Improving Clinical Prognostic Model Methodology: Letter to the Editor

Bullock, Garrett S.; Collins, Gary S.

doi:10.1177/03635465211005721

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…This data-driven approach to prognostic factor selection is generally not recommended for constructing multivariable models, as it may result in some clinically important factors being excluded from final analyses; this means that prognostic effects may not be properly adjusted for. Instead, recent recommendations are that multivariable models should be constructed using prognostic factors identified from the literature and clinical reasoning [ 10 , 33 ]. Therefore, none of the included studies could be considered as low RoB.…”

Section: Resultsmentioning

confidence: 99%

Prognostic factors associated with changes in knee pain outcomes, identified from initial primary care consultation data. A systematic literature review

et al. 2023

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Background Data collected during initial primary care consultations could be a source of baseline prognostic factors associated with changes in outcome measures for patients with knee pain. Objectives To identify, appraise and synthesize studies investigating prognostic factors associated with changes in outcome for people presenting with knee pain in primary care. Methods EMBASE, CINAHL, AMED, MEDLINE and MedRxiv electronic databases were searched from inception to March 2021 and repeated in August 2022. Prospective cohort studies of adult participants with musculoskeletal knee pain assessing the association between putative prognostic factors and outcomes in primary care were included. The Quality in Prognostic Studies (QUIPS) tool and The Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, specific to prognostic reviews were used to appraise and synthesize the evidence respectively. Results Eight studies were included. Eight knee pain outcomes were identified. Methodological and statistical heterogeneity resulted in qualitative analysis. All evidence was judged to be of low to very low quality. Bilateral knee pain (multivariable odds ratio (OR) range 2.60–2.74; 95%CI range 0.90–8.10, p value = 0.09) and a lower educational level (multivariable (OR) range 1.74–5.6; 95%CI range 1.16–16.20, p value = <0.001) were synonymously associated with persisting knee pain at 12-month follow up. A total of 37 univariable and 63 multivariable prognostic factors were statistically associated with outcomes ( p ≤ 0.05) in single studies. Conclusions There was consensus from two independent studies that bilateral knee pain and lower educational level were associated with persistent knee pain. Many baseline factors were associated with outcome in individual studies but not consistently between studies. The current understanding, accuracy and reliability of the prognostic value of initial primary care consultation data for knee pain outcomes are limited. This review will provide an essential guide for candidate variable selection in future primary care prognostic confirmatory studies. Key messages Bilateral knee pain and lower educational level were associated with persistent knee pain. Many baseline factors were associated with outcome in individual studies but not consistently between studies. The current understanding, accuracy and reliability of the prognostic value of initial primary care consultation data for knee pain outcomes are limited.

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Section: Resultsmentioning

confidence: 99%

Prognostic factors associated with changes in knee pain outcomes, identified from initial primary care consultation data. A systematic literature review

et al. 2023

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“…A subject knowledge approach guided by literature, expert opinion and feedback from patients was chosen for the selection of the prognostic factors. [36][37][38] The candidate prognostic factors that are evaluated in each participant at each time point are displayed in table 1. The clinical assessment takes 60 min (including preparations) with a fixed order of clinical tests.…”

Section: Candidate Prognostic Factors For Ul Functionmentioning

confidence: 99%

Prognostic factors for the development of upper limb dysfunctions after breast cancer: the UPLIFT-BC prospective longitudinal cohort study protocol

De Groef,

Vets,

Devoogdt

et al. 2024

BMJ Open

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IntroductionUpper limb (UL) dysfunctions are highly prevalent in people after breast cancer and have a great impact on performing activities in daily living. To improve care, a more comprehensive understanding of the development and persistence of UL dysfunctions is needed. Therefore, the UPLIFT-BC study will primarily examine the prognostic value of different factors at the body functions and structures, environmental and personal level of the International Classification of Functioning, Disability and Health (ICF) framework at 1-month post-surgery for persisting UL dysfunctions at 6 months after finishing cancer treatment.Methods and analysisA prospective longitudinal cohort study, running from 1-week pre-surgery to 6 months post-local cancer treatment, is performed in a cohort of 250 women diagnosed with primary breast cancer. Different potentially prognostic factors to UL dysfunctions, covering body functions and structures, environmental and personal factors of the ICF, are assessed pre-surgically and at different time points post-surgery. The primary aim is to investigate the prognostic value of these factors at 1-month post-surgery for subjective UL function (ie, QuickDASH) at 6 months post-cancer treatment, that is, 6 months post-radiotherapy or post-surgery (T3), depending on the individuals’ cancer treatment trajectory. In this, factors with relevant prognostic value pre-surgery are considered as well. Similar analyses are performed with an objective measure for UL function (ie, accelerometry) and a composite score of the combination of subjective and objective UL function. Second, in the subgroup of participants who receive radiotherapy, the prognostic value of the same factors is explored at 1-month post-radiotherapy and 6 months post-surgery. A forward stepwise selection strategy is used to obtain these multivariable prognostic models.Ethics and disseminationThe study protocol was approved by the Ethics Committee of UZ/KU Leuven (reference number s66248). The results of this study will be published in peer-reviewed journals and will be presented at several research conferences.Trial registration numberNCT05297591.

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Improving Clinical Prognostic Model Methodology: Letter to the Editor

Cited by 2 publications

References 13 publications

Prognostic factors associated with changes in knee pain outcomes, identified from initial primary care consultation data. A systematic literature review

Prognostic factors associated with changes in knee pain outcomes, identified from initial primary care consultation data. A systematic literature review

Prognostic factors for the development of upper limb dysfunctions after breast cancer: the UPLIFT-BC prospective longitudinal cohort study protocol

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