Preoperative physical health and psychosocial characteristics influence postoperative mobility in veterans following total knee arthroplasty: A structural equation modeling approach

Abstract

Background: Preoperative physical activity (PA) levels persist in patients following total knee arthroscopy (TKA), despite improved function and mobility following rehabilitation. Long-standing activity behaviors and preexisting psychosocial characteristics may explain suboptimal PA post-TKA. Objective: To (1) confirm latent constructs from outcome measures capturing symptoms, function, psychosocial factors, and mobility and (2) examine relationships between constructs measured pre-TKA and their influence on post-TKA outcomes using factor analyses and structural equation modeling. Design: Secondary analysis of a randomized clinical trial. Setting: Veterans Administration medical center. Patients: U.S. military Veterans (n = 113; age 67.3 ± 7.3; mean ± SD; body mass index 29.0 ± 3.5 kg/m2; 90% male) scheduled for TKA. Intervention: Participants received TKA postoperative rehabilitation and were randomized to a PA behavior-change intervention targeting increased walking exercise or control group. Main Outcome Measures: The Western Ontario Measurement Arthritis, Falls Efficacy Scale International, Functional Comorbidity Assessment, Veterans RAND-12 Health Survey, Multidimensional Scale for Perceived Social Support, Geriatric Depression Scale, Self-Efficacy for Exercise scale, Timed-Up and Go, 6-minute walking test, and Life-Space Assessment (LSA) score. Results: A direct relationship was observed between pre-TKA physical characteristics and pre-TKA psychosocial characteristics (β =.734, z = 7.871, p