Disentangling treatment pathways for knee osteoarthritis: a study protocol for the TREATright study including a prospective cohort study, a qualitative study and a cost-effectiveness study

Simon Majormoen Bruhn, Lina Holm Ingelsrud, Thomas Bandholm, Søren Thorgaard Skou, Henrik M Schroder, Susanne Reventlow, Anne Møller, Jakob Kjellberg, Thomas Kallemose, Anders Troelsen, Simon Majormoen Bruhn, Lina Holm Ingelsrud, Thomas Bandholm, Søren Thorgaard Skou, Henrik M Schroder, Susanne Reventlow, Anne Møller, Jakob Kjellberg, Thomas Kallemose, Anders Troelsen

Abstract

Introduction: Knee osteoarthritis (OA) is associated with chronic knee pain and functional disability that negatively affect the ability to carry out normal daily activities. Patients are offered a large variety of non-surgical treatments, often not in accordance with clinical guidelines. This observational study will provide a comprehensive overview of treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon, including timing and order of treatment modalities, predictors of treatment outcomes, cost-effectiveness of treatment pathways and patients' views on different treatment pathways.

Methods and analysis: Patients with primary referrals to an orthopaedic surgeon due to knee OA are consecutively invited to participate and fill out a questionnaire prior to their consultation with an orthopaedic surgeon. Follow-up questionnaires will be obtained at 6 and 24 months after inclusion. Based on a prospective cohort study design, including questionnaires and register data, we will (1) describe treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon; (2) describe the characteristics of patients choosing different treatment pathways; (3) develop predictive models for patient-self-determined classifications of good and poor treatment outcomes; (4) evaluate the cost-effectiveness of treatment pathways that live up to clinical guidelines versus pathways that do not; based on a qualitative study design using semistructured individual interviews, we will (5) describe the patients' perspectives on treatment pathways for knee OA.

Ethics and dissemination: The study is approved by the Danish regional ethical committee (journal number H-17017295) and the Danish Data Protection Agency (journal number AHH-2017-072). Data will be anonymised and handled in line with the General Data Protection Regulation and the Danish Data Protection Act. The study results will be submitted to international open-access peer-reviewed journals and disseminated at conferences.

Trial registration number: NCT03746184, pre-results.

Keywords: knee; musculoskeletal disorders; orthopaedic & trauma surgery; quality in healthcare; rehabilitation medicine.

Conflict of interest statement

Competing interests: STS is the associate editor of the Journal of Orthopaedic & Sports Physical Therapy, has received grants from The Lundbeck Foundation, personal fees from Munksgaard and TrustMe-ED, all of which are outside the submitted work. He is cofounder of Good Life with Osteoarthritis in Denmark, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. STS is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement number 801790). Both are unrelated to the current project. TB has received speaker’s honoraria for talks or expert testimony on the efficacy of exercise therapy to enhance recovery after surgery at meetings or symposia held by biomedical companies (Zimmer Biomet and Novartis). He has received fees for writing textbook chapters (Munksgaard) and for organising postgraduate education, such as postgraduate courses in clinical exercise physiology or PhD courses on clinical research methodology. He is an exercise physiologist as well as a physical therapist; hence, a potential cognitive bias is exercise preference/love of exercise. HMS is the associate editor of The Knee. AT has received grants and personal fees from Zimmer Biomet outside the submitted work.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Timeline for data collection for the prospective cohort study.

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