Title : How to monitor and discriminate the causes of lower limb swelling during home-based rehabilitation after total knee arthroplasty? A delphi study
Abstract:
Background: Patients undergoing total knee arthroplasty (TKA) are mostly elderly, and they may face certain difficulties in managing their symptoms at home. Swelling in the lower limbs after TKA hinders surgical outcomes. Prolonged duration of swelling requires monitoring and remote management during home-based rehabilitation. Various causes of swelling exist, but there is a lack of indicators to monitor and discriminate different causes of lower limb swelling, making it difficult to implement targeted interventions. This study aims to clarify the indicators to monitor and discriminate the causes of lower limb swelling during home-based rehabilitation after TKA by literature research and consulting experts from various disciplines.
Method: The Delphi method was used. Based on literature research and analysis, a preliminary draft of indicators was developed. Fifteen experts from different disciplines were invited to evaluate the validity of the indicators and provide modification suggestions. Through two rounds of consultations, consensus was reached among the experts.
Results: After two rounds of Delphi consultations, consensus was reached. Agreement scores ranged from 4.40 to 5.00, with low variability (standard deviation 0.00-0.91) and high consistency (coefficient of variation 0.00-0.20). P<0.05 in the Kendall's W with an agreement rate of 80.00-100%. In the final set of indicators, there were five primary indicators (representing four swelling causes and a General Category), along with 23 secondary indicators and 40 tertiary indicators (further subdivisions of the secondary indicators).
Conclusion: This study has preliminarily established indicators for at-home differentiation of swelling post-TKA caused by four distinct reasons. Further research is needed to validate the value of these indicators in distinguishing the causes of swelling. In the future, the development of remote monitoring systems or devices to collect data on these indicators could enable personalized interventions tailored to specific swelling causes for patients.
Audience Take Away Notes:
- Challenges in Home Management: Elderly patients undergoing total knee arthroplasty (TKA) encounter difficulties managing post-surgical symptoms at home, particularly swelling in the lower limbs.
- Importance of Swelling Monitoring: Swelling in the lower limbs post-TKA can impact surgical outcomes, emphasizing the need for effective monitoring and management during home-based rehabilitation.
- Four causes of swelling after TKA: inflammatory reaction, poor venous return, joint bleeding and muscle injury.
- Precision Home Monitoring for Targeted Swelling Interventions: By measuring certain parameters at home, it becomes possible to distinguish the underlying causes of swelling, allowing for targeted interventions and thereby enhancing the effectiveness of interventions.
