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

Julia C A Noorduyn; M M H Teuwen; V A van de Graaf; N W Willigenburg; M Schavemaker; R van Dijk; G G M Scholten-Peeters; M W Heymans; M W Coppieters; R W Poolman; 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

Julia C A Noorduyn^* (Corresponding Author), M M H Teuwen, V A van de Graaf, N W Willigenburg, M Schavemaker, R van Dijk, G G M Scholten-Peeters, M W Heymans, M W Coppieters, R W Poolman, ESCAPE Research Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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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
Number of pages	8
Journal	Knee Surgery, Sports Traumatology, Arthroscopy
Volume	30
Early online date	7 Feb 2021
DOIs	https://doi.org/10.1007/s00167-021-06468-0
Publication status	Published - 1 Jan 2022

Bibliographical note

Acknowledgements
We thank all participants of the ESCAPE trial for their contribution in the study and the participating centers for their help in this study.
Funding
VG, NW, JN, and RP received financial support from The Netherlands Organisation for Health Research and Development (in Dutch: ZonMw) for the submitted work; the Achmea Healthcare Foundation (in Dutch Stichting Achmea Gezonheidszorg fonds), Dutch Arthritis Society and the foundation of medical research at the OLVG, Amsterdam, the Netherlands; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work

Keywords

Meniscus
Physical therapy
Prognostic mode
Knee

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Noorduyn, J. C. A., Teuwen, M. M. H., van de Graaf, V. A., Willigenburg, N. W., Schavemaker, M., van Dijk, R., Scholten-Peeters, G. G. M., Heymans, M. W., Coppieters, M. W., Poolman, R. W., & ESCAPE Research Group (2022). In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 231–238 . https://doi.org/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. / Noorduyn, Julia C A (Corresponding Author); Teuwen, M M H; van de Graaf, V A et al.
In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 30, 01.01.2022, p. 231–238 .

Research output: Contribution to journal › Article › peer-review

Noorduyn, JCA, Teuwen, MMH, van de Graaf, VA, Willigenburg, NW, Schavemaker, M, van Dijk, R, Scholten-Peeters, GGM, Heymans, MW, Coppieters, MW, Poolman, RW & ESCAPE Research Group 2022, 'In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery', Knee Surgery, Sports Traumatology, Arthroscopy, vol. 30, pp. 231–238 . https://doi.org/10.1007/s00167-021-06468-0

Noorduyn JCA, Teuwen MMH, van de Graaf VA, Willigenburg NW, Schavemaker M, van Dijk R et al. In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Jan 1;30:231–238 . Epub 2021 Feb 7. doi: 10.1007/s00167-021-06468-0

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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 = "Meniscus, Physical therapy, Prognostic mode, Knee",

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 {ESCAPE Research Group} and Mol, {Ben Willem J.}",

note = "Acknowledgements We thank all participants of the ESCAPE trial for their contribution in the study and the participating centers for their help in this study. Funding VG, NW, JN, and RP received financial support from The Netherlands Organisation for Health Research and Development (in Dutch: ZonMw) for the submitted work; the Achmea Healthcare Foundation (in Dutch Stichting Achmea Gezonheidszorg fonds), Dutch Arthritis Society and the foundation of medical research at the OLVG, Amsterdam, the Netherlands; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work",

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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 - ESCAPE Research Group

AU - Mol, Ben Willem J.

N1 - Acknowledgements We thank all participants of the ESCAPE trial for their contribution in the study and the participating centers for their help in this study. Funding VG, NW, JN, and RP received financial support from The Netherlands Organisation for Health Research and Development (in Dutch: ZonMw) for the submitted work; the Achmea Healthcare Foundation (in Dutch Stichting Achmea Gezonheidszorg fonds), Dutch Arthritis Society and the foundation of medical research at the OLVG, Amsterdam, the Netherlands; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work

PY - 2022/1/1

Y1 - 2022/1/1

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 - Meniscus

KW - Physical therapy

KW - Prognostic mode

KW - Knee

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DO - 10.1007/s00167-021-06468-0

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C2 - 33550450

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JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

ER -

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

Abstract

Bibliographical note

Keywords

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