基于患者自报与功能数据,构建更精准的膝骨关节炎疼痛变化预测模型。
Personalized Prediction Models for Changes in Knee Pain among Patients with Osteoarthritis Participating in Supervised Exercise and Education
- 用自报信息和功能指标训练随机森林模型,筛选出6个关键变量。
- 模型预测准确率达58%(允许15分误差),优于平均值的51%。
- 提示需引入新变量才能提升预测性能,适合临床个性化干预决策。
膝骨关节炎(OA)是一种普遍的慢性疾病,影响行动能力并降低生活质量。尽管运动疗法和患者教育对缓解疼痛和功能障碍有效,但应用率仍较低。个性化预后模型可提高患者参与度,但现有模型在预测膝痛变化方面的准确性尚不充分。本研究旨在验证现有模型,并提出一个简洁的个性化模型,用于预测膝骨关节炎患者参与监督式教育与运动治疗项目(GLA:D)前后的疼痛变化。模型使用患者自报信息及功能测量数据,通过变量重要性评估与临床推理精简变量。我们训练了随机森林回归模型,比较了全量、连续变量及仅6个最具预测力变量的模型表现。三种模型表现相似,R²为0.31–0.32,均方根误差(RMSE)为18.65–18.85,与已有模型相当,尽管样本量更大。允许15点疼痛评分偏差时,简洁模型正确预测比例达58%,高于平均值的51%。补充分析结果一致。表明该简洁模型比平均改善值更准确预测疼痛变化,但样本量扩大或增加变量未提升性能,提示需引入GLA:D以外的新变量以改进预测。
原文摘要 · Abstract (English)
Knee osteoarthritis (OA) is a widespread chronic condition that impairs mobility and diminishes quality of life. Despite the proven benefits of exercise therapy and patient education in managing the OA symptoms pain and functional limitations, these strategies are often underutilized. Personalized outcome prediction models can help motivate and engage patients, but the accuracy of existing models in predicting changes in knee pain remains insufficiently examined. To validate existing models and introduce a concise personalized model predicting changes in knee pain before to after participating in a supervised education and exercise therapy program (GLA:D) for knee OA patients. Our models use self-reported patient information and functional measures. To refine the number of variables, we evaluated the variable importance and applied clinical reasoning. We trained random forest regression models and compared the rate of true predictions of our models with those utilizing average values. We evaluated the performance of a full, continuous, and concise model including all 34, all 11 continuous, and the six most predictive variables respectively. All three models performed similarly and were comparable to the existing model, with R-squares of 0.31-0.32 and RMSEs of 18.65-18.85 - despite our increased sample size. Allowing a deviation of 15 VAS points from the true change in pain, our concise model and utilizing the average values estimated the change in pain at 58% and 51% correctly, respectively. Our supplementary analysis led to similar outcomes. Our concise personalized prediction model more accurately predicts changes in knee pain following the GLA:D program compared to average pain improvement values. Neither the increase in sample size nor the inclusion of additional variables improved previous models. To improve predictions, new variables beyond those in the GLA:D are required.
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