Article

Few studies have investigated or identified common clinical tests and
measures as being associated with progression of hip osteoarthritis (OA); fewer
still are longitudinal studies exploring prognostic variables associated with
long-term outcome following physical therapy treatment. OBJECTIVE: The purpose of
this study was to determine a set of prognostic factors that maximize the
accuracy of identifying patients with hip osteoarthritis (OA) likely to
demonstrate a favorable response to physical therapy intervention. DESIGN: This
was a prognostic study. METHODS: Ninety-one patients with a clinical diagnosis of
hip OA were analyzed to determine which clinical measures, when clustered
together, were most predictive of a favorable response to physical therapy
intervention. Responders were determined based on OMERACT-OARSI response
criteria, which included percent and absolute changes in pain, function, and
global rating of change over 1 year. These data served as the reference standard
for determining the predictive validity of baseline clinical examination
variables. Using multivariate regression analyses and calculations for
sensitivity, specificity, and positive and negative likelihood ratios, a cluster
was identified. RESULTS:
Five baseline variables (unilateral hip pain, age of
/=6/10 on a numeric pain rating scale, 40-m self-paced walk
test time of </=25.9 seconds, and duration of symptoms of </=1 year) were
retained in the final model. Failure to exhibit a condition of 1 of the 5
predictor variables decreased the posttest probability of responding favorably to
physical therapy intervention from 32% to <1% (negative likelihood ratio=0.00,
95% confidence interval=0.00-0.70). Having at least 2 out of 5 predictor
variables at baseline increased the posttest probability of success with physical
therapy intervention from 32% to 65% (positive likelihood ratio=3.99, 95%
confidence interval=2.66-4.48), and having 3 or more of 5 predictor variables
increased the posttest probability of success to 99% or higher. A comparison with
a control group that did not receive physical therapy further substantiated the
cluster. LIMITATIONS: The small sample size and the number of variables entered
into the logistic regression model may have resulted in spurious findings. This
study must be validated in replication studies before it can be considered for
use in clinical practice. CONCLUSIONS: This study completed the first step in the
development of a preliminary cluster of baseline variables that identify patients
with hip OA as positive responders to physical therapy intervention.

Langue : ANGLAIS