The 6-m timed hop test is a prognostic factor for outcomes in patients with meniscal tears treated with exercise therapy or arthroscopic partial meniscectomy: a secondary, exploratory analysis of the Odense–Oslo meniscectomy versus exercise (OMEX) trial
To identify the prognostic factors for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears treated with exercise therapy (ET) or arthroscopic partial meniscectomy (APM).
One hundred and seven patients, with mean age 49.6 (SD 6.2) years and BMI 25.7 (SD 3.7), were included in this analysis of data from the OMEX trial (http://www.clinicaltrials.gov NCT01002794). Linear and Poisson regression models were built to explore the associations between potential prognostic factors (patient characteristics, knee function-related and disease-related factors) and 2-year patient-reported outcomes: the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Pain, Symptoms, ADL, Sport/Rec, QoL and 5-point Global Rating of Change scales for knee pain (GRC Pain) and function (GRC Function). Analyses were performed for the whole cohort and for the two treatment groups (n = 55 and 52) with adjustments for age, sex, BMI and baseline KOOS.
For the whole cohort, a 1-s better baseline 6-m timed hop test result was associated with 3.1–7.1 points better 2-year scores for all KOOS subscales (95% CIs 1.1–5.2 to 4.1–10.1 points). A 1.61–2.80 s better test was associated with scores equivalent to previously calculated clinical relevant differences for each KOOS subscale. For the groups of patients treated with ET and APM, respectively, 2.09–3.60 s and 0.63–1.99 s better tests were associated with clinical relevant differences. For the whole cohort, a 1-s better test was associated with 26% (95% CI 15–38%) and 22% (95% CI 11–34%) higher possibility for better or much better GRC Pain and Function scores. Patients treated with ET had 17% (95% CI 2–33%) increased possibility for better or much better GRC Pain score, and patients treated with APM had 65% (95% CI 32–108%) and 70% (95% CI 38–109%) increased possibility for better or much better GRC Pain and Function scores.
The 6-m timed hop test result was a significant prognostic factor for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears, especially in those treated with APM.
Level of evidence
Key wordsDegenerative meniscal tears Degenerative meniscal lesions Middle aged Arthroscopic partial meniscectomy Exercise therapy Prognostic factors Lower extremity performance 6-m timed hop test
The authors acknowledge the patients in this study for their participation. Further, they acknowledge research coordinators Kristin Bølstad and Emilie Jul-Larsen for the organization of the participants, physiotherapists Marte Lund, Karin Rydevik and Christian Vilming for assistance with data collection and radiologist Rana Tariq for reading the MRI scans. Nanna Kurtze is acknowledged for giving permission to copy her previously published table illustrating the calculation of the HUNT 1 activity index. The authors also acknowledge the Norwegian Sports Medicine Clinic (NIMI), Oslo, Norway, for supporting the Norwegian Research Center for Active Rehabilitation (NAR) with rehabilitation facilities and research staff. NAR is a collaboration between the Norwegian School of Sports Sciences, Department of Orthopaedic Surgery, Oslo University Hospital, and NIMI. Finally, the authors acknowledge the Department of Orthopaedic Surgery, Oslo University Hospital, and the Department of Orthopaedic Surgery, Martina Hansens Hospital, Bærum, for accessibility to the outpatient and surgical clinics.
Ewa M. Roos, May Arna Risberg (MAR) and Silje Stensrud (SS) developed the concept and design for the RCT this study cohort is extracted from. SS, Lars Engebretsen and Nina Jullum Kise (NJK) collected the data. NJK and MAR developed the idea for this secondary study of data from the RCT. NJK wrote the manuscript. NJK and independent statistician Jonas Ranstam did the statistical analyses. All authors had full access to all of the data including statistical reports and tables in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
This study was funded by Sophies Minde Ortopedi AS, Swedish Rheumatism Association, Swedish Scientific Council, Region of Southern Denmark, Danish Rheumatism Association, and the Health Region of South-East Norway. The researchers were independent from the funder.
Compliance with ethical standards
Conflict of interest
All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that they have no support from any company for the submitted work; no relationships with any company that might have an interest in the submitted work in the previous 3 years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and they have no non-financial interests that may be relevant to the submitted work.
This study was approved by the regional ethics committee of the Health Region of South-East Norway (reference No. 2009/230).