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Graber J, Juarez-Colunga E, Thigpen C, Waugh D, Bade M, Stevens-Lapsley J, Kittelson A. Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty. Disabil Rehabil 2022; 44:7535-7542. [PMID: 34751608 PMCID: PMC9306324 DOI: 10.1080/09638288.2021.1995054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
Purpose: To develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD).Materials and Methods: We conducted a retrospective analysis of post-TKA quadriceps strength recovery in a longitudinal dataset consisting of both clinical and research HHD data. We created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape. We created reference charts from the models to display the recovery of population centiles over the first six postoperative months.Results: A total of 588 patient records with 1176 observations were analyzed. Reference charts for both sexes demonstrated a rapid increase in quadriceps strength over the first 60 postoperative days followed by a more gradual increase over the next 120 days. Males appeared to demonstrate faster recovery and greater strength on average compared to females. The quadriceps strength recovery of three female patient records was plotted on the reference chart to illustrate the charts' potential clinical utility.Conclusions: These reference charts provide normative data for quadriceps strength recovery after TKA as assessed by HHD. The reference charts may augment clinicians' ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.Implications for RehabilitationHandheld dynamometry (HHD) is an objective and clinically feasible method for assessing muscle strength, but normative HHD values are lacking for quadriceps strength recovery after total knee arthroplasty (TKA).We created sex-specific reference charts which provide normative quadriceps strength HHD values for the first 180 days after TKA.These reference charts may improve clinicians' ability to monitor and intervene upon post-TKA quadriceps strength deficits.
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Affiliation(s)
- Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | | | - Dawn Waugh
- ATI Physical Therapy, Greenville, SC, USA
| | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
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Yau LK, Henry FU, Man Hong C, Amy C, Wai Kwan Vincent C, Ping Keung C, Kwong Yuen C. Swelling assessment after total knee arthroplasty. J Orthop Surg (Hong Kong) 2022; 30:10225536221127668. [PMID: 36122907 DOI: 10.1177/10225536221127668] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Total knee arthroplasty is a commonly performed elective orthopaedic surgery. Patients may endure substantial knee swelling following surgery, which are attributable to both effusion and edema. Studies have been aiming to identify an accurate and reliable method to quantify post-operative knee swelling to aid monitoring progress and treatment. The aim of this article was to review the means of clinically applicable measurements for knee swelling post TKA. METHODS The medical literature was searched using PubMed to search for articles published using the terms knee edema, effusion, swelling, knee arthroplasty, knee replacement, total knee arthroplasty, total knee replacement, TKA, TKR. Year of publication was not restricted. Only English language publications were included. Only full-text published articles from peer-reviewed journals were eligible for inclusion. The knee swelling measurement methods used in post TKA were reviewed. RESULTS Advancement in bioimpedance spectroscopy and handheld 3D scanning technology allows quick and precise quantification of knee swelling volume that the traditional clinical circumferential measurement and volumetric measurement lack. Handheld 3D scanning is also a potential tool to estimate the change of knee effusion volume and muscular volume after the surgery. Magnetic resonance imaging is accurate in effusion measurement but also the most time and resource demanding method. CONCLUSION Bioimpedance spectroscopy and 3D scanning technology can be the future tools for clinically measurement of knee swelling after total knee arthroplasty.
