Application characteristics and clinical effectiveness of clinical finding staging in guiding non-surgical treatment of knee osteoarthritis involving 92 medical institutions.

BACKGROUND

Accumulating evidence suggests that the radiographic phenotypes of patients with knee osteoarthritis (KOA) often do not correlate with their clinical findings, which are the primary reason for seeking medical care. Therefore, at OARSI 2024, we proposed a clinical finding staging system-Chinese medicine staging (CMS)-to guide the treatment of KOA. However, the clinical effectiveness and application characteristics of CMS in guiding non-surgical treatment of KOA remain unclear.

METHODS

A total of 14,985 KOA patients were included in the study. Data from 13,983 patients were used to analyze the characteristics of CMS application, while 1465 patients were used to evaluate CMS-guided clinical effectiveness, and 152 patients were included in a comparative analysis of clinical effectiveness without CMS guidance. The demographic characteristics of the CMS-using population were examined, and the correlation between CMS and treatment modalities was analyzed to clarify CMS application characteristics. VAS and WOMAC scores were compared between the CMS-guided and non-CMS-guided groups both before treatment and at week 8 of treatment, using the minimal clinically significant difference as the benchmark.

RESULTS

In application characteristics, regarding nonsurgical treatments, an increase in the CMS led to a decrease in basic treatment and an increase in nonpharmacological and pharmacological treatments (P < 0.001). Regarding surgical treatments, no change in the proportion of surgical interventions was observed with worsening CMS (P > 0.05). In clinical effectiveness, at week 8 of treatment, VAS scores and WOMAC scores were significantly lower in CMS-guided group (VSA: 3.51; 95% CI, 3.42-3.60, Pain: 3.55; 95% CI, 3.40-3.70, Stiffness: 1.18; 95% CI, 1.11-1.25, Function: 12.57; 95% CI, 12.07-13.08, Total: 17.31; 95% CI, 16.63-17.99), which had a higher net difference than non-CMS-guided group (VSA: 3.30; 95% CI, 3.05-3.54, Pain: 3.14; 95% CI, 2.68-3.60, Stiffness: 0.95; 95% CI, 0.76-1.15, Function: 11.36; 95% CI, 9.80-12.91, Total: 15.45; 95% CI, 13.40-17.49). The net differences in CMS-guided group were all higher than in MCID.

CONCLUSION

CMS is consistent with the patient's clinical finding, is suitable for guiding non-surgical treatment of KOA and can achieve clinically significant therapeutic effects.