{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T08:21:58Z","timestamp":1765268518437,"version":"3.37.3"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,5,21]],"date-time":"2018-05-21T00:00:00Z","timestamp":1526860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institute for Health Research","doi-asserted-by":"crossref","award":["349856"],"award-info":[{"award-number":["349856"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Musculoskeletal Care"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The aim of the present study was to assess the validity of clusters combining history elements and physical examination tests to diagnose symptomatic knee osteoarthritis (SOA) compared with other knee disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective diagnostic accuracy study, in which 279 consecutive patients consulting for a knee complaint were assessed. History elements and standardized physical examination tests were obtained independently by a physiotherapist and compared with an expert physician's composite diagnosis, including clinical examination and imaging. Recursive partitioning was used to develop diagnostic clusters for SOA. Diagnostic accuracy measures were calculated, including sensitivity, specificity, and positive and negative likelihood ratios (LR+\/\u2212), with associated 95% confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 129 patients had a diagnosis of SOA (46.2%). Most cases (76%) had combined tibiofemoral and patellofemoral knee OA and 63% had radiological Kellgren\u2013Lawrence grades of 2 or 3. Different combinations of history elements and physical examination tests were used in clusters accurately to discriminate SOA from other knee disorders. These included age of patients, body mass index, presence of valgus\/varus knee misalignment, palpable knee crepitus and limited passive knee extension. Two clusters to rule in SOA reached an LR+ of 13.6 (95% CI 6.5 to 28.4) and three clusters to rule out SOA reached an LR\u2013 of 0.11 (95% CI 0.06 to 0.20).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Diagnostic clusters combining history elements and physical examination tests were able to support the differential diagnosis of SOA compared with various knee disorders without relying systematically on imaging. This could support primary care clinicians' role in the efficient management of these patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/msc.1245","type":"journal-article","created":{"date-parts":[[2018,5,21]],"date-time":"2018-05-21T07:49:08Z","timestamp":1526888948000},"page":"370-379","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8672-5672","authenticated-orcid":false,"given":"Simon","family":"D\u00e9cary","sequence":"first","affiliation":[{"name":"School of Rehabilitation, Faculty of Medicine University of Montreal  Montreal QC Canada"},{"name":"Orthopaedic Clinical Research Unit, Maisonneuve\u2010Rosemont Hospital Research Center Centre int\u00e9gr\u00e9 universitaire de sant\u00e9 et de services sociaux de l'Est\u2010de\u2010l'\u00cele\u2010de\u2010Montr\u00e9al  Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debbie","family":"Feldman","sequence":"additional","affiliation":[{"name":"School of Rehabilitation, Faculty of Medicine University of Montreal  Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Fr\u00e9mont","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Faculty of Medicine Laval University  Quebec City QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean\u2010Pierre","family":"Pelletier","sequence":"additional","affiliation":[{"name":"Osteoarthritis Research Unit University of Montreal Hospital Research Center (CRCHUM)  Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanne","family":"Martel\u2010Pelletier","sequence":"additional","affiliation":[{"name":"Osteoarthritis Research Unit University of Montreal Hospital Research Center (CRCHUM)  Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Fallaha","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maisonneuve\u2010Rosemont Hospital University of Montreal  Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Pelletier","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maisonneuve\u2010Rosemont Hospital University of Montreal  Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvain","family":"Belzile","sequence":"additional","affiliation":[{"name":"Department of Surgery Laval University Hospital Center (CHUL), Laval University  QC Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie\u2010Pierre","family":"Sylvestre","sequence":"additional","affiliation":[{"name":"Department of Social Preventive Medicine, School of Public Health University of Montreal Hospital Research Center (CRCHUM)  Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal\u2010Andr\u00e9","family":"Vendittoli","sequence":"additional","affiliation":[{"name":"Orthopaedic Clinical Research Unit, Maisonneuve\u2010Rosemont Hospital Research Center Centre int\u00e9gr\u00e9 universitaire de sant\u00e9 et de services sociaux de l'Est\u2010de\u2010l'\u00cele\u2010de\u2010Montr\u00e9al  Montreal QC Canada"},{"name":"Department of Surgery, Maisonneuve\u2010Rosemont Hospital University of Montreal  Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois","family":"Desmeules","sequence":"additional","affiliation":[{"name":"School