Skip to main content

Advertisement

SpringerLink
Log in

The five times sit-to-stand test predicts same-day discharge for outpatients undergoing total joint arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To examine whether a patient’s pre-operatively administered five times sit-to-stand (FTSTS) test score, when used alone or when combined with previously established predictors, relates to same-day discharge (SDD) after total knee or hip arthroplasty.

Methods

This study utilized a multivariate, retrospective, observational design. Electronic medical record data for included participants were used to analyze the relationship between the patient factors (including the novel FTSTS variable) and the SDD outcome. Univariate and multiple variable regression modeling was undertaken to understand the strength of the relationship between the independent variables with the dependent variable. Receiver operating curve (ROC) analysis was performed to determine the area under the curve (AUC) for the novel model. Cut score analysis was performed to establish the score which has the greatest utility for stratifying patients based upon their likelihood of achieving SDD.

Results

All independent variables related to the SDD outcome with varying effect sizes. The dichotomized FTSTS score related to the SDD outcome with medium effect (Exp(B) = 2.56). The score of 13.6 s was established as the point where the test was most highly sensitive and specific. The combined model including all included patient characteristics had a classification accuracy of 64.7% and an area under the curve score of .724.

Conclusion

The FTSTS score had higher predictive accuracy than all other stand-alone patient characteristics for the SDD outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

References

  1. Etkin CD, Springer BD (2017) The American Joint Replacement Registry-the first 5 years. Arthroplast Today 3(2):67–9

    Article  PubMed  PubMed Central  Google Scholar 

  2. Konnyu KJ, Thoma LM, Bhuma MR, Cao W, Adam GP, Mehta S, Aaron RK, Racine-Avila J, Panagiotou OA, Pinto D, Balk EM (2021) Prehabilitation and Rehabilitation for Major Joint Replacement [Internet]. Comparative Effectiveness Review No. 248. https://doi.org/10.23970/AHRQEPCCER248

  3. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M et al (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1323–30

    Article  PubMed  Google Scholar 

  4. Stambough JB, Nunley RM, Curry MC, Steger-May K, Clohisy JC (2015) Rapid recovery protocols for primary total hip arthroplasty can safely reduce length of stay without increasing readmissions. J Arthroplasty 30(4):521–6

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zhu S, Qian W, Jiang C, Ye C, Chen X (2017) Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J 93(1106):736–42

    Article  PubMed  Google Scholar 

  6. Argenson J-NA, Husted H, Lombardi AJ, Booth RE, Thienpont E (2016) Global forum: an international perspective on outpatient surgical procedures for adult hip and knee reconstruction. JBJS 98(13):e55

    Article  Google Scholar 

  7. Barnes CL, Iorio R, Zhang X, Haas DA (2020) An examination of the adoption of outpatient total knee arthroplasty since 2018. J Arthroplasty 35(6s):S24-s7

    Article  PubMed  Google Scholar 

  8. Courtney PM, Rozell JC, Melnic CM, Lee GC (2015) Who should not undergo short stay hip and knee arthroplasty? Risk factors associated with major medical complications following primary total joint arthroplasty. J Arthroplasty 30(9 Suppl):1–4

    Article  PubMed  Google Scholar 

  9. Baker P, Andrews SN, Mathews K, Nishioka S, Nakasone CK (2021) Stepping toward outpatient total hip arthroplasty with a rapid discharge protocol. J Orthop 27:153–7

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kim KY, Anoushiravani AA, Elbuluk A, Chen K, Davidovitch R, Schwarzkopf R (2018) Primary total hip arthroplasty with same-day discharge: who failed and why. Orthopedics (Online) 41(1):35–42

    Article  Google Scholar 

  11. Martinkovich SC, Trott GL, Garay M, Sewecke JJ, Sauber TJ, Sotereanos NG (2020) Patient characteristics and surgical start time affect length of stay following anterior total hip arthroplasty. J Arthroplasty 35(8):2114–8

