Development of a Clinical Prediction Rule to Identify Patients With Knee Pain and Clinical Evidence of Knee Osteoarthritis Who Demonstrate a Favorable Short-Term Response to Hip Mobilization

Abstract

Background and Purpose: The primary purpose of this study was to develop a clinical prediction rule (CPR) for identifying patients with knee pain and clinical evidence of knee osteoarthritis (OA) with favorable short-term response to hip mobilizations. The secondary purpose was to determine the predictive validity of individual clinical tests for identifying these same patients.Subjects and Methods: Sixty subjects with knee OA, aged 51 to 79 years, completed self-report questionnaires, a clinical examination of the hip and knee, and functional tests and were treated with 4 hip mobilizations. Follow-up testing was completed 2 days later. The reference criterion for determining a favorable response was either (1) a decrease of at least 30% on composite Numerical Pain Rating Scale score obtained during functional tests or (2) a Global Rating of Change Scale score of at least 3.Results: The CPR developed in this study comprised 5 variables: (1) hip or groin pain or paresthesia, (2) anterior thigh pain, (3) passive knee flexion less than 122 degrees, (4) passive hip medial (internal) rotation less than 17 degrees, and (5) pain with hip distraction. Based on the pretest probability of success (68%), the presence of one variable had a positive likelihood ratio of 5.1 and increased the probability of a successful response to 92% at 48-hour follow-up. If 2 variables were present, the positive likelihood ratio was 12.9 and the probability of success increased to 97%.Discussion and Conclusion: The results suggest that the CPR developed in this study could improve clinicians’ decision making and efficiency in examining and treating patients with knee OA.

Association of physical performance with muscle strength and hip range of motion in hip osteoarthritis

“…Although causality cannot be inferred from cross-sectional data, it is possible that addressing hip ROM deficits that fall below the breakpoints would improve function, which is reminiscent of the substantial functional improvements associated with hip joint mobilizations demonstrated by Hoeskma et al (18) and Currier et al (47). Interestingly, although Hoeskma et al (48) did not identify patient subgroups for whom mobilizations would be most beneficial, the clinical criteria used to diagnose hip OA in their study included less than 115°and 15°for hip flexion and internal rotation, respectively (49).…”

“…Because these values fell below our breakpoints, one would expect most, if not all, of their patients to benefit from hip joint mobilizations. Equally, Currier et al (47) found that individuals with symptomatic hip OA and hip internal rotation of less than 17°tended to respond favorably to hip mobilizations. Again, because the ROM was below our breakpoint, their results match our expectations.…”

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

“…A GROC score of z3 has previously been used as the criterion to determine a favorable response to manual physical therapy interventions. 54 A 2.0-point change in the NPRS has been reported to be clinically meaningful. 55 While there is currently no estimate of the minimal clinically meaningful difference for elbow extension ROM during the ULNT, it has been reported that differences greater than 7.5u represent true (non-error) differences.…”

Potential Pitfalls of Clinical Prediction Rules

“…Th e rules are algorithmic in nature and involve condensed information that identifi es the smallest number of indicators that are statistically diagnostic to the targeted condition 6 . Th e number of derived or validated CPRs is increasing 6 , specifi cally in rehabilitation medicine where prescriptive studies have been developed for musculoskeletal interventions for low back pain 7,8 , cervical pain 9,10 , and knee dysfunction 11,12 . Clinical prediction rules may best be classifi ed into three distinct groups: 1) diagnostic, 2) prognostic, and 3) prescriptive 1,13 .…”