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

doi:10.1016/j.joca.2024.04.018

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

Department of Physiotherapy and Occupational Therapy (PROgrez)

Research output: Contribution to journal › Article › Research › peer-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.

Original language	English
Pages (from-to)	972-981
Number of pages	10
Journal	Osteoarthritis and Cartilage
Volume	32
Issue number	8
Early online date	6 May 2024
DOIs	https://doi.org/10.1016/j.joca.2024.04.018
Publication status	Published - Aug 2024

Funding

Dr. Skou is currently funded by a grant from Region Zealand (Exercise First) and two grants from the European Union's Horizon 2020 research and innovation program, one from the European Research Council (MOBILIZE, grant agreement No. 801790) and the other under grant agreement No. 945377 (ESCAPE).

Funders	Funder number
Region Sjælland
European Research Council under the European Union	801790
European Union	945377

Keywords

Aged
Allied Health Personnel
Cost-Benefit Analysis
Exercise Therapy/methods
Female
Humans
Male
Middle Aged
Orthopedics
Osteoarthritis, Knee/therapy
Patient Care Team
Quality of Life
Single-Blind Method
Knee osteoarthritis
Randomized control trial
Service model
Stratified
Community

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Tan, B. Y., Su-Yin, Y., Pereira, M. J., Yue, T. C., Joo, L. C., Julia Poh-Hwee, N. G., Thiam, L. K., Hao, P. Y., Briggs, A. M., Hunter, D. J., Skou, S. T., Thumboo, J., & Car, J. (2024). 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. Osteoarthritis and Cartilage, 32(8), 972-981. https://doi.org/10.1016/j.joca.2024.04.018

Tan, Bryan Yijia ; Su-Yin, Yang ; Pereira, Michelle Jessica et al. / 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. In: Osteoarthritis and Cartilage. 2024 ; Vol. 32, No. 8. pp. 972-981.

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title = "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",

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.",

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

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doi = "10.1016/j.joca.2024.04.018",

language = "English",

volume = "32",

pages = "972--981",

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Tan, BY, Su-Yin, Y, Pereira, MJ, Yue, TC, Joo, LC, Julia Poh-Hwee, NG, Thiam, LK, Hao, PY, Briggs, AM, Hunter, DJ, Skou, ST, Thumboo, J & Car, J 2024, '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', Osteoarthritis and Cartilage, vol. 32, no. 8, pp. 972-981. https://doi.org/10.1016/j.joca.2024.04.018

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. / Tan, Bryan Yijia; Su-Yin, Yang; Pereira, Michelle Jessica et al.
In: Osteoarthritis and Cartilage, Vol. 32, No. 8, 08.2024, p. 972-981.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT) in knee osteoarthritis

T2 - Effectiveness-implementation hybrid randomized controlled trial of a community-based, multidisciplinary, stratified intervention

AU - Tan, Bryan Yijia

AU - Su-Yin, Yang

AU - Pereira, Michelle Jessica

AU - Yue, Tan Chun

AU - Joo, Lim Chien

AU - Julia Poh-Hwee, N G

AU - Thiam, Lee Keng

AU - Hao, Pua Yong

AU - Briggs, Andrew M

AU - Hunter, David J.

AU - Skou, Soren T

AU - Thumboo, Julian

AU - Car, Josip

PY - 2024/8

Y1 - 2024/8

N2 - 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.

AB - 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.

KW - Aged

KW - Allied Health Personnel

KW - Cost-Benefit Analysis

KW - Exercise Therapy/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Orthopedics

KW - Osteoarthritis, Knee/therapy

KW - Patient Care Team

KW - Quality of Life

KW - Single-Blind Method

KW - Knee osteoarthritis

KW - Randomized control trial

KW - Service model

KW - Stratified

KW - Community

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DO - 10.1016/j.joca.2024.04.018

M3 - Article

C2 - 38710437

SN - 1063-4584

VL - 32

SP - 972

EP - 981

JO - Osteoarthritis and Cartilage

JF - Osteoarthritis and Cartilage

IS - 8

ER -

Tan BY, Su-Yin Y, Pereira MJ, Yue TC, Joo LC, Julia Poh-Hwee NG et al. 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. Osteoarthritis and Cartilage. 2024 Aug;32(8):972-981. Epub 2024 May 6. doi: 10.1016/j.joca.2024.04.018