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

• DOI: 10.1016/j.joca.2024.04.018
• Publication Date: 2024-05-06T09:07:58Z
• Authors: Bryan Y. Tan; Su-Yin Yang; Michelle J. Pereira; Chun Yue Tan; Chien Joo Lim; Julia P. Ng; Keng Thiam Lee; Yong Hao Pua; Andrew M. Briggs; David J. Hunter; Soren T. Skou; Julian Thumboo; Josip Car
• Keywords: Male; Patient Care Team; Randomized control trial; Knee/therapy; Cost-Benefit Analysis; Allied Health Personnel; 610; Stratified; Community; Middle Aged; Exercise Therapy/methods; Orthopedics; Osteoarthritis; 616; Quality of Life; Humans; Female; Single-Blind Method; Knee osteoarthritis; Service model; Aged

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).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.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.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.Clinicaltrials.gov Identifier: NCT03809975. Registered January 18, 2019. https://clinicaltrials.gov/ct2/show/NCT03809975.