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Affiliation(s)
- Li Ka Yau
- Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong SAR, China
| | - F U Henry
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Hong Kong SAR, China
| | - Cheung Man Hong
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Hong Kong SAR, China
| | - Cheung Amy
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, 26473Queen Mary Hospital, Hong Kong SAR, China
| | - Chan Wai Kwan Vincent
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, 26473Queen Mary Hospital, Hong Kong SAR, China
| | - Chan Ping Keung
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Hong Kong SAR, China
| | - Chiu Kwong Yuen
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Hong Kong SAR, China
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Graber J, Kittelson A, Juarez-Colunga E, Jin X, Bade M, Stevens-Lapsley J. Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty. J Am Med Inform Assoc 2022; 29:1899-1907. [PMID: 35903035 PMCID: PMC10161535 DOI: 10.1093/jamia/ocac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Prediction models can be useful tools for monitoring patient status and personalizing treatment in health care. The goal of this study was to compare the relative strengths and weaknesses of 2 different approaches for predicting functional recovery after knee arthroplasty: a neighbors-based "people-like-me" (PLM) approach and a linear mixed model (LMM) approach. MATERIALS AND METHODS We used 2 distinct datasets to train and then test PLM and LMM prediction approaches for functional recovery following knee arthroplasty. We used the Timed Up and Go (TUG)-a common test of mobility-to operationalize physical function. Both approaches used patient characteristics and baseline postoperative TUG values to predict TUG recovery from days 1-425 following surgery. We then compared the accuracy and precision of PLM and LMM predictions. RESULTS A total of 317 patient records with 1379 TUG observations were used to train PLM and LMM approaches, and 456 patient records with 1244 TUG observations were used to test the predictions. The approaches performed similarly in terms of mean squared error and bias, but the PLM approach provided more accurate and precise estimates of prediction uncertainty. DISCUSSION AND CONCLUSION Overall, the PLM approach more accurately and precisely predicted TUG recovery following knee arthroplasty. These results suggest PLM predictions may be more clinically useful for monitoring recovery and personalizing care following knee arthroplasty. However, clinicians and organizations seeking to use predictions in practice should consider additional factors (eg, resource requirements) when selecting a prediction approach.
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Affiliation(s)
- Jeremy Graber
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Elizabeth Juarez-Colunga
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado, USA
| | - Xin Jin
- Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado, USA
| | - Michael Bade
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Jennifer Stevens-Lapsley
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
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Patient-perceived knee enlargement after total knee arthroplasty: prevalence, risk factors, and association with functional outcomes and radiological analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1305-1312. [DOI: 10.1007/s00264-022-05388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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Carmichael J, Dennis D, Jennings J, Stevens-Lapsley J, Bade M. Feasibility and initial efficacy of a multimodal swelling intervention after total knee arthroplasty: A prospective pilot study with historical controls. Knee 2022; 35:25-33. [PMID: 35183923 DOI: 10.1016/j.knee.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Swelling after total knee arthroplasty (TKA) is often profound and persistent, increasing risks of DVT, infection, and wound dehiscence, and impairing rehabilitation. We investigated the feasibility and initial efficacy of a multimodal swelling control intervention (MSI), comprised of an inelastic adjustable compression garment (CG), manual lymph drainage (MLD) massage, and home exercise program (HEP) after total knee arthroplasty (TKA) compared to a control group. METHODS Sixteen individuals (mean age 64.7 ± 7.1y) performed MSI for three weeks after TKA, through day 21 (D21). Outcome measures included patient satisfaction, safety, patient adherence, and swelling measured by Single Frequency Bioimpedance Assessment (SF-BIA). All outcomes were measured preoperatively and at postoperative D4, D7, D14, D21 and, three weeks after discontinuing MSI, on D42. Efficacy of MSI was calculated with Hedge's g effect size estimates using the SF-BIA ratios for MSI versus CONTROL (N = 56; mean age 64.3 ± 9.3y) at key post operative time points. RESULTS Patient satisfaction was 93% with no adverse events. Adherence to CG, MLD, and HEP were 85%, 99%, and 97% respectively. Peak swelling reduction with MSI was at D21 (Hedges' g = 1.60 at D21 (95% CI 0.99, 2.21)). Minimal change in swelling was observed three weeks after cessation of MSI on D42. CONCLUSIONS The self-administered MSI program is feasible and demonstrated strong initial efficacy to control swelling after TKA. Minimal rebound swelling was observed once MSI was withdrawn at D21. Future studies should examine the efficacy of inelastic adjustable compression in a randomized controlled trial.
