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 Y
AU - Yang, Su-Yin
AU - Pereira, Michelle J
AU - Tan, Chun Yue
AU - Lim, Chien Joo
AU - Ng, Julia P
AU - Lee, Keng Thiam
AU - Pua, Yong Hao
AU - Briggs, Andrew M
AU - Hunter, David J
AU - Skou, Soren T
AU - Thumboo, Julian
AU - Car, Josip
N1 - Copyright © 2024 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
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 (KOOS4) ≤75) were enrolled. Primary outcome was KOOS4 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 (KOOS4) ≤75) were enrolled. Primary outcome was KOOS4 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 - Humans
KW - Female
KW - Male
KW - Osteoarthritis, Knee/therapy
KW - Middle Aged
KW - Aged
KW - Cost-Benefit Analysis
KW - Allied Health Personnel
KW - Single-Blind Method
KW - Orthopedics
KW - Quality of Life
KW - Patient Care Team
KW - Exercise Therapy/methods
UR - http://www.scopus.com/inward/record.url?scp=85194099270&partnerID=8YFLogxK
U2 - 10.1016/j.joca.2024.04.018
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 -