Clinical Interpretability of Quadriceps Strength and Gait Speed Performance in Total Knee Arthroplasty

Abstract

OBJECTIVE: After a total knee arthroplasty, physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function.

DESIGN: A sample of 2624 patients with primary total knee arthroplasty participated in this retrospective longitudinal study. Monthly, for 4 mos after surgery, quadriceps strength and gait speed were quantified. At the month-6 time point, self-reported walking and stair climbing function was measured.

RESULTS: All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher month-6 self-reported walking and stair climbing function ( P < 0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P < 0.001). Among female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 wks after total knee arthroplasty.

CONCLUSIONS: By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting.

TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.

CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand how self-reported walking and stair climbing abilities improved from baseline before total knee arthroplasty (total knee arthroplasty) to 6 mos postoperatively; (2) Describe the time course of the 2 performance-based measures of quadriceps strength and walking speed after a total knee arthroplasty; and (3) Relate the trajectories of post-total knee arthroplasty quadriceps strength and walking speed measurements across distinct levels of self-reported walking and stair climbing function.

LEVEL: Advanced.

ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.