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Ahmed I, Moiz H, Carlos W, Edwin C, Staniszewska S, Parsons N, Price A, Hutchinson C, Metcalfe A. The use of magnetic resonance imaging (MRI) of the knee in current clinical practice: A retrospective evaluation of the MRI reports within a large NHS trust. Knee 2021; 29:557-563. [PMID: 33774589 DOI: 10.1016/j.knee.2021.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is one of the most widely used investigations for knee pain as it provides detailed assessment of the bone and soft tissues. The aim of this study is to report the frequency of each diagnosis identified on MRI scans of the knee and explore the relationship between MRI results and onward treatment. METHODS Consecutive MRI reports from a large NHS trust performed in 2017 were included in this study. The hospital electronic system was consulted to identify whether a patient underwent x-ray prior to the MRI, attended an outpatient appointment or underwent surgery. RESULTS 4466 MRI knees were performed in 2017 with 71.2% requested in primary care and 28.1% requested in secondary care. The most common diagnosis was signs of arthritis (55.2%), followed by meniscal tears (42.8%) and ACL tears (8.3%). 49.4% of patients who had an MRI attended outpatients and 15.6% underwent surgery. The rate of knee surgery was significantly higher for patients who had their scans requested in secondary care (32.9% vs 8.9%, p < 0.001). CONCLUSION The rate of surgical intervention following MRI is low and given these results it seems unlikely that the scan changes practice in most cases. The rate of surgery and outpatient follow up was significantly higher in scans requested by secondary care. We urge clinicians avoid wasteful use of MRI and recommend the use of plain radiography prior to MRI where arthritis may be present.
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Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Haseeb Moiz
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - William Carlos
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Claire Edwin
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Sophie Staniszewska
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Nick Parsons
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Andrew Price
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Charles Hutchinson
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
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Koëter S, Van Tienen TG, Rijk PC, Vincken PWJ, Segers MJM, Van Essen B, Van Melick N, Stegeman BH, Van Arkel ERA. Dutch Guideline on Knee Arthroscopy Part 2: non-meniscus intra-articular knee injury: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop 2021; 92:81-84. [PMID: 33228429 PMCID: PMC7924887 DOI: 10.1080/17453674.2020.1850081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - A guideline committee of medical specialists and a physiotherapist was formed on the initiative of the Dutch Orthopedic Association (NOV) to update the Guideline Arthroscopy of the Knee: Indications and Treatment 2010. This next Guideline was developed between June 2017 and December 2019. In part 1 we focused on the meniscus; this part 2 addresses all other aspects of knee arthroscopy.Methods - The guideline was developed in accordance with the criteria of the AGREE instrument (AGREE II: Appraisal of Guidelines for Research and Evaluation II) with support of a professional methodologist from the Dutch Knowledge Institute of Medical Specialists. The scientific literature was searched and systematically analyzed. Conclusions and recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Recommendations were developed considering the balance of benefits and harms, the type and quality of evidence, the values and preferences of the people involved, and the costs.
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Affiliation(s)
- Sander Koëter
- Department of Orthopedic Surgery Canisius Wilhelmina Ziekenhuis, Nijmegen;
| | | | - Paul C Rijk
- Department of Orthopedic Surgery Medisch Centrum Leeuwarden, Leeuwarden;
| | | | | | - Bert Van Essen
- Department of Sports Medicine Maxima Medisch Centrum, Veldhoven;
| | | | | | - Ewoud R A Van Arkel
- FocusKliniek Orthopedie Haaglanden Medisch Centrum, Den Haag, The Netherlands
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Swart NM, van Oudenaarde K, Bierma-Zeinstra SMA, Bloem JL, Bindels PJE, Algra PR, Reijnierse M, Luijsterburg PAJ. Predicting no return to sports after three months in patients with traumatic knee complaints in general practice by combining patient characteristics, trauma characteristics and knee complaints. Eur J Gen Pract 2019; 25:205-213. [PMID: 31431084 PMCID: PMC6853237 DOI: 10.1080/13814788.2019.1646241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: It remains unclear to what extent patients with traumatic knee complaints aged 18–45 years seen in general practice experience difficulties with return to sports. Objectives: This study aims to determine the proportion of patients with a knee trauma that return to sports at six weeks and three months follow-up. Also examined were associations between no return to sports and baseline patient/trauma characteristics, knee complaints and MR (magnetic resonance) findings, as well as the additive value of MR findings. Methods: Included were patients with traumatic knee complaints participating in a randomized controlled trial assessing the cost-effectiveness of an MR scan in general practice. Patients were classified as ‘no return to sports’ or ‘return to sports’ (sports on pre-injury or adapted level). Potential baseline predictors for no return to sports were assessed using logistic regression analyses. The area under the curves (AUC) was compared. Results: At six weeks and three months follow-up, 147 (59%) and 175 (74%) patients, respectively, reported return to sports. Combining patient characteristics, trauma characteristics and knee complaints predicted no return to sports with an AUC of 0.86 (95%CI: 0.81–0.90) at six weeks and of 0.82 (95%CI: 0.76–0.88) at three months follow-up. After adding MR findings, the AUC was 0.79 (95%CI: 0.71–0.87) at six weeks and 0.79 (95%CI: 0.70–0.88) at three months follow-up. Conclusion: Three out of four patients with a knee trauma in general practice reported return to sports at three months follow-up. A combination of patient/trauma characteristics and knee complaints predicted no return to sports, whereas MR findings had no additive value. Trial registration: Dutch trial registration: registration number: NTR3689. registration date: 7 November 2012.
