PT-led Triage for Patients With Hip o Knee Osteoarthritis

PT-led Triage in Secondary Care Settings for Patients With Hip or/and Knee Osteoarthritis

The aim of this project is to compare PT-led triage in secondary care setting for patients with hip or/and knee osteoarthritis (OA) with standard care (i.e. assessment of orthopedic surgeon). Comparison between cost-effectiveness, selection accuracy, patients perceived quality of care, quality of life and physical function will be made.

A further aim is to explore patients expectations and experiences of PT-led triage in a secondary care setting.

Study Overview

• Status: Active, not recruiting
• Conditions: Knee Osteoarthritis; Hip Osteoarthritis
• Intervention / Treatment: Other: Assessment by PT/Orth surgeon

Detailed Description

Osteoarthritis (OA) is a common musculoskeletal disorder and the number of people in need of surgical treatment for hip and knee OA is increasing. The waiting time for consultation with an orthopedic surgeon (OS) is long and the majority of the patient referred for assessment are not appropriate for surgical intervention. To reduce the number of patients seen by an OS and thereby shorten the waiting time, Sahlgrenska University Hospital started a Physiotherapist-led (PT-led) triage project in 2017. With PT-led triage the patients are assessed by a physiotherapist to establish the most appropriate care management; if the patient is appropriate for surgery, should be referred for continued rehabilitation, or referred back to the referring physician. To our knowledge this model of care with PT-led triage in secondary care setting have not been scientifically evaluated in Sweden.

The aim of this project is to compare PT-led triage in a secondary care setting with standard care (i.e. assessment of OS for patients with knee or /and hip OA). A further aim is to determine if a digital triage tool can accurately predict when a primary knee or hip referral is deemed for nonsurgical versus surgical intervention by the surgeon following the first consultation.

Patients referred from primary care to Sahlgrenska University hospital with primary hip and/or knee OA will be included and randomized to consultation with either PT (triage) or OS (standard practice). Data about patient reported health-related quality of life, pain, function, and patients' perception of quality of care will be collected using questionnaires at baseline, 3 and 12 months after the consultation.

Data about waiting time for consultation, proportion of patients appropriate for surgery, further investigations, and data to be able to perform cost analysis will be collected from patients´ journals, the patient administration systems, both locally and via the region Västra Götaland´s database (VEGA).

A qualitative approach will be used to further investigate patients expectations and experience of a PT-led trige.

• Study Type: Interventional
• Enrollment (Actual): 675
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Gothenburg, Sweden
    • Sahlgrenska University Hospital
  • Västra Götaland
    • Gothenburg, Västra Götaland, Sweden
      • Sahlgrenska University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Referred to Sahlgrenska University hospital
• Primary osteoarthritis in the hip or knee
• Understanding and speaking Swedish

Exclusion Criteria:

• Prior assessment by and referral from an orthopedic surgeon for the current problem
• Secondary osteoarthritis (posttraumatic osteoarthritis, femoral head necrosis), when stated on the referral
• Referred to a specific surgeon

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: PT-led triage; Patients are assessed by PT	Other: Assessment by PT/Orth surgeon; Assessment by orthopaedic surgeon or a PT
Other: Standard care; The patiens are assessed by a orthopedic surgeon	Other: Assessment by PT/Orth surgeon; Assessment by orthopaedic surgeon or a PT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Short form of the Quality from Patients Perspective (QPP)	A Measure of patients' perception of quality of care regarding four dimensions: caregivers' medical-technical competence; care organizations' physical-technical conditions; degree of identity-orientation in the caregivers' attitudes and actions; and the care organizations' socio-cultural atmosphere	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heath-related quality of life - EuroQol (EQ5-D)	Measure of health-related quality of life and consists of 5 items. General health is measured using a VAS scale (0 to 100) with 100 being the best possible health state	Baseline, 3 and 12 months
Pain Disability index (PDI	A questionnaire where respondents are asked to rate disability on a numeric rating scale ranging from 0 (no disability) to 10 (maximum disability) in seven areas; family and home responsibilities, recreation, social activity, occupation, sexual behavior, self-care, and life-support activity.	Baseline, 3 and 12 months
Forgotten Joint Score (FJS)	A questionnaire that was developed to find subtle differences between patients who grade their hip / knee as "very good" and "excellent". The score is graded from 0 to 100, where a high score is better	Basline, 3 and 12 months
Oxford Hip/Knee Score (OHS/OHK	A questionnaire consisting of 12 questions that concern areas such as pain and disabilities the patient has experienced during the past four weeks.	Basline, 3 and 12 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients expectations and experiences of PT-led triage	Qualitative semistructured one to one interviews	Interviews sep 2024-nov 2024

Collaborators and Investigators

• Sponsor: Sahlgrenska University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 26, 2020
• Primary Completion (Estimated): December 31, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: December 7, 2020
• First Submitted That Met QC Criteria: December 7, 2020
• First Posted (Actual): December 14, 2020

Study Record Updates

• Last Update Posted (Actual): May 11, 2025
• Last Update Submitted That Met QC Criteria: May 6, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Keywords: Osteoarthritis; Knee; Hip; PT-led triage
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee; Osteoarthritis, Hip
• Other Study ID Numbers: Triage and hip/knee OA

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No