Benefit form manual physiotherapy and exercise in knee osteoarthritis
Most patients with knee osteoartritis will benefit from a low-risk, cost-effective program of manual physical therapy and supporting exercise. This clinical prediction rule identifies those patients who may not benefit from such a program. After validation, this rule could improve primary patient management, allowing more appropriate referrals and choices in intervention.
Research authors: Deyle GD, Gill NW, Allison SC, Hando BR, Rochino DA
Details Formula Study characteristics Files & References
★★
Model author
Model ID
497
Version
1.10
Revision date
2016-05-09
Specialty
MeSH terms
  • Osteoarthritis
  • Physiotherapy (Techniques)
  • Exercise
  • Clinical Prediction Rule
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    Study design:
    Using a retrospective combined-cohort study design, baseline patient examinations were reviewed from 2 RCTs1,2 to identify variables that indicate which individuals with knee osteoarthritis (OA) are unlikely to benefit from manual physical therapy and exercise.3

    Data collection:
    Data was extracted from the research folders of all study participants. From April to December 2008, an extensive database was prepared of examination findings and performed analyses to determine the variables that predict likely treatment nonsuccess with manual physical therapy and exercise.3

    Primary endpoint:
    Improvement of <12% in the total WOMAC score after 4 weeks of treatment defined non-success.

    Sources: 
    1. Deyle GD, Allison SC, Matekel RL, et al. Physical therapy treat- ment effectiveness for osteoarthritis of the knee: a random- ized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85:1301-1317.
    2. Deyle GD, Henderson NE, Matekel RL, et al. Effectiveness of man- ual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000;132:173-181.
    3. Deyle GD, Gill NW, Allison SC, et al. Knee OA: which patients are unlikely to benefit from manual PT and exercise? J Fam Pract. 2012;61(1):E1-8.

    Study Population

    Total population size: 101
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name Mean SD Unit
    Age 62.5 10.4 years
    Height 166 10.4 cm
    Weight 84.5 17.8 kg
    Duration of symptoms 76.1 87.9 months
    WOMAC (VAS) total baseline 1059.8 447.1 mm
    6-minute walk test baseline 425.6 114.8 meters

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Side(s) involved Unilateral 63
    Bilateral 38
    Physical activity relative to peers (self-report) Much more active 26
    Somewhat more active 33
    About the same 20
    Somewhat less active 21
    Radiographic severity score 0 6
    1 25
    2 33
    3 25
    4 9

    Total score:
    ...
    points

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    Result
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    Total score: points

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    Outcome stratification

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    Conditional information

    Result interpretation

    How this model should be used: 
    For most patients with knee osteoarthritis (OA), the combined intervention of manual physical herapy and exercise is clinically beneficial, relatively inexpensive, and has no known adverse effects.This model defines the population of patients with knee OA who are unlikely to benefit from manual physical therapy and exercise, requiring alternative interventions.

    Definition of nonsuccess: 
    Nonsuccess was defined as improvement of <12% in the total Western ontario macmaster (WOMAC) score after 4 weeks of treatment.2

    Model performance: 
    The final regression model was a good fit to the data: Hosmer & Lemeshow test X2 = 2.90 (P=.940); Nagelkerke R2=0.680.

    Sources: 
    1 Ludica CA. Can a program of manual physical therapy and su- pervised exercise improve the symptoms of osteoarthritis of the knee? J Fam Pract. 2000;49:466-467.
    2 Deyle GD, Gill NW, Allison SC, et al. Knee OA: which patients are unlikely to benefit from manual PT and exercise? J Fam Pract. 2012;61(1):E1-8.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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