Research output: Contribution to journal › Article › Academic › peer-review
An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers : a marker-by-treatment analysis of the ESCAPE study. / ESCAPE Research Group.
In: Knee surgery, sports traumatology, arthroscopy, Vol. 30, No. 6, 06.2022, p. 1937-1948.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers
T2 - a marker-by-treatment analysis of the ESCAPE study
AU - Noorduyn, Julia C. A.
AU - van de Graaf, Victor A.
AU - Willigenburg, Nienke W.
AU - Scholten-Peeters, Gwendolyne G. M.
AU - Mol, Ben W.
AU - Heymans, Martijn W.
AU - Coppieters, Michel W.
AU - Poolman, Rudolf W.
AU - ESCAPE Research Group
AU - Scholtes, V. A. B.
AU - Mutsaerts, E. L. A. R.
AU - Krijnen, M. R.
AU - van Deurzen, D. F. P.
AU - Moojen, D. J. F.
AU - Bloembergen, C. H.
AU - de Gast, A.
AU - Snijders, T.
AU - Halma, J. J.
AU - Saris, D. B. F.
AU - Wolterbeek, N.
AU - Neeter, C.
AU - Kerkhoffs, G. M. M. J.
AU - Peters, R. W.
AU - van den Brand, I. C. J. B.
AU - de Vos-Jakobs, S.
AU - Spoor, A. B.
AU - Gosens, T.
AU - Rezaie, W.
AU - Hofstee, D. J.
AU - Burger, B. J.
AU - Haverkamp, D.
AU - Vervest, A. M. J. S.
AU - van Rheenen, T. A.
AU - Wijsbek, A. E.
AU - van Arkel, E. R. A.
AU - Thomassen, B. J. W.
AU - Sprague, S.
AU - Mol, B. W. J.
AU - Schavemaker, M.
AU - Wolkenfelt, J.
AU - Teuwen, M.
AU - Butter, I. K.
AU - van Tulder, M. W.
N1 - Funding Information: We thank all participants of the ESCAPE trial for their contribution in the study and the participating centers for their help in this study. V. A. B. Scholtes, E. L. A. R. Mutsaerts, M. R. Krijnen, D. F. P. van Deurzen, D. J. F. Moojen, I. K. Butter: Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands. A. Gast, T. Snijders, J. J. Halma: Clinical Orthopedic Research Center Midden-Nederland, Zeist, the Netherlands. D. B. F. Saris: Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, The Netherlands. D. B. F. Saris: Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA. N. Wolterbeek: Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands. C. Neeter: Fysiken Physical Therapy, Amsterdam, The Netherlands. G. M. M. J. Kerkhoffs: Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands. R. W. Peters: Department of Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands. I. C. J. B. van den Brand, S. de Vos-Jakobs, A. B. Spoor, T. Gosens, W. Rezaie: Department of Orthopaedic Surgery, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands. W. Rezaie: Department of Orthopaedic Surgery, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium. D. J. Hofstee, B. J. Burger, C. H. Bloembergen: Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. D. Haverkamp: Department of Orthopaedic Surgery, Xpert Orthopedie, Amsterdam, The Netherlands. A. M. J. S. Vervest, T. A. van Rheenen, A. E. Wijsbek: Department of Orthopaedic Surgery, Tergooi Hospital, Hilversum, The Netherlands. E. R. A. Arkel, B. J. W. Thomassen: Department of human and Technology, The Hague University of Applied Sciences, Den Haag, The Netherlands. S. Sprague: Division of Orthopaedic Surgery, Department of Surgery, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. B. W. J. Mol: Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Australia. M. Schavemaker: Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands. J. Wolkenfelt: Department of Orthopaedic Surgery, Bergman clinics, Rijswijk, The Netherlands. M. Teuwen: Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands. M. W. van Tulder: Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands. Funding Information: This study was funded by the Dutch Arthritis Society (in Dutch: ReumaNederland; grant number 18-2-201), the Netherlands Organization for Health Research and Development (in Dutch: ZonMw; grant number 837002009), Zilverenkruis Health Insurance (grant number Z436) and the foundation of medical research of OLVG, Amsterdam (grant number 15u.025). The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: © 2022, The Author(s).
PY - 2022/6
Y1 - 2022/6
N2 - Purpose: Marker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained, that can potentially identify whether meniscal surgery or physical therapy is the superior intervention for an individual patient. This study aimed to introduce a novel approach in orthopaedic research to identify relevant treatment selection markers that affect treatment outcome following meniscal surgery or physical therapy in patients with degenerative meniscal tears. Methods: Data were analysed from the ESCAPE trial, which assessed the treatment of patients over 45 years old with a degenerative meniscal tear. The treatment outcome of interest was a clinically relevant improvement on the International Knee Documentation Committee Subjective Knee Form at 3, 12, and 24 months follow-up. Logistic regression models were developed to predict the outcome using baseline characteristics (markers), the treatment (meniscal surgery or physical therapy), and a marker-by-treatment interaction term. Interactions with p < 0.10 were considered as potential treatment selection markers and used these to develop predictiveness curves which provide thresholds to identify marker-based differences in clinical outcomes between the two treatments. Results: Potential treatment selection markers included general physical health, pain during activities, knee function, BMI, and age. While some marker-based thresholds could be identified at 3, 12, and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. Conclusion: This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. However, this study may serve as an exemplar for other orthopaedic trials to investigate the heterogeneity in treatment effect. It will help clinicians to quantify the additional benefit of one treatment over another at an individual level, based on the patient’s baseline characteristics. Level of evidence: II.
AB - Purpose: Marker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained, that can potentially identify whether meniscal surgery or physical therapy is the superior intervention for an individual patient. This study aimed to introduce a novel approach in orthopaedic research to identify relevant treatment selection markers that affect treatment outcome following meniscal surgery or physical therapy in patients with degenerative meniscal tears. Methods: Data were analysed from the ESCAPE trial, which assessed the treatment of patients over 45 years old with a degenerative meniscal tear. The treatment outcome of interest was a clinically relevant improvement on the International Knee Documentation Committee Subjective Knee Form at 3, 12, and 24 months follow-up. Logistic regression models were developed to predict the outcome using baseline characteristics (markers), the treatment (meniscal surgery or physical therapy), and a marker-by-treatment interaction term. Interactions with p < 0.10 were considered as potential treatment selection markers and used these to develop predictiveness curves which provide thresholds to identify marker-based differences in clinical outcomes between the two treatments. Results: Potential treatment selection markers included general physical health, pain during activities, knee function, BMI, and age. While some marker-based thresholds could be identified at 3, 12, and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. Conclusion: This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. However, this study may serve as an exemplar for other orthopaedic trials to investigate the heterogeneity in treatment effect. It will help clinicians to quantify the additional benefit of one treatment over another at an individual level, based on the patient’s baseline characteristics. Level of evidence: II.
KW - Exercise
KW - Healthcare
KW - Individualized
KW - Knee
KW - Meniscus
KW - Orthopedics
KW - Prediction
KW - Rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85124338853&partnerID=8YFLogxK
U2 - 10.1007/s00167-021-06851-x
DO - 10.1007/s00167-021-06851-x
M3 - Article
C2 - 35122496
VL - 30
SP - 1937
EP - 1948
JO - Knee surgery, sports traumatology, arthroscopy
JF - Knee surgery, sports traumatology, arthroscopy
SN - 0942-2056
IS - 6
ER -
ID: 21878484