Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service

• Published in: BMJ open 2020-10, Vol.10 (10), p.e037070-e037070
• Main Authors: O'Leary, Shaun, Raymer, Maree, Window, Peter, Swete Kelly, Patrick, Elwell, Bula, McLoughlin, Ian, O'Sullivan, Will, Phillips, Ben, Wake, Anneke, Ralph, Andrew, O'Gorman, Helen, Jang, Ellen, Groves, Karen, Hislop, Andrew, Lee, Darryl, Garsden, Linda, Conroy, Michael, Wickins, Daniel, Vicenzino, Bill, Comans, Tracy, Cottrell, Michelle, Khan, Asaduzzaman, McPhail, Steven
• Format: Article
• Language: English
• Subjects: Anxiety; Arthritis; Audits; Handicapped accessibility; Hospitals; Humans; Knee; Knee Joint - diagnostic imaging; Longitudinal Studies; Medical records; musculoskeletal disorders; Osteoarthritis; Osteoarthritis, Knee - therapy; Pain; Patient-centered care; Patients; Physical Therapists; Physical therapy; Prospective Studies; Quality of life; Questionnaires; Rehabilitation Medicine; Risk factors; Variables
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-037070

ObjectivesTo explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.DesignProspective multisite longitudinal study.SettingAdvanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.Participants238 patients with KOA.Primary and secondary outcome measuresStandardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores −7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI).ResultsOverall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (p