In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

the ESCAPE Research Group

doi:10.1007/s00167-021-06468-0

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

the ESCAPE Research Group

Research output: Contribution to Journal › Article › Academic › peer-review

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 < 0.157. For both models the performance was assessed and corrected for the models' optimism through an internal validation using bootstrapping technique with 500 repetitions.

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.

Original language	English
Pages (from-to)	231-238
Journal	Knee Surgery, Sports Traumatology, Arthroscopy
Volume	30
Issue number	1
Early online date	7 Feb 2021
DOIs	https://doi.org/10.1007/s00167-021-06468-0 https://doi.org/10.1007/s00167-021-06468-0
Publication status	Published - Jan 2022

Funding

We thank all participants of the ESCAPE trial for their contribution in the study and the participating centers for their help in this study. Escape Research Group Collaborators: Scholtes VAB1, Mutsaerts ELAR1, Wolkenfelt J1, Krijnen MR1, van Deurzen DFP1, Moojen DJF1, Bloembergen CH1, de Gast A2, Snijders T2, Halma JJ2, Saris DBF3, Wolterbeek N4, Neeter C5, Kerkhoffs GMMJ6, Peters RW7, van den Brand ICJB8, de Vos-Jakobs S8, Spoor AB8, Gosens T8, Rezaie W8,9, Hofstee DJ10, Burger BJ10, Haverkamp D11, Vervest AMJS12, van Rheenen TA12, Wijsbek AE12, van Arkel ERA13, Thomassen BJW13, Sprague S14, Mol BWJ15, van Tulder MW16, J. van der Kraan17 1: Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands. 2: Department of Orthopaedic Surgery, Clinical Orthopaedic Research Center, Diakonessenhuis, Utrecht, The Netherlands. 3: Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, The Netherlands. 4: Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands. 5: Fysiken Physical Therapy, Amsterdam, The Netherlands. 6: Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands. 7: Department of Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands. 8: Department of Orthopaedic Surgery, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands. 9: Department of Orthopaedic Surgery, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium. 10: Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. 11: Department of Orthopaedic Surgery, Xpert Orthopedie, Amsterdam, The Netherlands. 12: Department of Orthopaedic Surgery, Tergooi Hospital, Hilversum, The Netherlands. 13: Department of human and Technology, The Hague University of Applied Sciences, Den Haag, The Netherlands. 14: Division of Orthopaedic Surgery, Department of Surgery, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 15: Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Australia. 16: Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Vrije Universiteit, Amsterdam, The Netherlands. 17: Dutch Patients Federation, Utrecht, The Netherlands.

Funders	Funder number
Department of Health Sciences
Department of Obstetrics and Gynaecology, School of Medicine, Monash University
Dutch Patients Federation
Fysiken Physical Therapy
Hague University of Applied Sciences, Den Haag

Keywords

Knee
Meniscus
Physical therapy
Prognostic model

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@article{d82730666cb9462e9985fab0f24d11d6,

title = "In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery",

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 < 0.157. For both models the performance was assessed and corrected for the models' optimism through an internal validation using bootstrapping technique with 500 repetitions.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.",

keywords = "Knee, Meniscus, Physical therapy, Prognostic model",

author = "Noorduyn, {Julia C.A.} and Teuwen, {M. M.H.} and {van de Graaf}, {V. A.} and Willigenburg, {N. W.} and M. Schavemaker and {van Dijk}, R. and Scholten-Peeters, {G. G.M.} and Heymans, {M. W.} and Coppieters, {M. W.} and Poolman, {R. W.} and Scholtes, {V. A.B.} and Mutsaerts, {E. L.A.R.} and J. Wolkenfelt and M. Krijnen and {van Deurzen}, {D. F.P.} and Moojen, {D. J.F.} and Bloembergen, {C. H.} and {de Gast}, Gast and T. Snijders and Halma, {J. J.} and Saris, {D. B.F.} and N. Wolterbeek and C. Neeter and Kerkhoffs, {D. M.M.J.} and Peters, {R. W.} and {van den Brand}, {I. C.J.B.} and {de Vos-Jakobs}, S. and Spoor, {A. B.} and T. Gosens and W. Rezaie and Hofstee, {D. J.} and Burger, {B. J.} and D. Haverkamp and Vervest, {A. M.J.S.} and {van Rheenen}, {T. A.} and Wijsbek, {A. E.} and {van Arkel}, {E. R.A.} and Thomassen, {B. J.W.} and S. Sprague and Mol, {B. W.J.} and {van Tulder}, {M. W.} and {van der Kraan}, J. and {the ESCAPE Research Group}",

year = "2022",

month = jan,

doi = "10.1007/s00167-021-06468-0",

language = "English",

volume = "30",

pages = "231--238",

journal = "Knee Surgery, Sports Traumatology, Arthroscopy",

issn = "0942-2056",

publisher = "John Wiley and Sons Inc.",

number = "1",

}

TY - JOUR

T1 - In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

AU - Noorduyn, Julia C.A.

AU - Teuwen, M. M.H.

AU - van de Graaf, V. A.

AU - Willigenburg, N. W.

AU - Schavemaker, M.

AU - van Dijk, R.

AU - Scholten-Peeters, G. G.M.

AU - Heymans, M. W.

AU - Coppieters, M. W.

AU - Poolman, R. W.

AU - Scholtes, V. A.B.

AU - Mutsaerts, E. L.A.R.

AU - Wolkenfelt, J.

AU - Krijnen, M.

AU - van Deurzen, D. F.P.

AU - Moojen, D. J.F.

AU - Bloembergen, C. H.

AU - de Gast, Gast

AU - Snijders, T.

AU - Halma, J. J.

AU - Saris, D. B.F.

AU - Wolterbeek, N.

AU - Neeter, C.

AU - Kerkhoffs, D. M.M.J.

AU - Peters, R. W.

AU - van den Brand, I. C.J.B.

AU - de Vos-Jakobs, S.

AU - Spoor, A. B.

AU - Gosens, T.

AU - Rezaie, W.

AU - Hofstee, D. J.

AU - Burger, B. J.

AU - Haverkamp, D.

AU - Vervest, A. M.J.S.

AU - van Rheenen, T. A.

AU - Wijsbek, A. E.

AU - van Arkel, E. R.A.

AU - Thomassen, B. J.W.

AU - Sprague, S.

AU - Mol, B. W.J.

AU - van Tulder, M. W.

AU - van der Kraan, J.

AU - the ESCAPE Research Group

PY - 2022/1

Y1 - 2022/1

N2 - 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 < 0.157. For both models the performance was assessed and corrected for the models' optimism through an internal validation using bootstrapping technique with 500 repetitions.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.

AB - 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 < 0.157. For both models the performance was assessed and corrected for the models' optimism through an internal validation using bootstrapping technique with 500 repetitions.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.

KW - Knee

KW - Meniscus

KW - Physical therapy

KW - Prognostic model

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U2 - 10.1007/s00167-021-06468-0

DO - 10.1007/s00167-021-06468-0

M3 - Article

C2 - 33550450

SN - 0942-2056

VL - 30

SP - 231

EP - 238

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

IS - 1

ER -

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

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