Dataset Information

A scoping review of how early-stage knee osteoarthritis has been defined.

ABSTRACT:

Background

Early-stage knee osteoarthritis (KOA) classification criteria will enable consistent identification and trial recruitment of individuals with knee osteoarthritis (OA) at an earlier stage of the disease when interventions may be more effective. Toward this goal, we identified how early-stage KOA has been defined in the literature.

Methods

We performed a scoping literature review in PubMed, EMBASE, Cochrane, and Web of Science, including human studies where early-stage KOA was included as a study population or outcome. Extracted data included demographics, symptoms/history, examination, laboratory, imaging, performance-based measures, gross inspection/histopathologic domains, and the components of composite early-stage KOA definitions.

Results

Of 6142 articles identified, 211 were included in data synthesis. An early-stage KOA definition was used for study inclusion in 194 studies, to define study outcomes in 11 studies, and in the context of new criteria development or validation in six studies. The element most often used to define early-stage KOA was Kellgren-Lawrence (KL) grade (151 studies, 72%), followed by symptoms (118 studies, 56%), and demographic characteristics (73 studies, 35%); 14 studies (6%) used previously developed early-stage KOA composite criteria. Among studies defining early-stage KOA radiographically, 52 studies defined early-stage KOA by KL grade alone; of these 52, 44 (85%) studies included individuals with KL grade 2 or higher in their definitions.

Conclusion

Early-stage KOA is variably defined in the published literature. Most studies included KL grades of 2 or higher within their definitions, which reflects established or later-stage OA. These findings underscore the need to develop and validate classification criteria for early-stage KOA.

SUBMITTER: Liew JW

PROVIDER: S-EPMC10528892 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

A scoping review of how early-stage knee osteoarthritis has been defined.

Liew Jean W JW King Lauren K LK Mahmoudian Armaghan A Wang Qiuke Q Atkinson Hayden F HF Flynn David B DB Appleton C Thomas CT Englund Martin M Haugen Ida K IK Lohmander L Stefan LS Runhaar Jos J Neogi Tuhina T Hawker Gillian G

Osteoarthritis and cartilage 20230522 9

<h4>Background</h4>Early-stage knee osteoarthritis (KOA) classification criteria will enable consistent identification and trial recruitment of individuals with knee osteoarthritis (OA) at an earlier stage of the disease when interventions may be more effective. Toward this goal, we identified how early-stage KOA has been defined in the literature.<h4>Methods</h4>We performed a scoping literature review in PubMed, EMBASE, Cochrane, and Web of Science, including human studies where early-stage KO ...[more]

PMID: 37225053

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Project description:BackgroundEarly diagnosis of knee osteoarthritis (OA) is important in managing this disease, but such an early diagnostic tool is still lacking in clinical practice. The purpose of this study was to develop diagnostic models for early stage knee OA based on the first 2-year clinical course after the patient's initial presentation in primary care and to identify whether these course factors had additive discriminative value over baseline factors.MethodsWe extracted eligible patients' clinical and radiographic data from the CHECK cohort and formed the first 2-year course factors according to the factors' changes over the 2 years. Clinical expert consensus-based diagnosis, which was made via evaluating patients' 5- to 10-year follow-up data, was used as the outcome factor. Four models were developed: model 1, included clinical course factors only; model 2, included clinical and radiographic course factors; model 3, clinical baseline factors + clinical course factors; and model 4, clinical and radiographic baseline factors + clinical and radiographic course factors. All the models were built by a generalized estimating equation with a backward selection method. Area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI) were calculated for assessing model discrimination. Delong's method compared AUCs.ResultsSeven hundred sixty-one patients with 1185 symptomatic knees were included in this study. Thirty-seven percent knees were diagnosed as OA at follow-up. Model 1 contained 6 clinical course factors; model 2: 6 clinical and 3 radiographic course factors; model 3: 6 baseline clinical factors combined with 5 clinical course factors; and model 4: 4 clinical and 1 radiographic baseline factors combined with 5 clinical and 3 radiographic course factors. Model discriminations are as follows: model 1, AUC 0.70 (95% CI 0.67-0.74); model 2, 0.74 (95% CI 0.71-0.77); model 3, 0.77 (95% CI 0.74-0.80); and model 4, 0.80 (95% CI 0.77-0.82). AUCs of model 3 and model 4 were slightly but significantly higher than corresponding baseline-factor models (model 3 0.77 vs 0.75, p = 0.031; model 4 0.80 vs 0.76, p = 0.003).ConclusionsFour diagnostic models were developed with "fair" to "good" discriminations. First 2-year course factors had additive discriminative value over baseline factors.

Project description:BackgroundIn recent years, significant progress in the diagnosis of knee osteoarthritis (OA) has been made due to advancements in imaging techniques, especially magnetic resonance imaging (MRI). However, the diagnostic accuracy of MRI for knee OA lacks agreement in the literature due to limitations such as heterogeneous reference standards and suboptimal methodological assessment tools. This scoping review systematically collated the literature on the accuracy of MRI in diagnosing symptomatic knee OA and evaluated its methodological quality using a novel tool.MethodsA comprehensive search was conducted across seven electronic databases to identify systematic reviews, with or without meta-analyses, published until May 30, 2024. Selected articles were systematic reviews on test accuracy of MRI for knee OA, whose methodological quality was assessed using a tailored version of the A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool, and the test accuracy performance summarized.ResultsThe search yielded 8,586 records of which 73 full-text articles were assessed for eligibility. We included 3 systematic reviews with a total of 99 original studies (7,530 participants). The methodological quality assessment of the reviews revealed common deficiencies in research questions and inclusion criteria components (2/3, 66.7%), protocol registration (2/3, 66.7%), use of statistical methods (1/3, 33.3%), and risk of bias assessment (2/3, 66.7%). The reference standards used were histology (1/3, 33.3%), radiography (1/3, 33.3%), computed tomography (1/3, 33.3%), clinical evaluation (1/3, 33.3%) and direct visual inspection (1/3, 33.3%), open surgery (1/3, 33.3%) and arthroscopy (3/3, 100%). In two reviews with meta-analysis the accuracy of MRI was: sensitivity 61% [95% confidence interval (CI), 53-68%] and specificity 82% (95% CI, 77-87%) (low methodological quality); and sensitivity 74% (95% CI, 71-77%) and specificity 95% (95% CI, 94-95%) (high methodological quality). In the third systematic review, without meta-analysis, the MRI sensitivity and specificity ranged from 26% to 96% and from 50% to 100%, respectively (critically low methodological quality).ConclusionsThis scoping review highlights the heterogeneity and gaps in methodological quality of the literature regarding the accuracy of MRI in diagnosing knee OA. Our adaptation of AMSTAR 2 will help to ensure systematic reviews of diagnostic tests are assessed more effectively and reliably. There is a need for standardization in future studies and reviews to strengthen the evidence base for the use of MRI as a diagnostic tool for knee OA.

Dataset Information

A scoping review of how early-stage knee osteoarthritis has been defined.

Background

Methods

Results

Conclusion

Publications

A scoping review of how early-stage knee osteoarthritis has been defined.

Similar Datasets

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