Reference charts are commonly used in healthcare settings to assist in monitoring patients’ progress and to inform clinical decisions at the level of the individual patient. Fundamentally, clinicians and patients lack an evidence-based framework by which to judge individual patients’ recovery following TKA surgery, thus impeding efforts to advance personalized or patient-centered treatment approaches for this elective surgery. Postoperative protocols typically indicate recovery milestones based on the expected clinical course for the average person, but surgical populations are heterogeneous. Rehabilitation practices vary widely by clinical site, and the content and goals of therapy are based largely on clinicians’ experience and intuition. Despite the prevalence of TKA, there is little agreement in the clinical community regarding postoperative care and rehabilitation. There are approximately 700,000 procedures performed per year in the United States, and surgical rates are comparable in many European countries (120–200 per 100,000 people). Total knee arthroplasty (TKA) is one of the most common inpatient elective surgeries worldwide. ConclusionĪ reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following TKA. The reference chart performed adequately in a test set of 171 patients (377 observations), with accurate centile coverage and minimal average bias (< 3 degrees). Additionally, optimization of the number of knots in smoothing splines and power transformation of time improved model fit. The best fitting model utilized a non-linear time trend, with smoothing splines for median and variance parameters. ResultsĪ total of 1173 observations from 327 patients were used to develop a reference chart for knee flexion over the first 120 days following TKA. difference between observed and predicted values) in the test dataset. The performance of the reference chart was then validated against a test set of patients with later surgical dates, by examining the centile coverage and average bias (i.e.
the percent of observed data represented below specified centiles). Various models were compared using the Schwarz Bayesian Criterion, Mean Squared Error in 5-fold cross validation, and centile coverage (i.e. Reference charts were constructed using Generalized Additive Models for Location Scale and Shape. Retrospective analysis of data collected in routine rehabilitation practice for patients following TKA surgery. Our study aimed to develop and validate a reference chart for monitoring recovery of knee flexion following TKA surgery. Clinicians and patients lack an evidence-based framework by which to judge individual-level recovery following total knee arthroplasty (TKA) surgery, thus impeding personalized treatment approaches for this elective surgery.
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