%0 Journal Article
%T 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.
%A Window P
%A Raymer M
%A McPhail SM
%A Vicenzino B
%A Hislop A
%A Vallini A
%A Elwell B
%A O'Gorman H
%A Phillips B
%A Wake A
%A Cush A
%A McCaskill S
%A Garsden L
%A Dillon M
%A McLennan A
%A O'Leary S
%J BMJ Open
%V 14
%N 3
%D 2024 Mar 23
%M 38521532
%F 3.006
%R 10.1136/bmjopen-2023-078531
%X <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>Multisite prospective longitudinal study.<BR><B>METHODS: </B>Advanced practice physiotherapist-led multidisciplinary service across six tertiary hospitals.<BR><B>METHODS: </B>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.<BR><B>METHODS: </B>Baseline clinical nomogram scores were collected before a trial of individualised non-surgical management commenced.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.