Physiotherapy for Hip and Knee Pain

Overseen By Chad McClintock, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Queen's University

Disqualifiers: Non-English speakers, Cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

Duration: 12 months

728 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Physiotherapist-led primary care model for hip and knee pain?

Research suggests that physiotherapist-led care can be effective for managing chronic knee and hip pain by providing personalized lifestyle coaching, which helps improve mobility and quality of life. Additionally, physiotherapists are well-equipped to offer core treatments like exercise and weight management, which are important for managing osteoarthritis. ^{1 2 3 4 5}

Is physiotherapy for hip and knee pain safe for humans?

The research does not specifically address the safety of physiotherapy for hip and knee pain, but it is generally considered a safe treatment option for managing chronic pain and improving mobility. ^{1 2 4 5 6}

How is the physiotherapist-led primary care model for hip and knee pain different from other treatments?

The physiotherapist-led primary care model for hip and knee pain is unique because it involves physiotherapists diagnosing and creating management plans, focusing on lifestyle changes like exercise and weight control, rather than relying solely on medication or surgery. This approach emphasizes person-centered care and practical lifestyle coaching to manage pain and improve quality of life. ^{2 3 4 5 7}

What is the purpose of this trial?

This is a cluster randomized controlled trial to to evaluate the individual and health system impacts of implementing a new physiotherapist-led primary care model for hip and knee pain in Canada.

Research Team

Jordan Miller, PhD

Principal Investigator

Queen's University

Eligibility Criteria

This trial is for individuals experiencing hip and knee pain due to osteoarthritis. It's designed to assess a new way of care where physiotherapists lead the treatment in primary care settings, compared to the usual physician-led approach.

Inclusion Criteria

I am an adult seeking care for hip or knee pain.

Exclusion Criteria

Cannot understand, read, and write English

My hip or knee pain is caused by my cancer.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Assessment and Screening

Initial assessment and screening by a physiotherapist as the first point of contact

1 visit

1 visit (in-person)

Treatment

Participants receive a brief individualized intervention and additional PT care if needed

12 months

Regular visits as needed

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

Follow-up assessments at 3, 6, 9, and 12 months

Treatment Details

Interventions

• Physiotherapist-led primary care model for hip and knee pain

Trial Overview The study is testing a new model where physiotherapists take charge of primary care for patients with hip and knee osteoarthritis, versus the traditional method led by physicians. The impact on patient health and healthcare systems will be measured.

Participant Groups

Group I: Physiotherapist-led primary care model for hip and knee pain Experimental Treatment 1 Intervention

The index intervention will incorporate a PT within the primary care team and make them available at the first point of contact for people with hip or knee pain. There will be 4 key components of this intervention: 1) Initial assessment and screening; 2) Brief individualized intervention at first visit; 3) Health services navigation; 4) Providing additional PT care for people with an unmet need (e.g., no insurance coverage for PT).

Group II: Usual physician-led primary care model for hip and knee pain Active Control 1 Intervention

Participants will be seen by a primary care physician or a nurse practitioner, depending on the current practice at the clinic. Participants in both groups will be permitted to seek additional care outside of the primary care clinic.

Physiotherapist-led primary care model for hip and knee pain is already approved in Canada for the following indications:

Approved in Canada as Physiotherapist-led primary care model for:

• Hip pain
• Knee pain

Who Is Running the Clinical Trial?

Queen's University

Lead Sponsor

Trials

382

Recruited

122,000+

Kingston Health Sciences Centre

Lead Sponsor

Trials

312

Recruited

112,000+

Queen's University

Lead Sponsor

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

The Arthritis Society, Canada

Collaborator

Trials

27

Recruited

9,700+

Findings from Research

This scoping review aims to identify and analyze models of care (MoCs) specifically designed for patients with knee osteoarthritis (OA) in primary healthcare settings, addressing a significant gap in the implementation of evidence-based interventions.

The review will evaluate the core components and outcomes of these MoCs, which could enhance their transferability to practice and ultimately improve patient care and reduce healthcare costs associated with knee OA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Models of care for patients with knee osteoarthritis in primary healthcare: a scoping review protocol. Costa, D., Cruz, EB., Rodrigues, AM., et al.[2021]

A new four-step model of care for treating knee pain in older adults was developed, incorporating 27 recommended interventions identified from 77 publications, emphasizing a structured approach in primary care.

The model starts with self-care options like exercise and weight loss, progressing to pharmacological treatments and potentially surgery, ensuring that all older adults with knee pain receive appropriate and evidence-based care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of knee pain in older adults in primary care: development of an evidence-based model of care. Porcheret, M., Jordan, K., Croft, P.[2022]

In a randomized controlled trial involving 163 patients, those receiving physiotherapist-led orthopaedic triage reported significantly higher quality of care compared to those receiving standard practice, particularly in areas like examination, treatment information, and caregiver understanding.

Patients in the physiotherapist-led group felt their treatment expectations were better met and showed a greater intention to follow self-management advice, suggesting this model enhances patient-centered care and may improve treatment adherence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial. Samsson, KS., Bernhardsson, S., Larsson, ME.[2018]

The intervention involving workshops for general practitioners and physiotherapists led to a small, non-significant increase in the quality of care for patients with hip and knee osteoarthritis, particularly in providing information about treatment options and self-management strategies.

Patients reported higher odds of receiving information on treatment alternatives and self-management after the intervention, indicating improved communication and education, although there were minimal changes in referral practices and imaging use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving osteoarthritis management in primary healthcare: results from a quasi-experimental study. Østerås, N., Blaker, IB., Hjortland, T., et al.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Models of care for patients with knee osteoarthritis in primary healthcare: a scoping review protocol. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Treatment of knee pain in older adults in primary care: development of an evidence-based model of care. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial. [2018]

4. England pubmed.ncbi.nlm.nih.gov

Improving osteoarthritis management in primary healthcare: results from a quasi-experimental study. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Improving access to better care for people with knee and/or hip pain: service evaluation of allied health professional-led primary care. [2018]

6. Sweden pubmed.ncbi.nlm.nih.gov

Patients report inferior quality of care for knee osteoarthritis prior to assessment for knee replacement surgery - a cross-sectional study of 517 patients in Denmark. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Physiotherapy managers' views of musculoskeletal physiotherapy service provision in Ireland: a qualitative study. [2020]