Determining the Impact of a Physiotherapist-Led Primary Care Model for Hip and Knee Pain - A Pilot Trial

Jordan Miller, PT, PhD205 enrolled

Overview

This is a pilot cluster randomized controlled trial to to evaluate the individual and health system impacts of implementing a new physiotherapist-led primary care model for hip and knee pain in Canada.

Arthritis is one of the leading causes of pain, disability, and reduced quality of life in patients. Arthritis currently affects one in five Canadians (six million), which is expected to rise to nine million people by 2040. Osteoarthritis (OA) is the most common forms of arthritis, with hip and knee being two of the most common locations. For most people, the first point of contact for their pain is their primary care provider. Due to the rise in patients seeking support at the primary care level, the shortage of primary care providers, and the high burden on these providers, patients often do not receive timely access to the care they require. A promising strategy is to have an integrated model of care where a physiotherapist (PT) is the first point of contact within interprofessional primary care teams. PTs can provide a comprehensive and efficient management strategy for patients presenting to their primary care provider with hip and knee pain complaints. This study aims to determine the feasibility of conducting a cluster randomized trial in primary care settings in Ontario to evaluate the individual health outcomes and health system impact of implementing a new physiotherapist-led primary care model for people with hip and knee pain. The primary objectives of this pilot study are: 1. Determine the feasibility of participant recruitment, assessment procedures, and retention. 2. Determine the feasibility of implementing a new PT led primary care model for hip and knee pain. 3. Explore the perspectives of patient participants and HCPs related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value and impact on clinic processes and patient participant outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

205

Conditions

Hip Osteoarthritis Knee Osteoarthritis

Interventions

Physiotherapist-led primary care model for hip and knee painOTHER

1. Initial assessment and screening: The PT will provide a comprehensive assessment according to established clinical practice guidelines. 2. Brief individualized intervention at first visit: The PT intervention will be at the discretion of the PT to reflect real-world PT intervention. 3. Health services navigation: Participants will be provided with options available to them in their community for rehabilitation. For example, they may be referred to community PT for ongoing management or presented with group exercise options. Participants will be assessed regarding the need for specialist referrals or resources available to manage complex clinical presentations such as comorbidity or frailty. Participants may be referred to the primary care provider if no specialized services are needed or when the PT cannot provide a direct referral. All individuals may have their medications reviewed by a physician if deemed appropriate by the PT or requested by the participant.

Usual physician-led primary care model for hip and knee painOTHER

The physician led primary care intervention will be unstandardized to best reflect standard clinical practice in Canada.

Eligibility

Sex: ALLMin age: 19 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: \- Adults \>= 19 years who ask to book a primary care visits where the primary reason is for hip or knee pain of any duration. Exclusion Criteria: * Cannot understand, read, and write English * Known cancer causing hip or knee pain

Locations (1)

Queen's University

Kingston, Ontario, Canada

Outcomes

Primary Outcomes

Participant Recruitment Rate

A full trial will be feasible if the investigators are able to recruit 1.5 participants per week per site over 20 weeks

Time frame: 20 weeks

Assessment Procedures

The investigators consider ≥80% of all assessment items completed and a mean time for completion of ≤60 minutes acceptable.

Time frame: 12 months

Retention

The investigators consider an attrition rate of ≤20% at 12-month follow-up successful. ≤35% attrition will be considered partially successful; however, additional retention strategies would be required for the full trial based on evidence that ≥20% attrition threatens trial validity

Time frame: 12 months

PT Treatment Fidelity

Treatment fidelity will be measured through an audit of a PT fidelity checklist and electronic medical record (EMR) to determine the consistency of the care provided. An acceptable level of fidelity will be considered ≥80% for each intervention component.

Time frame: 20 weeks

Secondary Outcomes

Self-Reported Functioning

Self-report using the Lower Extremity Functional Scale (0-80 score with higher score representing higher function)