TY - JOUR
T1 - Diabetes mellitus blunts the symptoms, physical function, and health-related quality of life benefits of total knee arthroplasty
T2 - A systematic review with meta-analysis of data from more than 17 000 patients
AU - Na, Annalisa
AU - Oppermann, Laura M.
AU - Jupiter, Daniel C.
AU - Lindsey, Ronald W.
AU - Coronado, Rogelio A.
N1 - Funding Information:
1Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX. 2Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX. 3Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA. 4Department of Physical Therapy, The University of Texas Medical Branch, Galveston, TX. 5Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX. 6Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN. 7Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN. 8Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN. At the time of this work, Dr Na received funding from the Foundation for Physical Therapy Research and postdoctoral fellowship funding from the Interdisciplinary Rehabilitation Research Training Program of the National Institute on Disability, Independent Living, and Rehabilitation Research (US Department of Health and Human Services’ Administration for Community Living; number 90AR5009). Dr Coronado received funding from a US National Institutes of Health Rehabilitation Research Career Development Program grant (number K12 HD055929). The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Annalisa Na, Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102. E-mail: An838@drexel.edu U Copyright ©2021 JOSPT ®, Inc
Publisher Copyright:
© 2021 JOSPT®, Inc
PY - 2021/6
Y1 - 2021/6
N2 - U OBJECTIVE: To compare physical function, pain, impairments (stiffness, range of motion, and strength), and health-related quality of life (HRQoL) outcomes between patients with and without diabetes mellitus, before and after a total knee arthroplasty (TKA). U DESIGN: Prognosis systematic review. U LITERATURE SEARCH: We searched MEDLINE/PubMed, CINAHL, SPORTDiscus, and Web of Science to August 2019. U STUDY SELECTION CRITERIA: We included longitudinal studies that examined physical function, pain, impairments, and HRQoL outcomes among patients receiving a TKA and with or without diabetes. U DATA SYNTHESIS: For quantitative synthesis, we stratified outcomes based on time relative to TKA: preoperative, less than 1 year after a TKA (early postoperative), and 1 year or more after a TKA (late postoperative). We used random-effects meta-analysis to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation system for qualitative synthesis. U RESULTS: We included 21 studies (n = 17 472 patients). Patients with diabetes mellitus had worse preoperative physical function (SMD, -0.16; 95% CI: -0.24, -0.08) and HRQoL (SMD, -0.16; 95% CI: -0.26, -0.05), worse early postoperative pain (SMD, -0.22; 95% CI: -0.39, -0.05) and strength (SMD, -0.45; 95% CI: -0.77, -0.14), and worse late postoperative physical function (SMD, -0.23; 95% CI: -0.40, -0.06), range of motion (SMD, -0.23; 95% CI: -0.46, 0.00), and HRQoL (SMD, -0.19; 95% CI: -0.29, -0.08) than patients without diabetes mellitus. The overall risk of bias across studies was high, and the certainty of evidence ranged from low to very low. U CONCLUSION: Patients with diabetes mellitus had worse patient-reported and clinician-assessed outcomes before and after a TKA. Given the limitations of included studies, these results may change with future research.
AB - U OBJECTIVE: To compare physical function, pain, impairments (stiffness, range of motion, and strength), and health-related quality of life (HRQoL) outcomes between patients with and without diabetes mellitus, before and after a total knee arthroplasty (TKA). U DESIGN: Prognosis systematic review. U LITERATURE SEARCH: We searched MEDLINE/PubMed, CINAHL, SPORTDiscus, and Web of Science to August 2019. U STUDY SELECTION CRITERIA: We included longitudinal studies that examined physical function, pain, impairments, and HRQoL outcomes among patients receiving a TKA and with or without diabetes. U DATA SYNTHESIS: For quantitative synthesis, we stratified outcomes based on time relative to TKA: preoperative, less than 1 year after a TKA (early postoperative), and 1 year or more after a TKA (late postoperative). We used random-effects meta-analysis to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation system for qualitative synthesis. U RESULTS: We included 21 studies (n = 17 472 patients). Patients with diabetes mellitus had worse preoperative physical function (SMD, -0.16; 95% CI: -0.24, -0.08) and HRQoL (SMD, -0.16; 95% CI: -0.26, -0.05), worse early postoperative pain (SMD, -0.22; 95% CI: -0.39, -0.05) and strength (SMD, -0.45; 95% CI: -0.77, -0.14), and worse late postoperative physical function (SMD, -0.23; 95% CI: -0.40, -0.06), range of motion (SMD, -0.23; 95% CI: -0.46, 0.00), and HRQoL (SMD, -0.19; 95% CI: -0.29, -0.08) than patients without diabetes mellitus. The overall risk of bias across studies was high, and the certainty of evidence ranged from low to very low. U CONCLUSION: Patients with diabetes mellitus had worse patient-reported and clinician-assessed outcomes before and after a TKA. Given the limitations of included studies, these results may change with future research.
KW - Comorbidity
KW - Lower extremity
KW - Outcomes
KW - Replacement
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U2 - 10.2519/jospt.2021.9515
DO - 10.2519/jospt.2021.9515
M3 - Review article
C2 - 33870736
AN - SCOPUS:85107181982
SN - 0190-6011
VL - 51
SP - 269
EP - 280
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
IS - 6
ER -