Osteoarthritis, Knee, Osteoarthritis, Hip
Conditions
Keywords
physiotherapy, osteoarthritis, digital care
Brief summary
The overall aim of this study is to compare three different care models for patients with hip- and knee osteoarthritis. The primary aim is to evaluate whether an app-based care model is more beneficial for improving function in daily life than a web-based care model and standard care for patients with hip and / or knee osteoarthritis
Detailed description
The primary aim of this study is to evaluate whether an app-based care model is more beneficial for improving function in daily life than a web-based care model and standard care for patients with hip and / or knee osteoarthritis. The secondary aims are to evaluate how 1) patient-related outcome measures regarding the ability of the patient to forget about their problematic joint after treatment, quality of life, pain-related self-efficacy, and level of physical activity and 2) care consumption, cost-effectiveness, and carbon footprint differ between the three care models in a short-term (three months) and long-term perspective (one and three years respectively). Further aims are to evaluate how patient experience of the benefits provided by the two digital care models differs, how patient experience with respect to work alliance differs between the three care models, describe the adherence to using the app in the app-based care model and to describe what patient characteristics are associated with clinically meaningful improvements in function in daily life among patients recieving app-based care. The primary hypothesis is that patients who are randomized to an app-based care model will improve significantly more in terms of function in daily life from baseline to one year compared with patients who are randomized to a web-based model and usual care. The secondary hypothesis is that patients randomized to the app-based care model change equivalently from baseline to one year in terms of patient-reported measures, but that the app-based care model is more cost-effective compared with the other two care models at one and three years, respectively.
Interventions
OTHERPatient information
Patient education according to national guidelines, with information about e.g. disease progression, symptoms, treatment, exercise, self-care techniques and dietary information
OTHERSmart phone application based exercises
Individually based exercise programs individualized exercises where instructions are given through real-time video or pictures in combination with written descriptions.
OTHERWeb based exercises
Generic osteoarthritis exercise, including about 20 different exercises, provided by real-time videos and written description
OTHERGroup based information
Osteoarthritis specific information at three different group meeting (physical or digital) led by a physiotherapist, an occupational therapist and / or dietitian (each rehab clinic makes its own arrangement).
The patient is offered to regularly exercise at the clinic, individually or in a group under supervision from a physiotherapist.
OTHERSelf-monitoring
Patients will be followed by validated questionnaires and function tests (30 sec Chair-to-stand test) every six months until three years after the start of treatment. The patients will get a report of the results and a research coordinator will contact the patients if their symptoms/function has worsen and discuss further treatment
BEHAVIORALMotivational notifications
Automatic and daily reminders and / or motivational notifications
Individualized exercises that the patient performs on their own, i.e. at home or at a gym.
Sponsors
Vastra Gotaland Region
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
The participant: * has given their written consent to participate in the study * has been referred to the orthopaedic clinic at Sahlgrenska University Hospital /Mölndal for primary hip- and or knee osteoarthritis * has a positive attitude in using digital tools * has access to a smart phone / tablet * has been assessed not to be in need of hip or knee surgery trough triage based on a patient reported outcome (the Osteoarthritis Guidelines Instrument)
Exclusion criteria
Patients: * with secondary osteoarthritis (due to osteonecrosis) * referred to a specific orthopaedic surgeon * with impaired mental ability, reluctance or language difficulties that make it difficult to understand the meaning of participating in the study * who undergo treatment, have disability or illness that according to the research group can affect the treatment or the study result
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hip dysfunction/Knee Osteoarthritis Outcome Score (HOOS/KOOS) subscale Function in daily living (ADL) | baseline to 12 months after inclusion | The KOOS/HOOS questionnaires were developed as instruments to assess the patient's opinion about their knee and associated problems. KOOS consists of 5 subscales: Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and knee related Quality of life (QOL). The previous week is the time period considered when answering the questions. Standardized answer options are given (5 Likert boxes) and each question is assigned a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale (scoring instructions are available in a separate document). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Forgotten joint score (hip/knee) (FJS) | baseline | A questionnaire that was developed to find subtle differences between patients who grade their hip / knee as very good and excellent. The score is graded from 0 to 100, where a higher score is better. |
| Swedish National Board of Health and Welfare questions about physical activity | baseline | Questions intended for use in clinical health care to identify people that are insufficiently physically active. The respondents report their total time, in minutes, of moderate and vigorous physical activity, respectively, during a normal week on a categorical scale from a) 0-30 minutes, up to g) \>300 minutes. |
| Heath-related quality of life - EuroQol (EQ5-D) | baseline | Measure of health-related quality of life and consists of 5 items. General health is measured using a visual analog scale (0 to 100) with 100 being the best possible health state. |
| Medtech20 | 3 months after inclusion | A standardized tool measuring how medical devices affect people's sense of security, integrity, social participation and convenience. Each item is rated on a seven graded Likert-scale from, 0 = disagree to 6 = completely agree. Each item also has a Not applicable response option. A higher score indicates a better effect of the medical device. |
| Hip dysfunction/Knee Osteoarthritis Outcome Score (HOOS/KOOS) subscale pain, symptoms, function in sport and recreation, and knee/hip related quality of life | baseline | The KOOS/HOOS questionnaires were developed as instruments to assess the patient's opinion about their knee and associated problems. KOOS consists of 5 subscales: Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and knee related Quality of life (QOL). The previous week is the time period considered when answering the questions. Standardized answer options are given (5 Likert boxes) and each question is assigned a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale (scoring instructions are available in a separate document). |
| Pain Self-Efficacy Scale - 2 item | baseline | The Pain Self-Efficacy Questionnaire (PSEQ) is an established 10-item measure of pain self-efficacy that is widely used in clinical and research settings. In the present study a short form of the original questionnaire will be used. The two items are graded from 0 = not at all certain to 6 = very certain. |
| Cost Effectiveness | 3 months after inclusion | Indirect and direct health care costs. Total costs, costs per patient and per visit. Loss of income will be reported as number of days of abscence due to illness. |
| Assessment of carbon dioxide (CO2) equivalent emissions in kg - travelling | Baseline | Travelling to/from health care visits based on travel data reported in a questionnaire |
| Assessment of CO2 equivalent emissions in kg - electronical devices | 3 months after inclusion | Use of electronical devices in a lifecycle perspective based on user data from app |
| Working Alliance Inventory-Short Revised | 3 months after inclusion | A recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. The questionnaire is validated, has acceptable reliability and includes 12 items. The patient rates each item on a seven graded Likert-scale from 1 = not at all to 7 = completely. A higher score indicates a better therapeutic alliance. |
Countries
Sweden
Contacts
Primary ContactSusanne Beischer, PhD
Backup ContactMaziar Mohaddes, Assoc Prof
Outcome results
None listed