Management of Hip and Knee Osteoarthritis in Primary Health Care
2018年1月30日 更新者:Nina Osteras、Diakonhjemmet Hospital
Improved Management of Patients With Hip and Knee Osteoarthritis in Primary Health Care
Previous research has shown that the osteoarthritis care for persons with hip or knee osteoarthritis in Norway has a potential for improvement as the provided care may not necessarily reflect evidence-based guideline recommendations.
This study will determine if a new model for integrated osteoarthritis (OA) care in primary health care will result in improved quality of osteoarthritis care and health benefits for the patients (reduced pain and body weight, increased function and activity level) among patients with hip and/or knee osteoarthritis.
Further, this study will examine if the new model reduce the number of unnecessary referrals to Magnetic Resonance Imaging (MRI) and to orthopaedic surgeons in secondary care, and if it increases the number of referrals to physiotherapy treatment and the number of discharge reports from the physiotherapists to the referring general practitioner.
調査の概要
詳細な説明
A new model for integrated care for patients with hip and/or knee osteoarthritis (OA) in primary care will be developed and implemented.
The purpose of the model is to improve quality of OA care in primary health care services by increasing the collaboration between health care professionals and across health care levels, providing an integrated care and a patient pathway, and facilitating an active and healthy lifestyle among individuals with OA.
This implementation study represents a collaborative study between six municipalities and a hospital department aiming to fulfill the intentions of the Norwegian Health Care Coordination Reform.
The main aim of the present study is to implement and perform process and effect evaluations of this new model for integrated OA care.
The study design will be a cluster randomized controlled trial with a stepped wedge design.
Six neighboring municipalities will constitute the six clusters, which will switch from control (current OA care) to intervention phase (new OA model) in a randomized order.
All municipalities start the trial simultaneously and act as controls until the point in time they are randomized to crossover from control to intervention, and all municipalities have implemented the intervention by the end of inclusion.
The method consists of two parts; 1) Identification of barriers/facilitators + development of the model and interventions, 2) Implementation of the new model (interactive workshops) with process and effect evaluations.
Participants will be general practitioners and physiotherapists in primary care as well as people with hip or knee OA.
研究の種類
介入
入学 (実際)
393
段階
- 適用できない
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
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Oslo、ノルウェー、0319
- Diakonhjemmet Hospital
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参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
45年歳以上 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
説明
Inclusion Criteria:
- Activity-related hip and/or knee pain/complaints AND
- Clinical signs and symptoms corresponding to hip and/or knee OA OR radiologically diagnosed OA OR Registered in the medical journal with the ICPC codes L89 (osteoarthritis of the hip), L90 (osteoarthritis of knee), L91 (osteoarthritis not classified elsewhere), L13 (hip symptoms/complaints), L15 (knee symptoms/complaints) and/or L20 (joint symptoms/complaints not classified elsewhere).
Exclusion Criteria:
- Total hip or knee replacement in the actual joint(s) and no pain/complaints in the other hip or knee joint(s)
- Inflammatory rheumatic diseases (e.g. rheumatoid arthritis, spondyloarthritis)
- Malignant illness or other major conditions (i.e unstable cardiovascular disorders or lung disease, dementia) that restrict the ability to adhere to the recommended OA treatment
- Do not understand the Norwegian language
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:クロスオーバー割り当て
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
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介入なし:Control group
Usual care.
The participants enrolled in the control period will receive OA treatment as it is currently offered in primary health care services.
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実験的:Intervention group
New OA model.
Health professionals attend an interactive workshop, implementation of international recommendations for OA care, multidiciplinary collaboration
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The general practitioners and the physiotherapists will attend an inter-active workshop and deliver osteoarthritis care in line with international recommendations for osteoarthritis treatment.
The general practitioner will refer eligible patients to treatment by physiotherapists at "Healthy Living Center" or by physiotherapists in private practice.
This treatment will include a standardized patient education program followed by structured exercise program with individual adjustments.
