Factors influencing rehabilitation training compliance and prediction model construction in elderly patients with knee osteoarthritis

Zhang Qiaohong; Xu Qian; Li Jing; Xu Liping; Zang Lei; Hong Gang; Zhang Le; Qian Yanan

doi:10.11986/j.issn.1673-873X.2025.09.15

Abstract：Objective To explore the factors influencing rehabilitation training compliance in elderly patients with knee osteo-arthritis(KOA)and construct a prediction model.Methods A total of 237 elderly KOA patients who underwent arthro-scopic surgery at the Department of Orthopedics,Beijing Chao-Yang Hospital,Capital Medical University,from February 2023 to February 2025 were selected for the study.Based on rehabilitation training compliance 3 months after surgery,the patients were assigned to a low compliance group(n=96)and a high compliance group(n=141).General data and scores from the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Tampa Scale of Kinesiophobia-17(TSK-17),and the Family Adaptation,Partnership,Growth,Affection,and Resolve Index Scale(APGAR)were com-pared between the two groups.Multivariate logistic regression analysis was used to identify independent factors associated with low rehabilitation training compliance in elderly KOA patients,and a nomogram was drawn to construct a prediction model for low rehabilitation training compliance in elderly KOA patients.Results There were statistically significant differ-ences between the two groups in living arrangements,monthly household income per capita,type of medical insurance,Kellgren-Lawrence grading,disease location,WOMAC score,flexion angle,extension limitation angle,TSK-17 score,and APGAR score(P＜0.05).Multivariate logistic regression analysis showed that living alone(OR:67.318,95％CI:1.859-2 437.699),self-paid medical expenses(OR:34.541,95％CI:1.295-921.494),high WOMAC score(OR:1.768,95％CI:1.388-2.252),large extension limitation angle(OR:2.311,95％CI:1.247-4.283),and high TSK-17 score(OR:1.204,95％CI:1.067-1.360)were independent risk factors for low rehabilitation training compliance in elderly KOA patients(P＜0.05).A nomogram prediction model was constructed based on seven independent factors and validated.The area under the receiver operating characteristic curve(AUC)of the model was 0.952(95％CI:0.916-0.975),with a sensitivity of 93.75％and specificity of 82.98％,indicating good discriminatory ability.The calibration curve showed good calibration of the prediction model.The decision curve analysis(DCA)suggested that the prediction model has high clinical application value.Conclusion Living arrangement,type of medical insurance,WOMAC score,flexion angle,extension limitation an-gle,TSK-17 score,and APGAR score are relevant risk factors influencing rehabilitation training compliance in elderly KOA patients.The risk prediction model developed in this study can accurately identify the risk of low rehabilitation training com-pliance in elderly KOA patients and has clinical application value.