ORIGINAL RESEARCH article
Front. Rehabil. Sci.
Sec. Human Functioning Science: Classification, Measurement and Epidemiology of Functioning
ICF Rehabilitation Set Responsiveness After Total Knee Arthroplasty: A Retrospective Study
Provisionally accepted
- 1Xiangya Boai Rehabilitation Hospital, Changsha, China
- 2Taihe Hospital, Hubei University of Medicine, Hubei, China
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Introduction: The International Classification of Functioning, Disability and Health – Rehabilitation Set (ICF-RS) is a standardized tool for multidimensional rehabilitation assessment, but its responsiveness in post-total knee arthroplasty (TKA) inpatient settings remains underexplored. Methods: A retrospective single-center cohort study was conducted on 47 patients who underwent primary unilateral TKA and received inpatient rehabilitation in Changsha, China (January 2023–December 2024). ICF-RS scores (30 categories) were assessed at admission and discharge. Responsiveness was evaluated using Wilcoxon signed-rank tests with Benjamini-Hochberg FDR correction. Response counts (improved/stable/worsened) were the primary outcome presentation. Results: Of 30 ICF-RS categories, 27 showed 100% data completeness; 3 social/sexual items had substantial missingness. Following rehabilitation, 23 categories demonstrated statistically significant improvement after FDR correction. Consistent directional improvement was observed in mobility (d450 Walking: 24/47 improved), self-care (d510–d540), and pain (b280: 26/47 improved) domains. The total score decreased from 47.51 ± 13.59 to 35.81 ± 11.38 (Cohen's d = 1.51). Notably, b710 (joint mobility) showed no responsiveness (0/47 improved, 1/47 worsened), despite expected clinical range-of-motion gains. Discussion: ICF-RS demonstrates responsiveness to post-TKA inpatient rehabilitation for most functional domains. The lack of change in b710 highlights a limitation of generic assessment tools for capturing localized physical impairments in single-joint conditions, suggesting the need for complementary condition-specific measures. The study context— where ICF-RS scores influence reimbursement—underscores the importance of assessment integrity considerations in function-based payment implementations.
Keywords: Disability and health, International Classification of Functioning, Measurement properties, Rehabilitation, responsiveness, Total knee arthroplasty
Received: 10 Jan 2026; Accepted: 16 Feb 2026.
Copyright: © 2026 WANG, XU, WANG, HE, CUI, ZHOU, TONG, GAO, DU and FAN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei FAN
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