64 FYSIOTERAPEUTEN 5/25 KRONIKK Can physiotherapists timely detect patients at risk for delayed return to work after Total Knee Arthroplasty? Yes they can! Yvonne van Zaanen, Department of Public & Occupational Health, Amsterdam UMC, y.vanzaanen@amsterdamumc.nl. Paul Kuijer, Department of Public & Occupational Health, Amsterdam UMC. Fagkronikker vurderes redaksjonelt. Expert opinion pieces are reviewed by Fysioterapeuten. Fagkkronikken ble først publisert på www.fysioterapeuten.no. Physiotherapists play a crucial role in supporting patients’ recovery after total knee arthroplasty (TKA). One of the biggest challenges many face is regaining the ability to perform work-related activities, which are often physically demanding and require good knee function. Recent research highlights that the Work, Osteoarthritis, or Joint Replacement Questionnaire (WORQ), administered just three months after surgery, can identify patients who may experience limited work ability or a delayed return to work (RTW) (1). Detecting these patients early allows physiotherapists and healthcare teams to tailor rehabilitation programs and provide additional support, potentially improving long-term outcomes and helping patients reintegrate into their work lives more smoothly. Using the WORQ to assess work recovery The WORQ is a patient-reported outcome measure that focuses specifically on work-related knee activities (2, 3). It includes 13 common activities that place strain on the knee, such as kneeling, lifting, squatting, or working with hands below knee height. Patients rate their difficulty performing these tasks on a 5-point scale. Each activity is rated from 0, for extreme difficulty or not able to perform, to 4 which means no difficulty at all. The ratings of 13 activities add up to a score between 0 and 52, which is converted ((:52)x100) into a total score between 0 (extreme difficulty) and 100 (no difficulty at all). Based on their WORQ scores at three months post-TKA, patients fall into one of three recovery groups (illustration 1): • Early recovery (scores >70) • Intermediate recovery (scores 51-70) • Late recovery (scores <51) This grouping is not just academic—it has real-world implications. The scores predict how well patients will be able to perform knee-straining work tasks at six and twelve months after surgery and how soon they will return to work. For physiotherapists, this tool provides a timely, reliable way to identify which patients might need more intensive or specialized rehabilitation focused on workrelated goals. Work ability and return to work after TKA Patients with end-stage osteoarthritis of the knee face significant functional limitations before surgery. Everyday activities such as climbing stairs, walking on uneven surfaces, or kneeling can be painful or impossible. When these patients are of working age, which is increasingly common (4), these physical limitations naturally affect their ability to perform their job duties. Total knee arthroplasty is well known for reducing pain and improving general knee function in daily life, but its effect on specific work-related activities and return to work has been less clear (5). In our prospective cohort study including 182 Dutch working patients receiving TKA, we used the WORQ to assess patients’ self-reported difficulty with work activities before surgery and at 3, 6, and 12 months after surgery. Those who scored ≤50 at 3 months—the late recovery group—continued to experience significant limitations in work-related activities even a year after surgery (Figure 1). Many in this group showed little or no clinically important improvement from their preoperative status. By contrast, patients in the early recovery group (WORQ ≥71) showed clinical meaningful improvement by 3 months, and those in the intermediate group caught up by 12 months. These differences translated into meaningful impacts on return to work. Late recovery patients returned to work roughly three weeks later (median 84 days) than early recovery patients did (62 days) —a delay with important consequences for patients’ well-being. Illustration 1 WORQ-scores categorisation for early, intermediate and late of recovery groups.
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