Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study.

Shim, Joanna; Mclernon, David J.; Hamilton, David; Simpson, Hamish A.; Beasley, Marcus; Macfarlane, Gary J.

Abstract

Objectives: The aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA). Methods: This was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed. Results: Seven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months. Key predictors were poor clinical status, widespread body pain, high expectation of postoperative pain and lack of active coping. The developed model based on these variables demonstrated good discrimination. At the optimal cut-off, the final model had a sensitivity of 83%, specificity of 61% and positive likelihood ratio of 2.11. Excellent agreement was found between observed and predicted outcomes, and there was no evidence of overfitting in the model. Conclusion: We have developed and validated a clinical prediction model that can be used to identify patients at high risk of a poor outcome after TKA. This clinical risk score may be an aid to shared decision-making between patient and clinician.

Citation

SHIM, J., MCLERNON, D.J., HAMILTON, D., SIMPSON, H.A., BEASLEY, M. and MACFARLANE, G.J. 2018. Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study. Rheumatology advances in practice [online], 2(2), article rky021. Available from: https://doi.org/10.1093/rap/rky021

• Journal Article Type: Article
• Acceptance Date: Apr 27, 2018
• Online Publication Date: May 29, 2018
• Publication Date: Dec 31, 2018
• Deposit Date: Oct 14, 2021
• Publicly Available Date: Oct 14, 2021
• Journal: Rheumatology Advances in Practice
• Print ISSN: 2514-1775
• Electronic ISSN: 2514-1775
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 2
• Issue: 2
• Article Number: rky021
• DOI: https://doi.org/10.1093/rap/rky021
• Keywords: Knee pain; Osteoarthritis; Total knee arthroplasty; Prediction modelling; Clinical risk score; Model calibration; Model discrimination
• Public URL: https://rgu-repository.worktribe.com/output/1447247
• Related Public URLs: https://rgu-repository.worktribe.com/output/1489998