    Article  PubMed  Google Scholar 

  12. Turcotte JJ, Menon N, Kelly ME, Grover JJ, King PJ, MacDonald JH (2021) Preoperative predictors of same-day discharge after total knee arthroplasty. Arthroplast Today 7:182–7

    Article  PubMed  PubMed Central  Google Scholar 

  13. Keulen MHF, Asselberghs S, Boonen B, Hendrickx RPM, van Haaren EH, Schotanus MGM (2020) Predictors of (un)successful same-day discharge in selected patients following outpatient hip and knee arthroplasty. J Arthroplasty 35(8):1986–92

    Article  PubMed  Google Scholar 

  14. Verdier N, Boutaud B, Ragot P, Leroy P, Saffarini M, Nover L et al (2022) Same-day discharge to home is feasible and safe in up to 75% of unselected total hip and knee arthroplasty. Int Orthop 46(5):1019–27

    Article  PubMed  Google Scholar 

  15. Crawford DA, Hurst JM, Morris MJ, Hobbs GR, Lombardi AV Jr, Berend KR (2020) Impact of morbid obesity on overnight stay and early complications with outpatient arthroplasty. J Arthroplasty 35(9):2418–22

    Article  PubMed  Google Scholar 

  16. Moore MG, Brigati DP, Crijns TJ, Vetter TR, Schultz WR, Bozic KJ (2020) Enhanced selection of candidates for same-day and outpatient total knee arthroplasty. J Arthroplasty 35(3):628–32

    Article  PubMed  Google Scholar 

  17. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–8

    Article  CAS  PubMed  Google Scholar 

  18. Elings J, van der Sluis G, Goldbohm RA, Galindo Garre F, de Gast A, Hoogeboom TJ et al (2016) Development of a risk stratification model for delayed inpatient recovery of physical activities in patients undergoing total hip replacement. J Orthop Sports Phys Ther 46(3):135–43

    Article  PubMed  Google Scholar 

  19. Oosting E, Hoogeboom TJ, Appelman-de Vries SA, Swets A, Dronkers JJ, van Meeteren NL (2016) Preoperative prediction of inpatient recovery of function after total hip arthroplasty using performance-based tests: a prospective cohort study. Disabil Rehabil 38(13):1243–9

    Article  PubMed  Google Scholar 

  20. Hewlett-Smith N, Pope R, Furness J, Simas V, Hing W (2020) Prognostic factors for inpatient functional recovery following total hip and knee arthroplasty: a systematic review. Acta Orthop 91(3):313–8

    Article  PubMed  PubMed Central  Google Scholar 

  21. van der Sluis G, Goldbohm RA, Elings JE, Nijhuis-van der Sanden MW, Akkermans RP, Bimmel R et al (2017) Pre-operative functional mobility as an independent determinant of inpatient functional recovery after total knee arthroplasty during three periods that coincided with changes in clinical pathways. Bone Joint J 99-b(2):211–7

    Article  PubMed  Google Scholar 

  22. Poitras S, Wood KS, Savard J, Dervin GF, Beaule PE (2015) Predicting early clinical function after hip or knee arthroplasty. Bone Joint Res 4(9):145–51

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Poitras S, Au K, Wood K, Dervin G, Beaulé PE (2018) Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful? Int Orthop 42(10):2295–300

    Article  PubMed  Google Scholar 

  24. Prohaska MG, Keeney BJ, Beg HA, Swarup I, Moschetti WE, Kantor SR et al (2017) Preoperative body mass index and physical function are associated with length of stay and facility discharge after total knee arthroplasty. Knee 24(3):634–40

    Article  PubMed  PubMed Central  Google Scholar 

  25. Raad M, Amin RM, El Abiad JM, Puvanesarajah V, Best MJ, Oni JK (2019) Preoperative patient functional status is an independent predictor of outcomes after primary total hip arthroplasty. Orthopedics 42(3):e326–e30