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Affiliation(s)
- Joel Carmichael
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, 13121 E 17(th) Ave, Mail Stop C244, Aurora, CO 80045, USA.
| | - Doug Dennis
- Colorado Joint Replacement, 2535 Downing Street, Unit 100, Denver, CO 80210, USA.
| | - Jason Jennings
- Colorado Joint Replacement, 2535 Downing Street, Unit 100, Denver, CO 80210, USA; Department of Mechanical and Materials Engineering, University of Denver, 2199 S. University Blvd., Denver, CO 80218, USA.
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, 13121 E 17(th) Ave, Mail Stop C244, Aurora, CO 80045, USA; Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 Wheeling Street, Aurora, CO 80045, USA.
| | - Michael Bade
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, 13121 E 17(th) Ave, Mail Stop C244, Aurora, CO 80045, USA; Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 Wheeling Street, Aurora, CO 80045, USA.
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Marker RJ, Kittelson AJ, Jankowski CM, Scorsone JJ, Peters JC, Purcell WT. Development of a Reference Chart for Monitoring Cancer-Related Fatigue Throughout a Supervised Exercise Program. REHABILITATION ONCOLOGY 2022; 40:82-88. [PMID: 35711819 PMCID: PMC9197055 DOI: 10.1097/01.reo.0000000000000285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is one of the most reported and functionally limiting symptoms experienced by individuals living with and beyond cancer. Exercise is effective at reducing CRF, though currently it is not possible to predict the magnitude and time course of improvement for an individual participating in an exercise program. OBJECTIVE To develop a reference chart of CRF improvement for individuals participating in a 3-month cancer-specific exercise program. METHODS In this retrospective cohort study, CRF was assessed every two weeks (using the FACIT - Fatigue scale, range: 0 - 52 with lower scores indicating greater fatigue) in 173 individuals participating in a 3-month supervised exercise program (741 observations). No cancer types were excluded and individuals were either undergoing chemotherapy and/or radiation, or within 6 months of completing treatment. The reference chart was developed using Generalized Additive Models for Location Scale and Shape. RESULTS Each participant had an average of four CRF observations. Lower centiles demonstrated greater improvement than higher centiles (11 points over the duration of the program for the 10th and 4 points for the 90th percentiles). LIMITATIONS The population is biased to individuals self-selecting or being referred to a clinical exercise program. CONCLUSIONS This reference chart provides a novel method of monitoring CRF improvement during a cancer-specific exercise program. Setting appropriate expectations and informing exercise prescription adaptation are discussed in the context of representative data from three participants. Future research can investigate improvements in clinical outcomes and the remote monitoring of CRF through the implementation of the reference chart.
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Neighbors-based prediction of physical function after total knee arthroplasty. Sci Rep 2021; 11:16719. [PMID: 34408167 PMCID: PMC8373960 DOI: 10.1038/s41598-021-94838-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/05/2021] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to develop and test personalized predictions for functional recovery after Total Knee Arthroplasty (TKA) surgery, using a novel neighbors-based prediction approach. We used data from 397 patients with TKA to develop the prediction methodology and then tested the predictions in a temporally distinct sample of 202 patients. The Timed Up and Go (TUG) Test was used to assess physical function. Neighbors-based predictions were generated by estimating an index patient's prognosis from the observed recovery data of previous similar patients (a.k.a., the index patient's "matches"). Matches were determined by an adaptation of predictive mean matching. Matching characteristics included preoperative TUG time, age, sex and Body Mass Index. The optimal number of matches was determined to be m = 35, based on low bias (- 0.005 standard deviations), accurate coverage (50% of the realized observations within the 50% prediction interval), and acceptable precision (the average width of the 50% prediction interval was 2.33 s). Predictions were well-calibrated in out-of-sample testing. These predictions have the potential to inform care decisions both prior to and following TKA surgery.
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