Development International Classification of Functioning, Disability and Health Core Set for Post Total Knee Replacement Rehabilitation Program: Delphi-Based Consensus Study in Taiwan

Abstract

Osteoarthritis is one of the leading causes of disability. Total knee arthroplasty (TKA) is a surgical intervention for patients with severe osteoarthritis. Post TKA rehabilitation is crucial for improving patient’s quality of life. However, traditional rehabilitation has only focused on physical function; a systemic analysis of other dimensions such as social participation and environmental factors of post TKA rehabilitation is lacking. The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) to create a comprehensive rehabilitation program for patients with osteoarthritis post TKA. Before the Delphi-based consensus process, a literature review process was performed for related ICF categories selection. We used a three-round Delphi-based consensus among 20 physical therapists with orthopedic rehabilitation expertise in a university-based hospital. A five-point Likert scale was used to rate the importance of each item. The consensus of ratings was analyzed using Spearman’s rho and semi-interquartile range indices. The ICF core set for post TKA rehabilitation was determined based on a high level of consensus and a mean score of ≥4.0 in the third Delphi-based consensus round. The ICF core set comprised 32 categories, with 13 regarding body function, four regarding body structures, nine regarding activities and participation, four regarding environmental factors, and two regarding personal factors. Our ICF core set for post TKA rehabilitation can provide information on effective rehabilitation strategies and goal setting for patients post TKA. However, further validation and feasibility assessments are warranted.

Development and content validation of a questionnaire identifying patients’ functional priorities and abilities after hip or knee arthroplasty

“…57,60 The OA core set addresses second-level categories, but the survey included third-level activities to ensure a thorough exploration of the individual's participation in diverse life activities using original ICF wording. It is worth noting that an ICF core set for total knee arthroplasty was recently developed, 29 however patients were not involved in the development process.…”

“…Only the second-level categories of "toileting" (d530), "acquisition of goods and services" (d620), "doing housework" (d640), "assisting others" (d660), "intimate relationship" (d770), and "community life" (d970) were used as the details provided by the third level activities are less relevant for functional assessment after knee or hip arthroplasty. 29 Since the abilities related to hobbies, play, crafts, arts and culture were similar, they were merged into the category "Hobbies/ play /Crafts/ Arts and culture" "Lying down" (d4100) was split into lying down and getting up. "Center of gravity" was removed from "shifting the body's center of gravity" (d4106) to simplify the term.…”

Assessing perceived participation among older adults total hip arthroplasty and total knee arthroplasty patients six months post-surgery: a cross-sectional study

“…A more complete approach to recovery will involve looking at a lot of different outcome measures that show physical and mental impairments, activity limitations, and participation restrictions, as shown in the International Classification of Functioning (ICF) model at different follow-up points (4).…”