Discordance Between Self-Reported and Performance-Based Physical Function in Patients Who Have Knee Osteoarthritis: Associations With Pain Intensity and Negative Affect

Physical functioning before knee arthroplasty is not associated with (standardized) preoperative physiotherapy, but is tied to physical functioning 1-year post-surgery: A prospective cohort study

Background

and purpose This study investigates whether a (regionally) standardized physiotherapy approach, employing a stepped-care model, can more effectively enhance preoperative physical function in end-stage osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and improve postoperative outcomes, addressing the current gap in understanding the impact of such interventions.

Methods

This mono-center observational prospective cohort study followed 216 primary UKA or TKA patients for one-year post-surgery. Preoperative physiotherapy, recorded through self-reported questionnaires, included standardization and treatment frequency details. Physical functioning assessments encompassed quadriceps and hamstrings muscle strength, functional mobility (FM), and range of motion (ROM). Statistical analyses comprised multivariate and single linear regression for both UKA and TKA groups.

Results

Standardized preoperative physiotherapy correlated with superior preoperative extension ROM in TKA patients (B = -3.557, 95 % CI [-.915; -.241]), while less than 10 treatments were associated with superior preoperative extension ROM for both groups (β = -.202, p = .030 and β = -.228, p = .045). No associations were found between location or treatment frequency and preoperative muscle strength or FM. For both groups, preoperative FM, ROM, and muscle strength positively correlated with postoperative levels, except for extension ROM for UKA patients (p = .178).

Conclusion

While adherence to standardized preoperative physiotherapy at an affiliated practice did not significantly correlate with preoperative physical functioning levels, a strong relationship exists between preoperative and one-year postoperative physical functioning levels.

Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors

The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.

ChatGPT's role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study

BACKGROUND

Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored.

METHODS

In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires.

RESULTS

Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P <.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels.

CONCLUSIONS

ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.

Physical functions assessed by lower limb performance-based and self-reported outcome measures for knee musculoskeletal conditions: A scoping review

BACKGROUND

Physical function assessment is key for the management of knee musculoskeletal conditions. There are a wide variety of self-reported outcome measures (SROMs) and performance-based outcome measures (PBOMs) to assess physical function of individuals with knee conditions. However, the content of these measures has not been explored.

OBJECTIVE

To explore the range and frequency of physical functions assessed by lower limb PBOMs and SROMs for people with knee osteoarthritis (OA), anterior cruciate ligament (ACL) injuries, and patellofemoral pain (PFP).

METHODS

A scoping review was conducted. We included development or measurement properties studies of knee functional outcome measures for populations with knee OA, ACL injuries, and PFP. We extracted the physical functions assessed in each measure. Each identified physical function was linked to a code from the International Classification of Functioning, Disability and Health (ICF) framework.

RESULTS

4146 articles were screened. A total of 143 articles were included. The median number of physical functions assessed was nine for SROMs and one for PBOMs. The three most assessed physical functions were climbing stairs, walking short distances, and standing up from sitting. Climbing stairs was the most assessed physical function in measures for knee OA and PFP populations, whereas jumping was in measures for the ACL-injured population.

CONCLUSION

SROMs assess a broader range of physical functions, whereas PBOMs focus on discrete activities. ACL and PFP measures evaluated more challenging physical functions than knee OA measures. Current physical function outcome measures are not well suited to assess performance in knee OA populations with mild or diverse levels of impairment.

How Active Are Our Patients in the First 6 Weeks Following Total Knee Arthroplasty?

BACKGROUND

Patient activity after total knee arthroplasty (TKA) surgery has been estimated through patient-reported outcome measures. The use of data from an implanted sensor that transmits daily gait activity provides a more objective, complete recovery trajectory.

METHODS

In this retrospective analysis of 794 patients who received a TKA with sensors in the tibial extension between October 4, 2021, and January 13, 2023, the average age of the patients was 64 years, and the cohort was 54.9% women. During the 6-week postoperative period, 90.3% of patients transmitted data. Patient activity in terms of qualified step count, cadence, walking speed, stride length, functional tibial range of motion (ROM), and functional knee ROM were compared at 1 week, 3 weeks, and 6 weeks postoperatively.

RESULTS

All gait parameters increased in the first 6 weeks postsurgery: qualified step count increased 733%, cadence increased 22%, walking speed increased 50%, stride length increased 17%, tibial ROM increased 19%, and functional knee ROM increased 14%. There were statistically significant differences at both postoperative periods (P = .029, P < .001, and P < .001 at 3 and 6 weeks, respectively) in step counts for different body mass index (BMI) categories, with qualified step counts decreasing with increasing BMI. Patients under 65 years tended to have a higher qualified step count than those 65 and older at all time points, but these differences were not statistically significant. Men had significantly higher step counts than women (P < .001 at 1, 3, and 6 weeks).

CONCLUSIONS

Initial results with an implanted sensor that collects data during activities of daily living confirm that 90% of patients transmit objective gait metrics daily after TKA surgery. Those results differ by sex and BMI.

LEVEL OF EVIDENCE

III Retrospective Cohort Study.