{Reference Type}: Journal Article
{Title}: 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.
{Author}: Window P;Raymer M;McPhail SM;Vicenzino B;Hislop A;Vallini A;Elwell B;O'Gorman H;Phillips B;Wake A;Cush A;McCaskill S;Garsden L;Dillon M;McLennan A;O'Leary S;
{Journal}: BMJ Open
{Volume}: 14
{Issue}: 3
{Year}: 2024 Mar 23
{Factor}: 3.006
{DOI}: 10.1136/bmjopen-2023-078531
{Abstract}: <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.