Outpatient Evaluation of Knee Pain

Farha, Natalie; Spencer, Abby L.; McGervey, Megan

doi:10.1016/j.mcna.2020.08.017

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Various self-management strategies are being recommended for knee OA, and ESCEO and OARSI guidelines have advocated that structured exercise and weight loss should be core interventions in the treatment of OA along with pharmacological treatments [14][15][16][17]. Recent reviews recommend controlling obesity as an important aspect in the minimization of arthritic pain syndromes [18] and advocate the use of physical therapy [19] and obesity counselling to improve patient outcomes [20]. Furthermore, complementary and alternative medicine (CAM), such as nutritional supplements, herbal medicine, and acupuncture, are more or less accepted by authorities and have, for decades, been used consistently by patients for different health purposes including chronic joint pain [21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Estimating the Prevalence of Knee Pain and the Association between Illness Perception Profiles and Self-Management Strategies in the Frederiksberg Cohort of Elderly Individuals with Knee Pain: A Cross-Sectional Study

Ginnerup-Nielsen

Christensen

Heitmann

et al. 2021

JCM

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Knee pain is an early sign of later incident radiographic knee osteoarthritis (OA). However, the prevalence of knee pain in the general population is unknown. Additionally, it is unknown how people with knee pain choose to self-manage the condition and if the perception of the illness affects these choices. In this study, 9086 citizens between 60–69 years old in the municipality of Frederiksberg, Copenhagen, Denmark, were surveyed, of which 4292 responded. The prevalence of knee pain was estimated, and associations between illness perceptions (brief illness perception questionnaire [B-IPQ]), self-management strategies, and knee symptoms were assessed. The prevalence of knee pain was 21.4% of which 40.5% reported to use no self-management strategies (non-users). These non-users perceived their knee pain as less threatening and reported less severe symptoms than users of self-management strategies. Further, we found that a more positive illness perception was associated with less severe knee symptoms. In conclusion, among Danes aged 60–69 years, the knee pain prevalence is 21.4%, of which 40.5% use no treatment and perceive the condition as non-threatening. These non-users with knee pain represent a subpopulation being at increased risk of developing knee OA later in life, and there is a potential preventive gain in identifying these persons.

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Section: Introductionmentioning

confidence: 99%

Estimating the Prevalence of Knee Pain and the Association between Illness Perception Profiles and Self-Management Strategies in the Frederiksberg Cohort of Elderly Individuals with Knee Pain: A Cross-Sectional Study

Ginnerup-Nielsen

Christensen

Heitmann

et al. 2021

JCM

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“…32 The Downs and Black (D&B) Checklist for randomized studies examining health care interventions was also utilized to evaluate included RCTs. 33 The 27 item D&B Checklist was scored out of 32 total points where ranges of corresponding scores were given: excellent (26)(27)(28)(29)(30)(31)(32); good (20-25); fair (15)(16)(17)(18)(19); and poor (≤ 14). 34 Any identified case series was assessed with the Joanna Briggs Institute (JBI) checklist for case series.…”

Section: Data Collectedmentioning

confidence: 99%

“…16,17 When patient history, physical examination, current pain, and dysfunction or mechanical symp-toms indicate meniscal injury, non-operative or conservative treatment is recommended. 2,18 Thus, there is a need to consider other treatment options for patients who present with the signs and symptoms of a meniscal pathology due to the prevalence of meniscal injuries, potential undesired surgical outcomes (e.g., adverse long-term outcomes), and recommendations for conservative care. 2,12,19,20 The Mulligan Concept (MC), introduced by Brian Mulligan, is an innovative conservative treatment approach used to address common issues (e.g., joint pain, decreased ROM, movement dysfunction, etc.)…”

Section: A Introductionmentioning

confidence: 99%

The Efficacy of the Mulligan Concept to Treat Meniscal Pathology: A Systematic Review

