Implementation of a community-based, physiotherapy-led, multidisciplinary model of care for the management of knee osteoarthritis: protocol for a feasibility study

Abstract

IntroductionThere is a gap between the care people with knee osteoarthritis (OA) should receive according to evidence-based guidelines and the care they do receive. This feasibility study aims to test the feasibility of developing and implementing a codesigned, physiotherapy-led, multidisciplinary, evidence-based model of care for knee OA, among community physiotherapy practices in Australia, where community practice is defined as a professional physiotherapy business that is not controlled or paid for by the government.Methods and analysisA mixed-methods quasi-experimental (pre/postintervention) study. In the preintervention phase, all consented physiotherapists working in nine metropolitan-based, community physiotherapy practices, and 26 patients with knee OA will be recruited. Patients will be recruited from all practices by the physiotherapists, using the outlined inclusion/exclusion criteria. An audit of physiotherapy treatment notes will occur using a proforma, to gain an understanding of current community physiotherapy treatment and documentation. Patient and physiotherapist interviews will be conducted to determine current practice for the management of knee OA. A codesign phase will follow, where a model of care will be developed by researchers, patients, clinical staff, members of the public and other stakeholders, based on current guidelines for conservative management of knee OA. In the postintervention phase, a further 26 patients will be recruited, and the assessment process repeated to determine whether there is a change in practice. The feasibility outcome measures are: (1) number of patients who are recorded as receiving care according to current evidence-based guidelines; (2) number of patients who have patient-reported outcomes incorporated into their assessment and management plan; and (3) acceptability of the developed model to patients and physiotherapists. The clinical outcomes will include assessment of patient-reported outcome measures (pain, function, etc) in the preintervention and postintervention phases (baseline and 12 weeks) to assess trends towards change in participant symptoms.Ethics and disseminationEthical approval has been obtained from the University of New South Wales human ethics committee (approval number HC180864, approval period 6 February 2019 to 5 February 2024). The preintervention stage of this study is complete. The next stage is to implement the intervention and compare outcomes between the preintervention and postintervention phases. The results will be disseminated via peer-reviewed publications and presentations at conferences.Trial registration numberThe preintervention phase of the study is retrospectively registered at ClinicalTrials.gov with registration number: ACTRN12620000188932. The intervention and postintervention phase of the study is prospectively registered at ClinicalTrials.gov with registration number: ACTRN12620000218998.

The Use of Co-production, Co-design and Co-creation to Mobilise Knowledge in the Management of Health Conditions: A Systematic Review

“…Five of these studies collected and presented survey data alongside the narrative data (30,42,43,48,49). Three papers were qualitative study protocols (31,37,47). One was a patient-led (co-designed) qualitative study (46), and there were three case study collections (34,44,45).…”

“…Others were coproduction or co-design of a whole research project (29,(44)(45)(46). Prioritisation and consensus techniques were common, including nominal group and Delphi techniques (27,31,34,37,43,(47)(48)(49). One study used a writing committee (43) and others used meetings and discussion groups (27,32,36,37,44,49).…”

“…Prioritisation and consensus techniques were common, including nominal group and Delphi techniques (27,31,34,37,43,(47)(48)(49). One study used a writing committee (43) and others used meetings and discussion groups (27,32,36,37,44,49). Generally some form of workshop was common.…”

“…However, these claims were not based on robust evaluation data and evaluation methods were not clearly reported. A number of authors felt improving the relevance (40,41,43,46), acceptability (37,40) and usability (40,41) of outputs would improve outcomes or quality of care.…”

MicroRNA-186 ameliorates Knee osteoarthritis via regulation of P2X7-mediated Cathepsin-K/Runx2/ADAMTS5 signalling axis in articular chondrocytes

“…Knee osteoarthritis (KOA) is a chronic progressive joint deterioration disease involving the articular cartilage and tissues around the synovial joint ( Livings et al, 2020 ). KOA is associated with an increased death risk when compared to the normal population ( Heidari, 2011 ).…”