Development of a clinical decision-support tool for management of adolescent knee pain (The MAP-Knee tool)

Abstract

Background: Adolescent knee pain was historically viewed as a self-limiting condition. Still, it may severely impact health-related quality of life and physical activity, and almost half of adolescents may continue to experience pain into adulthood. Currently, no tool is available to support the consultation and shared decision-making process when an adolescent suffering from non-traumatic knee pain presents at clinical practice. By supporting shared decision-making and tailoring management strategies, such a tool could optimize treatment delivery and improve the prognosis of this common condition.

Objectives: This study aimed to develop a clinical decision-support tool (The MAP-Knee Tool) to improve the management of adolescents with non-traumatic knee pain.

Design: Development study with end-user testing.

Method: This multi-step study consisted of five steps ((1-4) initial development and (5) end-user testing with adolescents with or without non-traumatic knee pain and medical doctors). It ended with the first version of the MAP-Knee Tool for the six most common non-traumatic knee pain conditions. The tool includes four components: 1) tool for diagnosing, 2) credible explanations of the diagnoses based on two systematic literature searches and an Argumentative Delphi process with international experts, 3) prognostic factors based on an individual participant data meta-analysis, and 4) option grid including an unbiased presentation of management options based on the available evidence.

Results: We included seven children/adolescents (8-15 years old) and seven medical doctors for the end-user testing. All four components were revised accordingly, and the text was condensed as the initial draft was too comprehensive.

Conclusions: We developed a clinical decision-support tool for clinicians and adolescents with non-traumatic knee pain based on a multi-step process, including end-user testing to support the consultation in clinical practice.

Keywords: Adolescents; Decision support tool; Diagnostic uncertainty; Knee pain; Shared decision-making.