Reep

Leverett

Heywood

et al. 2022

International Journal of Sports Physical Therapy

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Background Meniscal pathologies are common knee injuries and arthroscopic surgery is the current accepted gold standard for treatment. However, there is evidence to support the use of the Mulligan Concept (MC) Mobilization with Movement (MWM) for meniscal pathologies including the ‘Squeeze’ technique, tibial internal rotation (IR), and tibial external rotation (ER). Hypothesis/Purpose The purpose of this systematic review was to critically appraise the literature to investigate the effectiveness of MC MWMs for meniscal lesions on patient reported pain, function, and multi-dimensional health status in patients with clinically diagnosed meniscal pathologies. Study Design Systematic Review Methods A literature search was completed across multiple databases using combinations of the words “knee, function, mobilization with movement, MWM, mulligan concept, MC, meniscal pathology, meniscal derangement, and meniscal tear.” Studies written within the prior 10 years that examined MC MWM techniques to treat knee meniscal injury were included. Articles that met the inclusion criteria (used MC MWM ‘Squeeze’ technique, tibial IR, or tibial ER for treatment of clinically diagnosed meniscal pathologies; Patient reported outcome [PRO] measures had to be used in the assessment of knee pain or function) were analyzed for quality. Randomized control trials were analyzed using the PEDro scale and the Downs & Black (D&B) checklist, case series were analyzed using the Joanna Briggs Institute (JBI) checklist, and case reports were analyzed using the CARES checklist. Results Six articles met the inclusion criteria and were included in this review, two randomized controlled studies, two case series, and two case reports consisting of 72 subjects. All six papers included reports of improvements in pain and function that were either statistically significant or met the minimal clinically important difference (MCID). Five studies reported the Disablement in the Physically Active (DPA) scale that also demonstrated statistically significant differences or met the MCID. The MC MWM ‘Squeeze’ technique, tibial IR, or tibial ER demonstrated the ability to reduce pain, improve function, and improve patient perceived disability following treatment of a clinically diagnosed meniscal pathology. These studies demonstrated short term results lasting from one week to 21 weeks. Conclusion Treatment interventions incorporating MC MWM techniques demonstrated reduction of pain and improvement in function in the short term in patients with clinically diagnosed meniscal pathologies. Level of Evidence 2a

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“…Knee pain affects approximately one quarter of the general population and is a common presenting complaint to primary and secondary care physicians. 1 , 2 Unsurprisingly this constitutes a significant socioeconomic burden to the healthcare system, with the management of knee osteoarthritis (KOA) alone costing billions of pounds globally each year. This figure is predicted to grow due to an ageing and increasingly overweight population.…”

Section: Introductionmentioning

confidence: 99%

An automated, web-based triage tool may optimise referral pathways in elective orthopaedic surgery: A proof-of-concept study

et al. 2023

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Introduction Knee pain is caused by various pathologies, making evaluation in primary-care challenging. Subsequently, an over-reliance on imaging, such as radiographs and MRI exists. Electronic-triage tools represent an innovative solution to this problem. The aims of this study were to establish the magnitude of unnecessary knee imaging prior to orthopaedic surgeon referral, and ascertain whether an e-triage tool outperforms existing clinical pathways to recommend correct imaging. Methods Patients ≥18 years presenting with knee pain treated with arthroscopy or arthroplasty at a single academic hospital between 2015 and 2020 were retrospectively identified. The timing and appropriateness of imaging were assessed according to national guidelines, and classified as ‘necessary’, ‘unnecessary’ or ‘required MRI’. Based on an eDelphi consensus study, a symptom-based e-triage tool was developed and piloted to preliminarily diagnose five common knee pathologies and suggest appropriate imaging. Results 1462 patients were identified. 17.2% ( n = 132) of arthroplasty patients received an ‘unnecessary MRI’, 27.6% ( n = 192) of arthroscopy patients did not have a ‘necessary MRI’, requiring follow-up. Forty-one patients trialled the e-triage pilot (mean age: 58.4 years, 58.5% female). Preliminary diagnoses were available for 33 patients. The e-triage tool correctly identified three of the four knee pathologies (one pathology did not present). 79.2% ( n = 19) of participants would use the tool again. Conclusion A substantial number of knee pain patients receive incorrect imaging, incurring delays and unnecessary costs. A symptom-based e-triage tool was developed, with promising performance and user feedback. With refinement using larger datasets, this tool has the potential to improve wait-times, referral quality and reduce cost.

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Outpatient Evaluation of Knee Pain

Cited by 4 publications

References 22 publications

Estimating the Prevalence of Knee Pain and the Association between Illness Perception Profiles and Self-Management Strategies in the Frederiksberg Cohort of Elderly Individuals with Knee Pain: A Cross-Sectional Study

Estimating the Prevalence of Knee Pain and the Association between Illness Perception Profiles and Self-Management Strategies in the Frederiksberg Cohort of Elderly Individuals with Knee Pain: A Cross-Sectional Study

The Efficacy of the Mulligan Concept to Treat Meniscal Pathology: A Systematic Review

An automated, web-based triage tool may optimise referral pathways in elective orthopaedic surgery: A proof-of-concept study

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