of Rehabilitation, Faculty of Medicine University of Montreal  Montreal QC Canada"},{"name":"Orthopaedic Clinical Research Unit, Maisonneuve\u2010Rosemont Hospital Research Center Centre int\u00e9gr\u00e9 universitaire de sant\u00e9 et de services sociaux de l'Est\u2010de\u2010l'\u00cele\u2010de\u2010Montr\u00e9al  Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,5,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-15-00681"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22583"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780290816"},{"key":"e_1_2_8_5_1","article-title":"STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"Bossuyt P. M.","year":"2015","journal-title":"BMJ"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.12.026"},{"volume-title":"Netter's Orthopaedic Clinical Examination","year":"2015","author":"Cleland J.","key":"e_1_2_8_7_1"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2016.03.010"},{"volume-title":"Orthopedic Physical Examination Tests: An Evidence\u2010Based Approach","year":"2011","author":"Cook C.","key":"e_1_2_8_9_1"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1983.tb01258.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204763"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23206"},{"key":"e_1_2_8_13_1","article-title":"Diagnostic validity of combining history elements and physical examination tests for traumatic and degenerative symptomatic meniscal tears","author":"Decary S.","year":"2017","journal-title":"PM R"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1799-3"},{"key":"e_1_2_8_15_1","article-title":"Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta\u2010analysis","author":"Decary S.","year":"2016","journal-title":"Physical Therapy in Sport"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-016-1010-2"},{"key":"e_1_2_8_17_1","first-page":"1","article-title":"Middle\u2010aged patients with an MRI\u2010verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis","author":"Hare K. B.","year":"2017","journal-title":"Acta Orthopaedica"},{"key":"e_1_2_8_18_1","article-title":"Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta\u2010regression and analysis","author":"Hart H. F.","year":"2016","journal-title":"British Journal of Sports Medicine"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1179\/jmt.2009.17.1.1E"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.11.008"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22418"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.06.018"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.310"},{"key":"e_1_2_8_24_1","article-title":"Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: The Cohort Hip and Cohort Knee study","author":"Lankhorst N. E.","year":"2016","journal-title":"Osteoarthritis Cartilage"},{"key":"e_1_2_8_25_1","article-title":"Subjective crepitus as a risk factor for incident symptomatic knee osteoarthritis: Data from the osteoarthritis initiative","author":"Lo G. H.","year":"2017","journal-title":"Arthritis Care & Research"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5937"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.08.242"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3779"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.051482"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22785"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.02.005"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta11500"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210815"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.02.008"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.11.019"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/85.3.257"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1439-y"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.3109\/13814788.2013.818132"},{"key":"e_1_2_8_39_1","article-title":"Diagnostic performance of clinical examination measures and pain presentation to identify patellofemoral joint osteoarthritis","author":"Stefanik J. J.","year":"2017","journal-title":"Arthritis Care & Research"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131555"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24336"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2016.01.986"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-3-25"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.05.014"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.113100"}],"container-title":["Musculoskeletal Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmsc.1245","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/msc.1245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T17:18:17Z","timestamp":1694971097000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/msc.1245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,21]]},"references-count":44,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1002\/msc.1245"],"URL":"https:\/\/doi.org\/10.1002\/msc.1245","archive":["Portico"],"relation":{},"ISSN":["1478-2189","1557-0681"],"issn-type":[{"type":"print","value":"1478-2189"},{"type":"electronic","value":"1557-0681"}],"subject":[],"published":{"date-parts":[[2018,5,21]]},"assertion":[{"value":"2018-01-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}