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Affiliation(s)
- Nynke M Swart
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kim van Oudenaarde
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul R Algra
- Department of Radiology, Northwest Clinics, location Alkmaar, Alkmaar, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pim A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Post-traumatic knee MRI findings and associations with patient, trauma, and clinical characteristics: a subgroup analysis in primary care in the Netherlands. Br J Gen Pract 2018; 67:e851-e858. [PMID: 29158244 DOI: 10.3399/bjgp17x693653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/06/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The added value of magnetic resonance imaging (MRI) in primary care is still being debated. A high diagnostic yield can be expected in young and active patients with post-traumatic knee complaints. AIM To determine the frequency of MRI abnormalities in young and active patients (aged 18-45 years) and the associations with patient, trauma, and clinical characteristics. DESIGN AND SETTING A subgroup analysis of 174 patients, aged 18-45 years with knee trauma of <6 months, allocated to MRI in a randomised controlled trial on the yield of MRI in primary care. Patients were recruited by 150 GPs in the Netherlands from October 2012 to November 2015. METHOD Associations were expressed using mean differences, odds ratio (OR) and predictive values. RESULTS Sixty-seven out of 174 patients (39%) had a positive MRI finding, predominantly anterior cruciate ligament (ACL) ruptures (22%) and/or traumatic meniscal tears (15%). Patients with a pre-existing musculoskeletal comorbidity had a two-fold lower prevalence of positive MRI findings (21%), OR 3.0 (95% confidence interval [CI] = 1.3 to 7.0). A 'sports related trauma' showed the highest OR of 4.6 (95% CI = 2.2 to 9.3) for a positive MRI finding. Clinical scores were statistically, significantly worse in patients with positive MRI findings, with mean differences ranging from 10 to 20%. Furthermore, increasing duration of complaints was correlated with decreasing prevalence rates of positive MRI findings. Overall, a popping sound and direct swelling showed the highest positive predictive value of 65% for the presence of positive MRI findings. CONCLUSION The results from this study enable a preselection of patients to increase the diagnostic yield of MRI in primary care.
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Kastelein M, Luijsterburg PAJ, Koster IM, Verhaar JAN, Koes BW, Vroegindeweij D, Bierma-Zeinstra SMA, Oei EHG. Knee osteoarthritis in traumatic knee symptoms in general practice: 6-year cohort study. BMJ Open Sport Exerc Med 2016; 2:e000153. [PMID: 27900195 PMCID: PMC5125421 DOI: 10.1136/bmjsem-2016-000153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/16/2022] Open
Abstract
Aim To identify degenerative knee abnormalities using MRI and radiography 6 years after knee trauma, their relation with persistent knee symptoms and baseline prognostic factors. Methods Adults (18–65 years) with incident traumatic knee symptoms visiting their general practitioner were followed up for 6 years and underwent baseline MRI and 6-year follow-up MRI and radiography. Logistic regression was used to analyse associations between various degenerative abnormalities on 6-year MRI and radiography, persistent knee symptoms and baseline prognostic factors for knee osteoarthritis (OA) on 6-year MRI. Results On 6-year radiography, 60% of patients showed no OA, 28% showed OA with Kellgren&Lawrence (K&L) grade 1 and 13% showed with K&L grade 2. On 6-year MRI, 55% of patients showed cartilage defect(s), 45% showed osteophyte(s), 36% showed subchondral cyst(s), 40% showed bone marrow oedema, 21% showed meniscal subluxation, 83% showed meniscal degeneration,11% showed effusion and 11% showed a Baker's cyst. Of these, most were significantly related with 6-year radiographic K&L grade, while only lateral cartilage defect(s), medial osteophyte(s) and medial meniscal subluxation were significantly related with persistent knee symptoms. 32% of patients showed new onset or progressive knee OA on 6-year MRI, for which age, history of non-traumatic knee symptoms and bone marrow oedema at baseline were independent prognostic factors. Conclusions Degenerative knee abnormalities on MRI are related to the K&L score; however, not all abnormalities are reflected in clinical outcome. Age, history of non-traumatic knee symptoms and bone marrow oedema predict knee OA 6 years after knee trauma, present in 32% of the patients.
