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Six‐year course and prognosis of nontraumatic knee symptoms in adults in general practice: A prospective cohort study
Author(s) -
Kastelein Marlous,
Luijsterburg Pim A. J.,
Belo Janneke N.,
Verhaar Jan A. N.,
Koes Bart W.,
BiermaZeinstra Sita M. A.
Publication year - 2011
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20522
Subject(s) - medicine , osteoarthritis , confidence interval , knee pain , odds ratio , cohort , prospective cohort study , cohort study , logistic regression , comorbidity , knee joint , physical therapy , rheumatology , surgery , alternative medicine , pathology
Abstract Objective To examine the 6‐year course of nontraumatic knee symptoms in adults in general practice, to identify prognostic factors for unfavorable outcome, and to develop a clinical prediction rule. Methods Adults (ages >35 years) with incident nontraumatic knee symptoms (n = 549) were followed for 6 years. Multivariable logistic regression analysis was used to identify prognostic factors associated with an unfavorable outcome, the area under the receiver operating curve (AUC) was calculated to determine discriminative ability, and a clinical prediction rule was developed. Unfavorable outcome is defined as persistent knee symptoms at 6‐year followup or having undergone knee replacement surgery during followup. Results At 6‐year followup, 42.1% of patients had an unfavorable outcome. Having persistent knee symptoms (odds ratio [OR] 5.31, 95% confidence interval [95% CI] 3.27–8.61) and fulfilling the clinical American College of Rheumatology (ACR) criteria for osteoarthritis (OA; OR 2.65, 95% CI 1.48–4.73) at 1‐year followup were significantly associated with unfavorable outcome, while fulfilling the clinical ACR criteria for OA at baseline was not. Baseline factors independently associated with an unfavorable outcome were low/middle education level, comorbidity of the skeletal system, duration of knee symptoms of >3 months, bilateral knee symptoms, self‐reported warm knee, history of nontraumatic knee symptoms, valgus alignment, pain at passive knee flexion/extension, and bony enlargement of the knee joint (AUC 0.80). Conclusion Nontraumatic knee symptoms in adults in general practice appear to become a chronic disorder in nearly half of the patients. The developed clinical prediction rule with 10 baseline prognostic factors can be used to select high‐risk patients for an unfavorable outcome at long‐term followup.