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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
oleh: Tracy Comans, Shaun O'Leary, Maree Raymer, Peter Window, Patrick Swete Kelly, Bula Elwell, Ian McLoughlin, Will O'Sullivan, Ben Phillips, Anneke Wake, Andrew Ralph, Helen O'Gorman, Ellen Jang, Andrew Hislop, Darryl Lee, Linda Garsden, Daniel Wickins, Michelle Cottrell, Asaduzzaman Khan, Steven McPhail
Format: | Article |
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Diterbitkan: | BMJ Publishing Group 2020-10-01 |
Deskripsi
Objectives To 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.Design Prospective multisite longitudinal study.Setting Advanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.Participants 238 patients with KOA.Primary and secondary outcome measures Standardised 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).Results Overall, 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).Conclusions These 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.