The general practitioner will schedule a follow-up after the 12-week treatment and will receive a treatment report from the physiotherapist.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Osteoarthritis Quality Indicator questionnaire
時間枠:6 months
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Patient reported achievement of quality indicators for osteoarthritis care
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6 months
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Pain
時間枠:6 months
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Pain level in hip/knee past week
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6 months
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Joint stiffness
時間枠:6 months
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Stiffness in the hip/knee past week
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6 months
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Global function
時間枠:6 months
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Hip/knee function in the past week
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6 months
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Patient global assessment of the OA disease
時間枠:6 months
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6 months
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Patient Acceptable Symptom State (PASS)
時間枠:6 months
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6 months
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Hip/knee function, quality of living subscale
時間枠:6 months
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Function (Knee injury and Osteoarthritis Outcome Score ADL subscale/ Hip disability and Osteoarthritis Outcome Score OoL subscale (K/HOOS)
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6 months
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Physical activity level
時間枠:6 months
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An index based on self-reported frequency, intensity, duration of physical activity
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6 months
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Daily sitting
時間枠:6 months
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Daily hours in sitting position
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6 months
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Satisfaction with the care provided
時間枠:6 months
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6 months
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Health related quality of life (EQ-5D)
時間枠:6 months
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6 months
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Self-reported body weight
時間枠:6 months
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6 months
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Health care use, medication use and sick leave
時間枠:6 months
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6 months
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Adverse events
時間枠:Up to 1 year
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Up to 1 year
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Health professionals' knowledge, attitude and behavior in OA care
時間枠:Pre- and post-workshop + 6 months post-workshop
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Pre- and post-workshop + 6 months post-workshop
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Referrals to orthopaedic surgeons
時間枠:Up to 1 year
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Number of referrals to secondary care that does not lead to scheduled joint surgery
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Up to 1 year
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Referrals to MRI
時間枠:Up to 1 year
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Number of referrals to MRI for OA assessment
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Up to 1 year
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Number of referrals to physiotherapy treatment
時間枠:Up to 1 year
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Up to 1 year
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Discharge reports from physiotherapists
時間枠:Up to 1 year
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Number of discharge reports from PTs at FLSs/ private practice to the referring GP
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Up to 1 year
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Arthritis Self-efficacy Scale
時間枠:6 months
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6 months
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協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
スポンサー
捜査官
- スタディディレクター:Kåre Hagen, Prof.、Project administrator/Research director
- 主任研究者:Nina Østerås, PhD、Researcher
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
- Moseng T, Dagfinrud H, van Bodegom-Vos L, Dziedzic K, Hagen KB, Natvig B, Rotterud JH, Vlieland TV, Osteras N. Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial. BMC Musculoskelet Disord. 2020 Apr 13;21(1):236. doi: 10.1186/s12891-020-03235-z.
- Osteras N, Moseng T, van Bodegom-Vos L, Dziedzic K, Mdala I, Natvig B, Rotterud JH, Schjervheim UB, Vlieland TV, Andreassen O, Hansen JN, Hagen KB. Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial. PLoS Med. 2019 Oct 15;16(10):e1002949. doi: 10.1371/journal.pmed.1002949. eCollection 2019 Oct. Erratum In: PLoS Med. 2019 Dec 19;16(12):e1002993.
- Moseng T, Dagfinrud H, Osteras N. Implementing international osteoarthritis guidelines in primary care: uptake and fidelity among health professionals and patients. Osteoarthritis Cartilage. 2019 Aug;27(8):1138-1147. doi: 10.1016/j.joca.2019.03.010. Epub 2019 May 8.
- Osteras N, van Bodegom-Vos L, Dziedzic K, Moseng T, Aas E, Andreassen O, Mdala I, Natvig B, Rotterud JH, Schjervheim UB, Vlieland TV, Hagen KB. Implementing international osteoarthritis treatment guidelines in primary health care: study protocol for the SAMBA stepped wedge cluster randomized controlled trial. Implement Sci. 2015 Dec 2;10:165. doi: 10.1186/s13012-015-0353-7.
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2015年1月1日
一次修了 (実際)
2017年10月1日
研究の完了 (実際)
2017年10月1日
試験登録日
最初に提出
2015年1月4日
QC基準を満たした最初の提出物
2015年1月5日
最初の投稿 (見積もり)
2015年1月7日
学習記録の更新
投稿された最後の更新 (実際)
2018年2月1日
QC基準を満たした最後の更新が送信されました
2018年1月30日
最終確認日
2018年1月1日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
New OA modelの臨床試験
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Nanyang Technological UniversityKK Women's and Children's Hospital; Club Rainbow Singapore; Muscular Dystrophy Association Singapore と他の協力者わからない
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Oasis Pharmaceuticals, LLCMayo Clinic; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)募集
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Afeka, The Tel-Aviv Academic College of EngineeringHebrew University of Jerusalem完了
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University of PennsylvaniaKarolinska University Hospital; Leiden University Medical Center; Vittore Buzzi Children's Hospital と他の協力者完了