van der Waal Johanna M, Bot Sandra D M, Terwee Caroline B, van der Windt Daniëlle A W M, Scholten Rob J P M, Bouter Lex M, Dekker Joost
Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Arthritis Rheum. 2005 Dec 15;53(6):920-30. doi: 10.1002/art.21581.
Patients frequently present with knee complaints in general practice. Information about the course and prognosis of knee complaints is needed to inform patients and facilitate decisions on referral and treatment. The objective of the study was to assess the course of knee complaints and to identify predictors of outcome in patients visiting their general practitioner with a new episode of knee complaints.
Data were collected by means of self-administered questionnaires. After 3 and 12 months of followup, the following outcomes were assessed: perceived recovery, change in pain, and change in physical functioning. As potential predictors of outcome, several sociodemographic variables, characteristics of the symptom, baseline scores of the outcome measures, and intra- and extra-individual variables were analyzed using multiple regression analyses.
We included 251 patients with a new episode of knee complaints presented in general practice. Only 25% reported recovery after 3 months, increasing to 44% after 12 months. A history of knee complaints, a longer duration of the current episode of knee complaints, other coexisting musculoskeletal complaints, and a higher level of distress were associated with a worse prognosis. In the linear regression models, 41-53% of the variance in pain reduction and improvement in functioning could be explained by the predictors. The area under the receiver operating characteristic curves, estimating the predictive accuracy of the Cox regression models concerning perceived recovery, was 0.77 after 3 months and 0.72 after 12 months.
Many patients did not recover after 12 months. Distress was found to be strongly associated with less pain reduction and less improvement in functioning.
在全科医疗中，患者经常因膝关节问题前来就诊。需要有关膝关节问题病程和预后的信息，以便为患者提供信息，并促进转诊和治疗决策。本研究的目的是评估膝关节问题的病程，并确定初次因膝关节问题就诊于全科医生的患者预后的预测因素。
通过自行填写问卷收集数据。在随访3个月和12个月后，评估以下结果：自我感觉的恢复情况、疼痛变化和身体功能变化。作为预后的潜在预测因素，使用多元回归分析对几个社会人口统计学变量、症状特征、结局指标的基线评分以及个体内和个体间变量进行了分析。
我们纳入了251例初次因膝关节问题就诊于全科医疗的患者。仅25%的患者在3个月后报告恢复，12个月后这一比例增至44%。膝关节问题病史、当前膝关节问题发作的持续时间较长、其他并存的肌肉骨骼问题以及更高水平的痛苦与较差的预后相关。在线性回归模型中，预测因素可解释疼痛减轻和功能改善中41%-53%的方差。在3个月时，估计Cox回归模型关于自我感觉恢复的预测准确性的受试者工作特征曲线下面积为0.77，12个月时为0.72。
许多患者在12个月后仍未恢复。发现痛苦与疼痛减轻较少和功能改善较少密切相关。
