Neuroscience Research Australia, Randwick, New South Wales, Australia
South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
BMJ Open. 2020 Jul 30;10(7):e039152. doi: 10.1136/bmjopen-2020-039152.
There is a gap between the care people with knee osteoarthritis (OA) should receive according to evidence-based guidelines and the care they do receive. This feasibility study aims to test the feasibility of developing and implementing a codesigned, physiotherapy-led, multidisciplinary, evidence-based model of care for knee OA, among community physiotherapy practices in Australia, where community practice is defined as a professional physiotherapy business that is not controlled or paid for by the government.
A mixed-methods quasi-experimental (pre/postintervention) study. In the preintervention phase, all consented physiotherapists working in nine metropolitan-based, community physiotherapy practices, and 26 patients with knee OA will be recruited. Patients will be recruited from all practices by the physiotherapists, using the outlined inclusion/exclusion criteria. An audit of physiotherapy treatment notes will occur using a proforma, to gain an understanding of current community physiotherapy treatment and documentation. Patient and physiotherapist interviews will be conducted to determine current practice for the management of knee OA. A codesign phase will follow, where a model of care will be developed by researchers, patients, clinical staff, members of the public and other stakeholders, based on current guidelines for conservative management of knee OA. In the postintervention phase, a further 26 patients will be recruited, and the assessment process repeated to determine whether there is a change in practice. The feasibility outcome measures are: (1) number of patients who are recorded as receiving care according to current evidence-based guidelines; (2) number of patients who have patient-reported outcomes incorporated into their assessment and management plan; and (3) acceptability of the developed model to patients and physiotherapists. The clinical outcomes will include assessment of patient-reported outcome measures (pain, function, etc) in the preintervention and postintervention phases (baseline and 12 weeks) to assess trends towards change in participant symptoms.
Ethical approval has been obtained from the University of New South Wales human ethics committee (approval number HC180864, approval period 6 February 2019 to 5 February 2024). The preintervention stage of this study is complete. The next stage is to implement the intervention and compare outcomes between the preintervention and postintervention phases. The results will be disseminated via peer-reviewed publications and presentations at conferences.
The preintervention phase of the study is retrospectively registered at ClinicalTrials.gov with registration number: ACTRN12620000188932. The intervention and postintervention phase of the study is prospectively registered at ClinicalTrials.gov with registration number: ACTRN12620000218998.
患有膝骨关节炎（OA）的人群所接受的护理与基于循证指南的护理之间存在差距。本可行性研究旨在测试在澳大利亚社区物理治疗实践中为膝 OA 开发和实施以代码设计为基础、由物理治疗师主导、多学科、基于证据的护理模式的可行性，其中社区实践被定义为不受政府控制或支付薪酬的专业物理治疗业务。
这是一项混合方法准实验（干预前后）研究。在干预前阶段，将招募 9 个都市区社区物理治疗实践中同意参与的所有物理治疗师，以及 26 名膝 OA 患者。将由物理治疗师根据既定的纳入/排除标准从所有实践中招募患者。将使用表格对物理治疗治疗记录进行审核，以了解当前社区物理治疗的治疗和记录情况。将对患者和物理治疗师进行访谈，以确定膝 OA 的当前管理实践。接下来是代码设计阶段，研究人员、患者、临床工作人员、公众和其他利益相关者将根据膝 OA 保守治疗的现行指南，开发护理模式。在干预后阶段，将再招募 26 名患者，并重复评估过程，以确定实践是否发生变化。可行性结果衡量指标包括：（1）记录为接受基于当前循证指南的护理的患者人数；（2）将患者报告的结果纳入其评估和管理计划的患者人数；以及（3）患者和物理治疗师对开发模型的接受程度。临床结果将包括在干预前和干预后阶段（基线和 12 周）评估患者报告的结果测量（疼痛、功能等），以评估参与者症状变化的趋势。
新南威尔士大学人类伦理委员会已批准该研究（批准号 HC180864，批准期限为 2019 年 2 月 6 日至 2024 年 2 月 5 日）。该研究的干预前阶段已经完成。下一阶段是实施干预，并比较干预前和干预后阶段的结果。研究结果将通过同行评议的出版物和会议报告进行传播。
该研究的干预前阶段在 ClinicalTrials.gov 上进行了回顾性注册，注册编号为：ACTRN12620000188932。该研究的干预和干预后阶段在 ClinicalTrials.gov 上进行了前瞻性注册，注册编号为：ACTRN12620000218998。
