Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 1

Objectives  Knee range of motion (ROM) at the point of discharge from acute care is used as a clinical indicator to benchmark performance between hospital services after total knee replacement (TKR). The utility of the current benchmark, including whether discharge ROM varies between hospitals, is u...

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Bibliographic Details
Published in:Journal of evaluation in clinical practice 2012-06, Vol.18 (3), p.644-651
Main Authors: Naylor, Justine M., Ko, Victoria, Rougellis, Steve, Green, Nick, Hackett, Danella, Magrath, Ann, Barnett, Anne, Kim, Grace, White, Megan, Nathan, Priya, Harmer, Alison, Mackey, Martin, Heard, Rob, Yeo, Anthony E. T., Adie, Sam, Harris, Ian A., Mittal, Rajat, Cho, Adam
Format: Article
Language:English
Subjects:
Aged
arthroplasty
Arthroplasty, Replacement, Knee
Benchmarking
Female
Humans
knee
Knee Joint - physiology
Male
Patient Discharge
physiotherapy
Postoperative Period
Quality Improvement
range of motion
Range of Motion, Articular
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Summary:Objectives  Knee range of motion (ROM) at the point of discharge from acute care is used as a clinical indicator to benchmark performance between hospital services after total knee replacement (TKR). The utility of the current benchmark, including whether discharge ROM varies between hospitals, is unknown. This study aimed to determine whether the benchmark [≥80 degrees flexion and ≤5 degrees fixed flexion (extension)] is realistic and whether the service provider is a predictor of knee ROM. Methods  A prospective, observational cohort study was conducted involving 176 TKR patients from four hospitals. Knee ROM was photographically assessed preoperatively and at discharge. ‘Hospital’, typical patient demographic data and preoperative ROM were identified a priori as potential predictors of knee ROM. Results  Overall, 2% [95% CI (confidence interval) 1–6] of patients attained the ROM benchmark. Individual hospital attainment of the benchmark ranged 0–7% with a significant difference (P = 0.047) evident between the best performer and the remaining hospitals. The overall rates of attainment of the individual flexion (25%, 95% CI 19–32) and extension (15%, 95% CI 10–21) components were similarly low, although the scatter between hospitals was large [flexion (2–47%); extension (8–44%)]. Preoperative flexion and hospital were significant (P = 0.002) predictors of discharge flexion, explaining 21% of the variance. Similarly, hospital and preoperative extension together with gender were significant (P 
ISSN:1356-1294
1365-2753
DOI:10.1111/j.1365-2753.2011.01655.x