Prospective Validity of a Clinical Prediction Rule for Response to Non-surgical Multidisciplinary Management of Knee Osteoarthritis in Tertiary Care: a Multisite Prospective Longitudinal Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Mar 23

PMID 38521532

Authors

Peter Window

Maree Raymer

Steven M McPhail

Bill Vicenzino

Andrew Hislop

Alex Vallini

Bula Elwell

Helen OGorman

Ben Phillips

Anneke Wake

Adrian Cush

Stuart McCaskill

Linda Garsden

Miriam Dillon

Andrew McLennan

Shaun OLeary

Affiliations

Soon will be listed here.

Abstract

Objectives: We tested a previously developed clinical prediction tool-a nomogram consisting of four patient measures (lower patient-expected benefit, lower patient-reported knee function, greater knee varus angle and severe medial knee radiological degeneration) that were related to poor response to non-surgical management of knee osteoarthritis. This study sought to prospectively evaluate the predictive validity of this nomogram to identify patients most likely to respond poorly to non-surgical management of knee osteoarthritis.

Design: Multisite prospective longitudinal study.

Setting: Advanced practice physiotherapist-led multidisciplinary service across six tertiary hospitals.

Participants: Participants with knee osteoarthritis deemed appropriate for trial of non-surgical management following an initial assessment from an advanced practice physiotherapist were eligible for inclusion.

Interventions: Baseline clinical nomogram scores were collected before a trial of individualised non-surgical management commenced.

Primary Outcome Measure: Clinical outcome (Global Rating of Change) was collected 6 months following commencement of non-surgical management and dichotomised to responder (a little better to a very great deal better) or poor responder (almost the same to a very great deal worse). Clinical nomogram accuracy was evaluated from receiver operating characteristics curve analysis and area under the curve, and sensitivity/specificity and positive/negative likelihood ratios were calculated.

Results: A total of 242 participants enrolled. Follow-up scores were obtained from 210 participants (87% response rate). The clinical nomogram demonstrated an area under the curve of 0.70 (p<0.001), with greatest combined sensitivity 0.65 and specificity 0.64. The positive likelihood ratio was 1.81 (95% CI 1.32 to 2.36) and negative likelihood ratio 0.55 (95% CI 0.41 to 0.75).

Conclusions: The knee osteoarthritis clinical nomogram prediction tool may have capacity to identify patients at risk of poor response to non-surgical management. Further work is required to determine the implications for service delivery, feasibility and impact of implementing the nomogram in clinical practice.

Citing Articles

A mixed-methods study of patient and healthcare professional perceptions of care pathways for knee osteoarthritis.

Mirt P, Erjavec K, Krsnik S, Kotnik P, Hussein M BMC Prim Care. 2024; 25(1):435.

PMID: 39709355 PMC: 11663303. DOI: 10.1186/s12875-024-02690-0.

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