Summary
Background
Nowadays, an increasing number of patients expect their physician to provide a measureable and, therefore, comparable treatment effect that quantifies success or failure of the applied therapy. Unfortunately, different knee classification schemes applied to the same patient may provide diverging results. Therefore, the objective of this paper was to present recommendations to clinicians for a meaningful outcome assessment of their patients.
Methods
Out of 39 knee evaluation systems available in the literature, we performed an elimination process based on the criteria (1) widespread use, (2) available reference values and (3) publication of at least one validation study.
Results
Six clinical scores were detected which met the inclusion criteria. Owing to authors’ recommendations and personal opinion the International Knee Documentation Committee (IKDC) Score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were identified to be the most suitable outcome measures that enable patients a realistic assessment of their treatment effect compared with individuals in similar life situations.
Conclusion
To our opinion the IKDC should be applied to athletic patients suffering from post-traumatic knee symptoms who are younger than 50 years. For non-athletes aged 50 years and older the WOMAC is considered suitable whereas the KOOS is recommended to all other patients with knee disorders.
Zusammenfassung
Grundlagen
Immer mehr Patienten erwarten von ihrem Arzt, dass er ihren Behandlungseffekt messbar und dadurch vergleichbar macht, sodass der Erfolg oder Misserfolg der angewandten Therapie abschätzbar wird. Leider können unterschiedliche Klassifikationsschemata das Knie eines Patienten widersprüchlich beurteilen. Daher haben wir es uns in dieser Arbeit zum Ziel gesetzt an Kliniker gerichtete Empfehlungen abzugeben, die ihnen als Entscheidungshilfe bei der Wahl jenes Beurteilungssystems dienen können, das für eine aussagekräftige Evaluierung des jeweiligen Patienten am besten geeignet ist.
Methodik
Der Eliminierungsprozess ausgehend von 39 Knie-Klassifikationsschemata, die in der Literatur vorzufinden sind, erfolgte gemäß den Kriterien 1) verbreitete Nutzung, 2) verfügbare Referenzwerte und 3) Veröffentlichung von mindestens einer Validierungsstudie.
Ergebnisse
Es konnten sechs klinische Scores identifiziert werden, die den Einschlusskriterien entsprachen. Basierend auf den von Autoren bereits veröffentlichten Empfehlungen sowie auf unserer persönlichen Einschätzung wurden der IKDC Score, der KOOS und der WOMAC als am besten geeignet erachtet, um den Behandlungseffekt eines Patienten nicht nur realistisch einzuschätzen, sondern auch mit Personen in ähnlichen Lebenssituationen zu vergleichen.
Schlussfolgerung
Nach unserer Ansicht sollte der IKDC Score bei sportlichen Patienten, die höchstens 50 Jahre alt sind und an post-traumatischen Symptomen leiden, zur Anwendung kommen. Für Nicht-Sportler, die mindestens 50 Jahre alt sind, erscheint uns der WOMAC als geeignet, während wir den KOOS für alle anderen Patienten mit Kniebeschwerden empfehlen.
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Negrin, L., Hajdu, S. Patient-specific evaluation of knee disorders in clinical practice. Wien Klin Wochenschr 126, 650–654 (2014). https://doi.org/10.1007/s00508-014-0600-y
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DOI: https://doi.org/10.1007/s00508-014-0600-y