Physical Performance Correlates with Self-Reported Physical Function and Quality of Life in Patients at 3 Months after Total Knee Arthroplasty

Abstract

Background: Although total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis, assessment of postoperative outcomes remains unclear. This study aimed to identify postoperative physical performance factors that are correlated with self-reported physical function and quality of life (QoL) at 3 months after unilateral TKA. Methods: In total, 158 patients who underwent unilateral primary TKA completed performance-based physical function tests at 3 months after surgery, including Stair Climbing Tests (SCT), 6-Minute Walk Tests (6MWT), Timed Up and Go tests (TUG), and instrumental gait analysis. We also measured the isometric knee flexor and extensor strengths of the operated and non-operated knees. Self-reported physical function and QoL were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Euro-QoL Five Dimensions (EQ-5D) questionnaire, respectively. Results: Bivariate analyses showed that WOMAC function and EQ-5D were correlated with age, other self-reported measures, and performance-based measures. The WOMAC pain (r=0.71, p<0.001) showed a high positive correlation. While the EQ-5D (r=-0.7, p<0.001) showed a highly negative correlation with WOMAC function, WOMAC pain (r=-0.67, p<0.001) showed a moderately negative correlation with EQ-5D. In multivariate linear regression analyses, WOMAC pain, peak torque of the flexor of the non-operated knee, and reductions in extensor and stride length were associated with self-reported physical function, whereas WOMAC pain, SCT ascent, and cadence were associated with postoperative QoL. Conclusions: Physical performance factors were significantly associated with self-reported physical function and QoL in patients at 3 months after unilateral TKA. These findings suggest that performance-based physical function could be used to assess outcomes after TKA.

Association between Agility, Health-Related Quality of Life, Depression, and Anthropometric Variables in Physically Active Older Adult Women with Depression

“…The present results showed a moderate inverse correlation (r = −0.34) between TUG and EQ-5D-3L, which means that subjects with higher TUG times (which equals poorer performance in the TUG) would have lower scores in the EQ-5D-3L, which translates to poorer health-related quality of life. There is not a consensus in the available body of evidence about the magnitude and direction of the correlation between these two variables; despite some authors’ results coinciding with ours [ 47 , 48 ], other authors [ 49 ] found that larger times in the TUG mean greater results in the EQ-5D-3L. Choi et al [ 47 ] agreed with the present results, showing a moderate inverse correlation (r = −0.42) between TUG and EQ-5D in total knee arthroplasty patients.…”

“…There is not a consensus in the available body of evidence about the magnitude and direction of the correlation between these two variables; despite some authors’ results coinciding with ours [ 47 , 48 ], other authors [ 49 ] found that larger times in the TUG mean greater results in the EQ-5D-3L. Choi et al [ 47 ] agreed with the present results, showing a moderate inverse correlation (r = −0.42) between TUG and EQ-5D in total knee arthroplasty patients. Lu et al [ 48 ] found a small inverse correlation between TUG and EQ-5D in older Chinese men and women (r = −0.25 and r = −0.21, respectively).…”

Untitled

“…otros autores (Alfonso-Rosa, Del Pozo-Cruz, Del Pozo-Cruz, Del Pozo-Cruz, Sañudo, Corrales-Sánchez, & Sañudo, 2013) encontraron justamente lo contrario, que mayores tiempos en el TUG tenían mayores resultados en el EQ-5D-3L. Las investigaciones que estuvieron de acuerdo con los resultados de este estudio, (Choi et al, 2020) mostraron una correlación inversa moderada (r=-0,42) entre TUG y EQ-5D en sus participantes. Otro estudio reciente, encontró una pequeña correlación inversa entre TUG y EQ-5D-3L en hombres chinos mayores (r=-0,25) (Lu et al, 2020); en la línea de Olivares et al que hallaron una pequeña correlación inversa entre TUG y cada dimensión del EQ-5D-3L en adultos de mediana edad y mayores, aunque no se informó de la asociación entre el rendimiento de TUG y la puntuación general del EQ-5D-3L (EQ-5D-3L index).…”

The impact of preoperative muscle strength on postoperative walking ability in patients undergoing total knee arthroplasty

“…Additionally, previous studies have reported reduced activity of the knee flexor muscles while walking, in patients after TKA [22]. It is well established that knee flexor muscle strength is related to self-reported physical function in patients undergoing TKA [14]. However, many of these previous studies were conducted several years after TKA was performed, and included studies with inadequate sample sizes.…”

“…As a result, patients who undergo TKA experience decreased postoperative walking ability (PWA) [11,12] and have a lower walking ability than healthy adults of the same age even 1 year post-surgery [13]. Previous reports have related the walking ability of TKA patients to their QOL [14]. Therefore, it is important to minimize the loss of walking ability associated with muscle weakness during rehabilitation post-TKA.…”