    Article  PubMed  Google Scholar 

  26. Johnson DJ, Castle JP, Hartwell MJ, D’Heurle AM, Manning DW (2020) Risk factors for greater than 24-hour length of stay after primary total knee arthroplasty. J Arthroplasty 35(3):633–7

    Article  PubMed  Google Scholar 

  27. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85-94

    Article  CAS  PubMed  Google Scholar 

  28. Reynaud V, Verdilos A, Pereira B, Boisgard S, Costes F, Coudeyre E (2020) Core outcome measurement instruments for clinical trials of total knee arthroplasty: a systematic review. J Clin Med 9 (8):2439. https://doi.org/10.3390/jcm9082439

  29. Özden F, Coşkun G, Bakırhan S (2020) The test-retest reliability and concurrent validity of the five times sit to stand test and step test in older adults with total hip arthroplasty. Exp Gerontol 142:111143

    Article  PubMed  Google Scholar 

  30. Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM (2005) Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test. Phys Ther 85(10):1034–45

    Article  PubMed  Google Scholar 

  31. Medina-Mirapeix F, Vivo-Fernández I, López-Cañizares J, García-Vidal JA, Benítez-Martínez JC, Del Baño-Aledo ME (2018) Five times sit-to-stand test in subjects with total knee replacement: reliability and relationship with functional mobility tests. Gait Posture 59:258–60

    Article  PubMed  Google Scholar 

  32. Schaubert KL, Bohannon RW (2005) Reliability and validity of three strength measures obtained from community-dwelling elderly persons. J Strength Cond Res 19(3):717–20

    PubMed  Google Scholar 

  33. Goldberg A, Chavis M, Watkins J, Wilson T (2012) The five-times-sit-to-stand test: validity, reliability and detectable change in older females. Aging Clin Exp Res 24(4):339–44

    Article  PubMed  Google Scholar 

  34. Lin YC, Davey RC, Cochrane T (2001) Tests for physical function of the elderly with knee and hip osteoarthritis. Scand J Med Sci Sports 11(5):280–6

    Article  CAS  PubMed  Google Scholar 

  35. Staartjes VE, Beusekamp F, Schröder ML (2019) Can objective functional impairment in lumbar degenerative disease be reliably assessed at home using the five-repetition sit-to-stand test? A prospective study. Eur Spine J 28(4):665–73

    Article  PubMed  Google Scholar 

  36. Metz CE (1978) Basic principles of ROC analysis. Semin Nucl Med 8(4):283–98

    Article  CAS  PubMed  Google Scholar 

  37. Piuzzi NS, Strnad GJ, SakrEsa WA, Barsoum WK, Bloomfield MR, Brooks PJ et al (2019) The main predictors of length of stay after total knee arthroplasty: patient-related or procedure-related risk factors. J Bone Joint Surg Am 101(12):1093–101

    Article  Google Scholar 

  38. Gazendam AM, Tushinski D, Patel M, Bali K, Petruccelli D, Winemaker M, et al (2022) Causes and predictors of failed same-day home discharge following primary hip and knee total joint arthroplasty: a Canadian perspective. Hip Int:p.11207000221111101.

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, RUSK Rehabilitation at NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17Th Street, 5Th Floor, Office 508, New York, NY, 10003, USA

    Susan Camillieri

Authors
  1. Susan Camillieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The author (Susan Camillieri) is responsible for the study conception and design, including material preparation, data collection and analysis, and manuscript preparation.

Corresponding author

Correspondence to Susan Camillieri.

Ethics declarations

Ethics approval

The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Consent to participate

Waivers of consent and authorization were obtained prior to initiation of this study.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Camillieri, S. The five times sit-to-stand test predicts same-day discharge for outpatients undergoing total joint arthroplasty. International Orthopaedics (SICOT) 48, 351–356 (2024). https://doi.org/10.1007/s00264-023-05994-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05994-5

Keywords

Search

Navigation