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Total Knee Arthroplasty Physical Therapist Management

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Prognostic Factors: Body mass index (BMI); Depression; Preoperative range of motion (ROM), Physical function, and Strength; Age; Diabetes; Number of comorbidities; and Sex   ➤ Physical therapist management should take into consideration the following factors when determining prognosis, treatment, and informed decision- making and expectation-setting with patients undergoing TKA: a. Higher BMI is associated with more postoperative complications and worse postoperative outcomes. b. Depression is associated with worse postoperative outcomes. c. Preoperative ROM is positively associated with postoperative ROM but has minimal, if any, effect on physical function and quality of life. d. Preoperative physical function is positively associated with postoperative physical function. e. Preoperative strength is positively associated with postoperative physical function. f. Age is associated with mixed patient-reported, performance-based, and impairment-based outcomes. g. Diabetes is not associated with worse functional outcomes. h. A greater degree of comorbidity is associated with worse patient-reported outcomes. i. Sex is associated with both positive and negative effects on postoperative outcomes. (Evidence Quality: High, Recommendation Strength: Moderate) ★★★★ Prognostic Factors: Tobacco AND Patient Support   ➤ It is the consensus of the work group that active tobacco use and lack of patient support (i.e., environmental factors including, but not limited to, support and relationships) should be considered as prognostic/risk factors associated with less than optimal functional outcomes. (Evidence Quality: Insufficient, Recommendation Strength: Best Practice) ★★★★ Postoperative Physical Therapist Supervision   ➤ Supervised physical therapist management should be provided for patients who have undergone TKA. The optimal setting should be determined by the patients' safety, mobility, environmental, and personal factors. (Evidence Quality: Moderate, Recommendation Strength: Moderate) ★★★★

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