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Clinical diagnosis of symptomatic midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot

Thomas, M.J.; Roddy, E.; Rathod, T.; Marshall, M.; Moore, A.; Menz, H.B.; Peat, G.

Clinical diagnosis of symptomatic midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot Thumbnail


Authors

T. Rathod

A. Moore

H.B. Menz

G. Peat



Abstract

OBJECTIVE: To derive a multivariable diagnostic model for symptomatic midfoot osteoarthritis (OA). METHODS: Information on potential risk factors and clinical manifestations of symptomatic midfoot OA was collected using a health survey and standardised clinical examination of a population-based sample of 274 adults aged =50 years with midfoot pain. Following univariable analysis, random intercept multi-level logistic regression modelling that accounted for clustered data was used to identify the presence of midfoot OA independently scored on plain radiographs (dorso-plantar and lateral views), and defined as a score of =2 for osteophytes or joint space narrowing in at least one of four joints (first and second cuneometatarsal, navicular-first cuneiform and talonavicular joints). Model performance was summarised using the calibration slope and area under the curve (AUC). Internal validation and sensitivity analyses explored model over-fitting and certain assumptions. RESULTS: Compared to persons with midfoot pain only, symptomatic midfoot OA was associated with measures of static foot posture and range-of-motion at subtalar and ankle joints. Arch Index was the only retained clinical variable in a model containing age, gender and body mass index (BMI). The final model was poorly calibrated (calibration slope, 0.64, 95% CI: 0.39, 0.89) and discrimination was fair-to-poor (AUC, 0.64, 0.58, 0.70). Final model sensitivity and specificity were 29.9% (22.7, 38.0) and 87.5% (82.9, 91.3), respectively. Bootstrapping revealed the model to be over-optimistic and performance was not improved using continuous predictors. CONCLUSIONS: Brief clinical assessments provided only marginal information for identifying the presence of radiographic midfoot OA among community-dwelling persons with midfoot pain.

Citation

Thomas, M., Roddy, E., Rathod, T., Marshall, M., Moore, A., Menz, H., & Peat, G. (2015). Clinical diagnosis of symptomatic midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Osteoarthritis and Cartilage, 23(12), 2094-2101. https://doi.org/10.1016/j.joca.2015.06.010

Journal Article Type Article
Acceptance Date Jun 9, 2015
Online Publication Date Jun 17, 2015
Publication Date 2015-12
Journal Osteoarthritis and Cartilage
Print ISSN 1063-4584
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 23
Issue 12
Pages 2094-2101
DOI https://doi.org/10.1016/j.joca.2015.06.010
Keywords Midfoot; Pain; Osteoarthritis; Diagnosis; Primary care
Publisher URL https://doi.org/10.1016/j.joca.2015.06.010

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