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Affiliation(s)
- Marlous Kastelein
- Department of General Practice , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Pim A J Luijsterburg
- Department of General Practice , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Ingrid M Koster
- Department of Radiology , Albert Schweitzer Hospital , Dordrecht , The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedics , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Bart W Koes
- Department of General Practice , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | | | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
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Kastelein M, Luijsterburg PAJ, Verhaar JAN, Koes BW, Bierma-Zeinstra SMA. Six-year course and prognosis of traumatic knee symptoms in general practice: Cohort study. Eur J Gen Pract 2015; 22:23-30. [PMID: 26653667 DOI: 10.3109/13814788.2015.1109075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Traumatic knee symptoms are frequently seen, however, evidence about the course and prognostic factors are scarce. OBJECTIVES To describe the one and six-year course of traumatic knee symptoms presenting in general practice, and to identify prognostic factors for persistent knee symptoms. METHODS Adolescents (≥12 years) and adults with traumatic knee symptoms (n = 328) from general practice were followed for six years with self-report questionnaires and physical examination. RESULTS Persistent knee symptoms were reported by 27% of the patients at one year and by 33% at six years. There was a strong relationship (OR: 11.0, 95% CI: 5.0-24.2) between having persistent knee symptoms at one year and at six-year follow-up. Prognostic factors associated with persistent knee symptoms at one year were age, poor general health, history of non-traumatic knee symptoms, absence floating patella and laxity on the anterior drawer test (AUC: 0.72). At six-year follow-up, age, body mass index > 27, non-skeletal co-morbidity, self-reported crepitus of the knee, history of non-traumatic knee symptoms, and laxity on the anterior drawer test were associated with persistent knee symptoms (AUC: 0.82). CONCLUSION Traumatic knee symptoms in general practice seem to become a chronic disorder in one out of three patients. Several prognostic factors assessed at baseline were associated with persistent knee symptoms at one and six-year follow-up.
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Affiliation(s)
- Marlous Kastelein
- a Department of General Practice , Erasmus MC, University Medical Center Rotterdam , The Netherlands
| | - Pim A J Luijsterburg
- a Department of General Practice , Erasmus MC, University Medical Center Rotterdam , The Netherlands
| | - Jan A N Verhaar
- b Department of Orthopaedics , Erasmus MC, University Medical Center Rotterdam , The Netherlands
| | - Bart W Koes
- a Department of General Practice , Erasmus MC, University Medical Center Rotterdam , The Netherlands
| | - Sita M A Bierma-Zeinstra
- a Department of General Practice , Erasmus MC, University Medical Center Rotterdam , The Netherlands ;,b Department of Orthopaedics , Erasmus MC, University Medical Center Rotterdam , The Netherlands
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Rathleff CR, Cavallius C, Jensen HP, Simonsen OH, Rasmussen S, Kaalund S, Østgaard SE. Successful conservative treatment of patients with MRI-verified meniscal lesions. Knee Surg Sports Traumatol Arthrosc 2015; 23:178-83. [PMID: 23575649 DOI: 10.1007/s00167-013-2494-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 04/03/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE To follow a prospective cohort of consecutive patients with MRI-verified meniscal lesions to identify pre-treatment prognostic factors for long-term results following arthroscopic or conservative treatment. METHODS In the course of 1 year, 291 patients with knee pain and clinically suspected of meniscal lesion were referred to the regional orthopaedic division and subjected to MRI and clinical examination by an experienced surgeon. Patients with MRI-verified meniscal lesions were treated according to an arthroscopy restrictive strategy meaning that treatment was initiated by conservative treatment. Arthroscopy was only performed if satisfying pain relief was not obtained. The Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained at baseline and after 12-24 months. A multiple linear regression model was used to investigate which pre-treatment prognostic factors were associated with improvement in the KOOS subscale pain from baseline to follow-up. RESULTS An MRI-verified meniscal lesion was found in 185 patients (64%). Among these, 58% were treated successfully by conservative treatment. A high KOOS subscale pain score at baseline was associated with less improvement from baseline to follow-up. Bucket-handle lesions were associated with larger improvement from baseline to follow-up compared to flap-tear lesions. CONCLUSION MRI findings and clinical status measured by KOOS subscale pain are prognostic for improvement among patients treated for MRI-verified meniscal lesions. Good results were observed for both operative and conservative treatment. The success rate for conservative treatment was 58%. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Camilla Rams Rathleff
