Age- and sex-based recovery curves to track functional outcomes in older adults with total knee arthroplasty.

Background: older adults with total knee arthroplasty (TKA) frequently undergo rehabilitation to address limited knee flexion range-of-motion, quadriceps weakness and gait speed limitations. This study aimed to develop age- and sex-specific recovery curves of knee flexion range-of-motion, quadriceps strength and fast gait speed post-TKA. Methods: a population-based sample of 2,987 patients undergoing primary TKA participated, of whom 2015 (68%) were 65 years of age or older. At 4, 8 and 12 weeks post surgery, knee flexion range-of-motion, quadriceps strength and fast gait speed were quantified. Quantile regression was used to determine the percentiles of the knee and gait measures. Results: the various knee and gait measures improved nonlinearly over time, with substantial improvements observed in the 1st 8-10 weeks post surgery. Age-specific, sex-specific recovery curves were developed to show the recovery patterns at multiple percentile levels. A web interface was created to facilitate easy computation of the percentile rank for a given outcome value. Conclusions: we have provided reference percentile values for knee flexion range-of-motion, quadriceps strength and gait speed recovery post-TKA. Such information may assist rehabilitation professionals in interpreting outcomes and quantifying deviations from the expected recovery pattern.

Predicting outcomes of acute low back pain patients in emergency department: A prospective observational cohort study.

Low back pain (LBP) is a common complaint among patients presenting to emergency department (ED) in Singapore. The STarT Back Screening Tool (SBT) was recently developed and validated for triage of LBP patients in primary care settings. This study aimed to investigate whether the SBT could provide prognostic information for long-term outcomes of acute LBP patients visiting the ED, who might benefit from appropriate and timely management at an earlier stage.Data were collected in a prospective observational cohort study from 177 patients who consulted emergency physicians for acute LBP and completed 6-month follow-up. Patients were administered the SBT and assessed at baseline. Follow-up assessments were conducted at 6 weeks and 6 months.A multiple linear regression model incorporating SBT total score, age, employment status, LBP history, and 6-week pain score was constructed to predict 6-month pain score. In the model, SBT total score and 6-week pain score were significantly associated with 6-month pain score (P < .05) with respective coefficients of 0.125 and 0.500. The model explained 40.1% of the variance for 6-month pain score.This study demonstrated that the multiple linear regression model showed predictive performance in determining long-term outcomes for acute LBP patients presenting to the ED.

Sex Differences and Impact of Body Mass Index on the Time Course of Knee Range of Motion, Knee Strength, and Gait Speed After Total Knee Arthroplasty.

OBJECTIVE: Quadriceps strength deficits and gait speed limitations remain significant issues after total knee arthroplasty (TKA), yet detailed longitudinal data characterizing these measures and their predictors are limited. This study aimed to describe the time course of knee range of motion, quadriceps strength, and gait speed post-TKA, and to assess whether sex and body mass index (BMI) influenced the time recovery of these measures. METHODS: A total of 1,025 patients (mean ± SD age 67 ± 8 years) undergoing primary TKA participated. At 4-, 8-, 12-, and 16-weeks postsurgery, knee range of motion, quadriceps strength, and gait speed were quantified. The associations of the knee and gait measures profile over time with sex and BMI were assessed using generalized least squares modeling. RESULTS: The various knee and gait measures improved nonlinearly over time, with substantial improvements observed in the first 8-10 weeks postsurgery. Sex and BMI influenced the time course of quadriceps strength (P < 0.001 for all interactions): improvements in quadriceps strength over time were slower in women and in patients with higher BMI. Post-TKA gait speed was consistently lower in women than in men, while BMI was negatively and nonlinearly related to gait speed. CONCLUSION: Although the various knee and gait measures improved over time, women and patients with higher BMI had poorer functional outcomes. The present study highlights the need for a mechanistic understanding of the results and targeted management of these patient subgroups.