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

• Published in: BMJ open 2024-03, Vol.14 (3), p.e078531-e078531
• Main Authors: Window, Peter, Raymer, Maree, McPhail, Steven M, Vicenzino, Bill, Hislop, Andrew, Vallini, Alex, Elwell, Bula, O'Gorman, Helen, Phillips, Ben, Wake, Anneke, Cush, Adrian, McCaskill, Stuart, Garsden, Linda, Dillon, Miriam, McLennan, Andrew, O'Leary, Shaun
• Format: Article
• Language: English
• Subjects: Accuracy; Activities of daily living; Arthritis; Bone diseases; Chronic Pain; Clinical Decision Rules; Decision making; Humans; Knee; Longitudinal Studies; Nomograms; Observational Study; Orthopedics; Osteoarthritis; Osteoarthritis, Knee - surgery; Patients; Prospective Studies; Questionnaires; Rehabilitation Medicine; Tertiary Healthcare; Variables
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-078531

ObjectivesWe 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.DesignMultisite prospective longitudinal study.SettingAdvanced practice physiotherapist-led multidisciplinary service across six tertiary hospitals.ParticipantsParticipants with knee osteoarthritis deemed appropriate for trial of non-surgical management following an initial assessment from an advanced practice physiotherapist were eligible for inclusion.InterventionsBaseline clinical nomogram scores were collected before a trial of individualised non-surgical management commenced.Primary outcome measureClinical 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.ResultsA 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