Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service

Abstract

ObjectivesTo explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.DesignProspective multisite longitudinal study.SettingAdvanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.Participants238 patients with KOA.Primary and secondary outcome measuresStandardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores −7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI).ResultsOverall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (p<0.01). The odds of a poor response increased with a greater degree of varus frontal knee alignment (OR 1.35 (1.03 to 1.78) per 5° increase in varus angle) and a severe (compared with mild) radiological rating of medial compartment degenerative change (OR 3.11 (1.04 to 9.3)) (p<0.05).ConclusionsThese characteristics may need to be considered in patients presenting for non-surgical multidisciplinary management of KOA in tertiary care. Measurement of these patient characteristics may potentially better inform patient-centred management and flag the need for judicious monitoring of outcome for some patients to avoid unproductive care.

People at a persistent pain service can walk it, but some struggle to talk about it: Reliability, detectable difference and clinically important difference of the six‐minute walk test

“…Effective working memory is necessary to make decisions, reason and plan, however is decreased in people with persistent pain (Berryman et al., 2013), potentially making accurate assessment of change more challenging than in non‐pain populations. Pre‐treatment expectations impact intervention outcomes in persistent pain conditions (Eklund et al., 2019; Hill et al., 2007; Lurie et al., 2016; O'Leary et al., 2020; Turner et al., 2002). Previous studies demonstrated 80% of people prioritised pain reduction as the most important outcome following pain treatment interventions (Casarett et al., 2001).…”

Evidence for key individual characteristics associated with outcomes following combined first-line interventions for knee osteoarthritis: A systematic review

“…After duplicates were removed, 6931 records were screened, and 151 full-text articles were reviewed ( Fig 1 ). 32 studies were included in the systematic review [ 10 , 12 , 14 – 18 , 21 , 24 – 48 ].…”

“…This study evaluated the association between baseline kinematics and knee pain but did not report data for age, sex, BMI, comorbidities, depression and OA severity. Seven studies were considered multidisciplinary with tailored interventions by health professionals such as dieticians or occupational therapists [ 10 , 12 , 15 , 18 , 30 , 39 , 43 ]. Fifteen studies were described as an OAMP, including GLA:D ® [ 26 , 41 , 45 , 46 ], BOA [ 24 , 25 , 28 , 29 , 44 , 48 ], Osteoarthritis Chronic Care Program (OACCP) [ 10 , 12 , 43 ] and the Joint Clinic [ 15 , 30 ].…”

“…Most outcomes were self-reported, including VAS, NRS and WOMAC for pain, self-reported minimum physical activity level [ 29 , 44 , 46 ] and composite measures such as WOMAC-G and OKS. Three studies reported a global rating of change [ 10 , 14 , 18 ]. Two studies measured walking speed with the 40metre fast-paced walk test [ 26 , 41 ].…”

“…The patient’s global assessment of improvement in pain or function (Likert scale). The scale is dichotomised to reflect a responder or non-responder cut-off value [ 18 ].…”