Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT) in knee osteoarthritis: Effectiveness-implementation hybrid randomized controlled trial of a community-based, multidisciplinary, stratified intervention

Bryan Yijia Tan, Yang Su-Yin, Michelle Jessica Pereira, Tan Chun Yue, Lim Chien Joo, N G Julia Poh-Hwee, Lee Keng Thiam, Pua Yong Hao, Andrew M Briggs, David J. Hunter, Soren T Skou, Julian Thumboo, Josip Car

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstract

OBJECTIVE: To compare the clinical and cost effectiveness of the Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT), a community-based, stratified, multidisciplinary intervention consisting of exercise, education, psychological and nutrition delivered through a chronic care model to usual hospital care in adults with knee osteoarthritis (OA).

METHODS: Pragmatic, parallel-arm, single-blinded superiority RCT trial. Community-dwelling, ambulant adults with knee OA (Kellgren-Lawrence grade > 1; Knee Injury and OA Outcome Score (KOOS 4) ≤75) were enrolled. Primary outcome was KOOS 4 at 12-months; secondary outcomes included: quality of life, physical performance measures, symptom satisfaction, psychological outcomes, dietary habits, and global perceived effect. Intention-to-treat analysis using generalized linear model (GLM) and regression modeling were conducted. Economic evaluation through a societal approach was embedded.

RESULTS: 110 participants (55 control, 55 intervention) were randomized. No between-group difference found for the primary outcome (MD [95%CI]: -1.86 [-9.11. 5.38]), although both groups demonstrated within-group improvement over 12-months. Among the secondary outcomes, the CONNACT group demonstrated superior dietary change (12 months) and physical performance measures (3 months), and global perceived effect (6 months). While there was no between-group difference in total cost, significant productivity gains (reduced indirect cost) were seen in the CONNACT group.

CONCLUSION: CONNACT was not superior to usual care at 1 year. Further efforts are needed to understand the underlying contextual and implementation factors in order to further improve and refine such community-based, stratified care models moving forward.

TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT03809975. Registered January 18, 2019. https://clinicaltrials.gov/ct2/show/NCT03809975.

OriginalsprogEngelsk
TidsskriftOsteoarthritis and Cartilage
DOI
StatusUdgivet, E-publikation før trykning - 6 maj 2024

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Copyright © 2024 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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