1. In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery
- Author
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Noorduyn, J.C.A., Teuwen, M.M.H., Graaf, V.A. van de, Willigenburg, N.W., Schavemaker, M., Dijk, R. van, Scholten-Peeters, G.G.M., Heymans, M.W., Coppieters, M.W., Poolman, R.W., Scholtes, V.A.B., Mutsaerts, E.L.A.R., Wolkenfelt, J., Krijnen, M.R., Deurzen, D.F.P. van, Moojen, D.J.F., Bloembergen, C.H., Gast, A.G. de, Snijders, T., Halma, J.J., Saris, D.B.F., Wolterbeek, N., Neeter, C., Kerkhoffs, D.M.M.J., Peters, R.W., Brand, I.C.J.B. van den, Vos-Jakobs, S. de, Spoor, A.B., Gosens, T., Rezaie, W., Hofstee, D.J., Burger, B.J., Haverkamp, D., Vervest, A.M.J.S., Rheenen, T.A. van, Wijsbek, A.E., Arkel, E.R.A. van, Thomassen, B.J.W., Sprague, S., Mol, B.W.J., Tulder, M.W. van, Kraan, J. van der, Escape Res Grp, Surgery, Amsterdam Movement Sciences, Epidemiology and Data Science, APH - Methodology, APH - Personalized Medicine, Neuromechanics, AMS - Musculoskeletal Health, AMS - Rehabilitation & Development, Faculty of Behavioural and Movement Sciences, and APH - Societal Participation & Health
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medicine.medical_specialty ,Knee Joint ,Meniscal tears ,Knee Injuries ,Meniscus (anatomy) ,Logistic regression ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,Knee ,Meniscus ,Orthopedics and Sports Medicine ,In patient ,030212 general & internal medicine ,Physical Therapy Modalities ,Prognostic models ,Aged ,business.industry ,030229 sport sciences ,Middle Aged ,Prognosis ,Explained variation ,Tibial Meniscus Injuries ,Surgery ,medicine.anatomical_structure ,Orthopedic surgery ,Physical therapy ,Prognostic model ,business - Abstract
Purpose Although physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscal tear, 24% still opt for meniscal surgery. The aim was to identify those patients with a degenerative meniscal tear who will undergo surgery following physical therapy. Methods The data for this study were generated in the physical therapy arm of the ESCAPE trial, a randomized clinical trial investigating the effectiveness of surgery versus physical therapy in patients of 45–70 years old, with a degenerative meniscal tear. At 6 and 24 months patients were divided into two groups: those who did not undergo surgery, and those who did undergo surgery. Two multivariable prognostic models were developed using candidate predictors that were selected from the list of the patients’ baseline variables. A multivariable logistic regression analysis was performed with backward Wald selection and a cut-off of p Results At 6 months, 32/153 patients (20.9%) underwent meniscal surgery following physical therapy. Based on the multivariable regression analysis, patients were more likely to opt for meniscal surgery within 6 months when they had worse knee function, lower education level and a better general physical health status at baseline. At 24 months, 43/153 patients (28.1%) underwent meniscal surgery following physical therapy. Patients were more likely to opt for meniscal surgery within 24 months when they had worse knee function and a lower level of education at baseline at baseline. Both models had a low explained variance (16 and 11%, respectively) and an insufficient predictive accuracy. Conclusion Not all patients with degenerative meniscal tears experience beneficial results following physical therapy. The non-responders to physical therapy could not accurately be predicted by our prognostic models. Level of evidence III.
- Published
- 2021