Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis

Décary, Simon; Feldman, Debbie Ehrmann; Frémont, Pierre; Pelletier, Jean‐Pierre; Martel‐Pelletier, Johanne; Fallaha, Michel; Pelletier, B.; Belzile, Sylvain; Sylvestre, Marie‐Pierre; Vendittoli, Pascal‐André; Desmeules, François

doi:10.1002/msc.1245

Cited by 2 publications

(3 citation statements)

References 42 publications

(66 reference statements)

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“…Therefore, for clinically “certain” knees, diagnostic abilities based on clinical data only should be considered as good enough, in contrast to clinically “uncertain” knees. Our results support expert recommendations and the results of previous studies [ 3 , 4 , 6 , 7 , 8 ], where diagnoses based on clinical findings were found to be reliable and where radiographs were deemed unnecessary for diagnosing typical KOA.…”

Section: Discussionsupporting

confidence: 90%

“…The European League Against Rheumatism Recommendations (EULAR) reported that three symptoms (knee pain, morning stiffness less than 30 min and functional limitation) combined with three clinical signs (crepitus, restricted range of motion and bone enlargement) could predict 99% radiographic KOA [ 3 ]. Similarly, recent studies showed that clinical manifestations, such as knee pain, crepitus, joint line tenderness, bony swelling and pain on flexion/extension could be used for identifying radiographic KOA [ 4 , 5 , 6 ]. Current recommendations advise not to use imaging in patients with typical OA presentations, but these were mainly based on expert opinion [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

Wang

Runhaar

Kloppenburg

et al. 2020

JCM

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Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was “certainly no OA” and 100 was “certainly OA”). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically “certain” and “uncertain” knees, respectively. Student paired t-tests compared certainty scores. Results: Most diagnoses of GPs (86%) and SPs (82%) were “consistent” after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically “uncertain” knees. Radiographs added some certainty to “consistent” OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04). Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

Wang

Runhaar

Kloppenburg

et al. 2020

JCM

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“…Having a diagnostic of knee OA was associated with a decreased probability of diagnostic discordance as well in our study. Knee OA may be easier to diagnose since older age of the patient is a good indicator of OA [ 26 ]. Having MRI results, which was associated with a higher probability of diagnostic discordance in both analyses, could be related to more complex traumatic injuries and reveal concomitant lesions, although this was not shown in our results.…”

Section: Discussionmentioning

confidence: 99%

Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study

Lowry

Bass

Vukobrat

et al. 2021

BMC Musculoskelet Disord

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Background Knee disorders are highly prevalent and may be a disabling condition. An accurate diagnosis is necessary to guide toward a rapid and efficient management of knee disorders. However, the ability to make a valid diagnosis is often complex for clinicians and evidence is mainly focused on clinician cognitive biases or errors produced during clinical reasoning. The aim of this secondary exploratory analysis is to identify patient-specific characteristics associated with diagnostic discordance between health care providers in making a diagnosis for a new knee disorder. Methods We performed a secondary analysis of a diagnostic study comparing the diagnostic ability of a physiotherapist to medical musculoskeletal specialists. Patients’ socio-demographic, psychosocial and clinical characteristics were compared between the concordant and discordant diagnostic groups. Psychosocial symptoms were evaluated using the validated Kessler 6 (K6) questionnaire. We performed multivariable logistic regressions using the Bayesian Information Criterion to identify the most probable model including patients’ characteristics associated with diagnostic discordance. Overall probability of identified variables to explain diagnostic discordance and associated odd ratios (OR) with 95% credibility intervals (95% CrI) were calculated. Results Overall, 279 participants were evaluated by a physiotherapist and medical musculoskeletal specialists. The mean age of the participants was 49.1 ± 15.8 years and 57.7% were female. The most common disorder was osteoarthritis (n = 117, 18.8% of cases were discordant). The most probable model explaining diagnostic discordance (11.13%) included having depressive symptoms, which was associated with an increased probability of diagnostic discordance (OR: 3.9; 95% CrI: 1.9 – 8.0) and having a higher number of comorbidities, which was associated with a decreased probability of diagnostic discordance (OR: 0.6; 95% CrI: 0.5 – 0.9). The depression item of the K6 questionnaire had a 99.4% chance to be included in a model explaining diagnostic discordance. Other variables taken separately had less than 50% chance to be included in a model explaining diagnostic discordance and cannot be considered significant. Conclusion Our results suggest that depressive symptoms may increase the risk of knee diagnostic discordance. Clinicians may be more likely to make diagnostic errors and should be more cautious when evaluating patients with knee disorders suffering from psychological distress.

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Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis

Cited by 2 publications

References 42 publications

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study

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