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 Y Tan¹, Su-Yin Yang², Michelle J Pereira³, Chun Yue Tan⁴, Chien Joo Lim⁴, Julia P Ng⁵, Keng Thiam Lee⁵, Yong Hao Pua⁶, Andrew M Briggs⁷, David J Hunter⁸, Soren T Skou⁹, Julian Thumboo¹⁰, Josip Car¹¹

Affiliations

¹ Department of Orthopaedic Surgery, Woodlands Health, Singapore; Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia. Electronic address: btanyj@hotmail.com.
² Psychology Service, Woodlands Health, Singapore.
³ Health Services Outcome Research, National Healthcare Group, Singapore.
⁴ Department of Orthopaedic Surgery, Woodlands Health, Singapore.
⁵ Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
⁶ Department of Physiotherapy, Singapore General Hospital, Singapore.
⁷ Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
⁸ Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
⁹ Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
¹⁰ Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
¹¹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.

PMID: 38710437
DOI: 10.1016/j.joca.2024.04.018

Randomized Controlled Trial

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 Y Tan et al. Osteoarthritis Cartilage. 2024 Aug.

. 2024 Aug;32(8):972-981.

doi: 10.1016/j.joca.2024.04.018. Epub 2024 May 6.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Woodlands Health, Singapore; Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia. Electronic address: btanyj@hotmail.com.
² Psychology Service, Woodlands Health, Singapore.
³ Health Services Outcome Research, National Healthcare Group, Singapore.
⁴ Department of Orthopaedic Surgery, Woodlands Health, Singapore.
⁵ Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
⁶ Department of Physiotherapy, Singapore General Hospital, Singapore.
⁷ Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
⁸ Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
⁹ Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
¹⁰ Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
¹¹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.

PMID: 38710437
DOI: 10.1016/j.joca.2024.04.018

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 (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.

Keywords: Community; Knee osteoarthritis; Randomized control trial; Service model; Stratified.

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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

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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

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