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
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
Affiliations
Tracy Comans
Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
Shaun O'Leary
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
Maree Raymer
Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Peter Window
Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Patrick Swete Kelly
Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Bula Elwell
Physiotherapy Department, Ipswich Hospital, Ipswich, Queensland, Australia
Ian McLoughlin
Physiotherapy Department, Ipswich Hospital, Ipswich, Queensland, Australia
Will O'Sullivan
Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
Ben Phillips
Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
Anneke Wake
Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
Andrew Ralph
Physiotherapy Department, Mackay Hospital, Mackay, Queensland, Australia
Helen O'Gorman
Physiotherapy Department, Mater Hospital, Brisbane, Queensland, Australia
Ellen Jang
Physiotherapy Department, Mater Hospital, Brisbane, Queensland, Australia
Andrew Hislop
Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
Darryl Lee
Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Linda Garsden
Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Daniel Wickins
Physiotherapy Department, Redcliffe Hospital, Redcliffe, Queensland, Australia
Michelle Cottrell
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
Asaduzzaman Khan
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
Steven McPhail
Clinical Informatics Directorate, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
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.
