Abstract
Life-space mobility describes the spatial areas through which an individual moves,
and the frequency and need for assistance. Although patients with knee osteoarthritis
(OA) have shown restricted life-space mobility, total knee arthroplasty (TKA) does
not improve it beyond preoperative levels. Life-space mobility after TKA was influenced
by self-efficacy for walking tasks; thus, an intervention to improve self-efficacy
for walking tasks may contribute to better life-space mobility. We provided a walking
event including several walking tasks as the intervention. We assessed the effect
of the walking event on life-space mobility and self-efficacy for walking tasks in
patients following TKA. In this nonrandomized controlled trial, patients who underwent
primary TKA were recruited. After recruitment, patients who could not participate
in the walking event due to scheduling conflicts were included in the control group.
The walking event consisted of 3.5 km of walking course and included walking tasks
as follows: crossing at the crosswalk, walking up- and downstairs without a railing,
walking along dirt roads, and walking up and down a slope. The primary outcome was
life-space mobility measured using Life-Space Assessment (LSA) and self-efficacy for
walking tasks measured using the modified Gait Efficacy Scale (mGES). We enrolled
104 patients, of whom 36 were assigned to the intervention group and participated
in the walking event. Participants in the intervention group had significantly better
LSA score (adjusted mean difference between groups: 13.9; 95% confidence interval:
12.4–15.5; p < 0.001) and mGES score (adjusted mean difference between groups: 13.8; 95% confidence
interval: 12.4–15.1; p < 0.001) than the control group even after adjusting for age, gender, body mass index,
elapsed time from surgery, the severity of knee OA of nonoperated limb, and patient-reported
functional outcome. The walking event including various walking tasks improved life-space
mobility and self-efficacy in patients following TKA. It is important to design a
program that can improve self-efficacy for walking tasks through mastery experiences
to improve life-space mobility after TKA.
Keywords
mobility - activity - self-efficacy - walking task - total knee arthroplasty
