATG; 17 participants ont rempli de nouveau le questionnaire une semaine plus tard en vue d'un test de fiabilité. L'analyse du questionnaire incluait le coefficient de corrélation intraclasse (CCI), l'homoscédasticité, l'asymétrie, la multicolinéarité et des mesures descriptives. Une régression linéaire hiérarchique en quatre étapes a permis de déterminer la relation entre, d'une part, l'âge des patients, leur indice de masse corporelle, leur ATG contralatérale antérieure et les scores de marche de six minutes et, d'autre part, les attentes. Résultats: le questionnaire avait une fiabilité test-retest bonne à élevée (CCI de 0,84, IC à 95 % de 0,57 à 0,94; p > 0,001). Le modèle définitif pouvait prédire de manière significative les scores d'attentes de R2 = 0,19 (p = 0,017). Conclusions: le présent questionnaire mesure avec fiabilité les attentes des patients avant l'ATG, mais d'autres recherches s'imposent. Les chercheurs croyaient qu'un plus jeune âge serait associé à des attentes plus élevées, mais un meilleur fonctionnement avant l'ATG semblait être lié davantage à des hautes attentes.
RESUMO
Although 25% of patients with end-stage knee osteoarthritis (OA) have reported a fall, there is limited information about risk factors for falling in patients awaiting total knee arthroplasty (TKA). The purpose of this study was to identify clinical and functional measures related to fall risk. A total of 259 participants awaiting TKA for OA participated in this secondary cross-sectional study. Participants were divided into fallers and non-fallers based on falling history in the prior 6 months. Clinical measures (hip and knee pain, neck and low back pain (LBP), knee range of motion, and quadriceps strength) and functional measures (six-minute walk test (6MWT), timed up and go test, and Knee Injury and Osteoarthritis Outcome Score (KOOS)) were assessed in patients 2-4 weeks prior to TKA. Independent t tests were used to examine differences between groups. Odds ratio was calculated to identify clinical risk factors for falling. Of all participants, 47 (18%) reported a fall in the previous 6 months. Fallers had 30% greater LBP (3.0 ± 2.5 vs. 2.1 ± 2.6; p = 0.025). Fallers walked 12% shorter distance in the 6MWT than non-fallers (378 ± 100 vs. 422 ± 105 m; p = 0.010). For every 1-point increase in LBP on a 0-10 scale, there was a 14% greater risk of falling (p = 0.028). For every 10-m increase in 6MWT, there was a 3.8% reduction in fall risk (p = 0.011). Greater LBP and worse walking endurance are associated with falls in individuals with end-stage OA. Future studies should determine if interventions that reduce LBP and improve walking performance also reduce the chance of falling.