- Orthopaedic Surgery Research Unit, Research and Innovation Center, Aalborg University Hospital, 15 Soendre Skovvej, 9000, Aalborg, Denmark ,
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Swart NM, van Oudenaarde KK, Algra PR, Bindels PJE, van den Hout WB, Koes BW, Nelissen RGHH, Verhaar JAN, Bloem HJL, Bierma-Zeinstra SMA, Reijnierse MM, Luijsterburg PAJ. Efficacy of MRI in primary care for patients with knee complaints due to trauma: protocol of a randomised controlled non-inferiority trial (TACKLE trial). BMC Musculoskelet Disord 2014; 15:63. [PMID: 24588860 PMCID: PMC3973891 DOI: 10.1186/1471-2474-15-63] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/27/2014] [Indexed: 11/12/2022] Open
Abstract
Background Patients with traumatic knee complaints regularly consult their general practitioner (GP). MRI might be a valuable diagnostic tool to assist GPs in making appropriate treatment decisions and reducing costs. Therefore, this study will assess the cost-effectiveness of referral to MRI by GPs compared with usual care, in patients with persistent traumatic knee complaints. Design and methods This is a multi-centre, open-labelled randomised controlled non-inferiority trial in combination with a concurrent observational cohort study. Eligible patients (aged 18–45 years) have knee complaints due to trauma (or sudden onset) occurring in the preceding 6 months and consulting their GP. Participants are randomised to: 1) an MRI group, i.e. GP referral to MRI, or 2) a usual care group, i.e. no MRI. Primary outcomes are knee-related daily function, medical costs (healthcare use and productivity loss), and quality of life. Secondary outcomes are disability due to knee complaints, severity of knee pain, and patients’ perceived recovery and satisfaction. Outcomes are measured at baseline and at 1.5, 3, 6, 9 and 12 months follow-up. Also collected are data on patient demographics, GPs’ initial working diagnosis, GPs’ preferred management at baseline, and MRI findings. Discussion In the Netherlands, the additional diagnostic value and cost-effectiveness of direct access to knee MRI for patients presenting with traumatic knee complaints in general practice is unknown. Although GPs increasingly refer patients to MRI, the Dutch clinical guideline ‘Traumatic knee complaints’ for GPs does not recommend referral to MRI, mainly because the cost-effectiveness is still unknown. Trial registration Dutch Trial Registration: NTR3689.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Pim A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Karstens S, Hermann K, Froböse I, Weiler SW. Predictors for patients with knee complaints receiving physiotherapy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.852241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Karstens S, Hermann K, Froböse I, Weiler SW. Predictors for half-year outcome of impairment in daily life for back pain patients referred for physiotherapy: a prospective observational study. PLoS One 2013; 8:e61587. [PMID: 23620772 PMCID: PMC3631224 DOI: 10.1371/journal.pone.0061587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/12/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE From observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy. METHODS We conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed. RESULTS A total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4), with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R(2), p<0.001). CONCLUSIONS With minimal information available from observational studies on the predictors of development of back problems for physiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the complaints can be named as outstanding factors. The results of this study can be used to facilitate comparison of patient therapy goals with the prognosis in everyday practice.
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Affiliation(s)
- Sven Karstens
- Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Cologne, Germany.
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