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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new approach to treating hip and knee pain by allowing physiotherapists to lead in primary care. The aim is to determine if having a physiotherapist available from the start can enhance care and potentially reduce visits to other healthcare providers. Participants will either receive this new physiotherapist-led primary care model for hip and knee pain or continue with the usual doctor-led approach to compare outcomes. This trial suits adults seeking primary care mainly for hip or knee pain. As an unphased trial, it offers a unique opportunity to contribute to innovative care models that could improve treatment for hip and knee pain.

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 prior data suggests that this physiotherapist-led primary care model is safe for hip and knee pain?

Research has shown that physiotherapist-led care for hip and knee pain is generally safe. In studies where physiotherapists managed rehabilitation for individuals with long-term conditions, many participants experienced reduced pain and disability. No major reports of serious side effects emerged, indicating that the treatment is well-tolerated.

One study examined a physiotherapist-led approach for managing hip and knee pain and found no major safety issues. This care model is being tested in various locations and aims to provide a safe alternative to traditional doctor-led care.

Overall, current evidence suggests that this physiotherapist-led approach is safe for managing hip and knee pain. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the physiotherapist-led primary care model for hip and knee pain because it integrates physiotherapists directly into the primary care team, offering a first point of contact for patients. This approach is unique because it combines initial assessment, personalized intervention, and health services navigation, potentially filling gaps for patients who lack insurance coverage for physical therapy. Unlike the usual physician-led model, this method emphasizes direct and immediate physiotherapy care, which could lead to more tailored treatment and quicker relief for patients.

What evidence suggests that the physiotherapist-led primary care model is effective for hip and knee pain?

This trial will compare a physiotherapist-led primary care model with a usual physician-led primary care model for hip and knee pain. Research has shown that physiotherapist-led care for hip and knee pain can be very effective. Studies have found that this approach helps patients move better and feel less pain. One study found that physiotherapist-led care can better manage joint and muscle problems like hip and knee pain. Another review highlighted how these treatments can increase physical activity and improve health. By focusing on personalized care and guidance, physiotherapists can assist patients who might not have insurance coverage for therapy. ^{3 4 6 7 8}

Who Is on the Research Team?

Jordan Miller, PhD

Principal Investigator

Queen's University

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05736133

Determining the Impact of a Physiotherapist-Led Primary ... PTs can provide a comprehensive and efficient management strategy for patients presenting to their primary care provider with hip and knee pain complaints. This ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7548042/

Effects on health and process outcomes of physiotherapist ... Physiotherapist-led (PT-led) orthopaedic triage is an evolving model of care for patients with musculoskeletal disorders. Objectives for this study were to ...

3. trialsjournal.biomedcentral.com trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2279-7

Determining the impact of a new physiotherapist-led primary ... This is a pilot cluster randomized controlled trial at four primary care sites, with two sites randomized to a new PT-led primary care model for ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S003194062500375X

Systematic review Physiotherapist-led health promotion ... Physiotherapy-led health promotion interventions in primary care can improve metabolic risk factors and physical activity levels for people with ...

5. bjsm.bmj.com bjsm.bmj.com/content/54/9/504.short

Physiotherapist-led treatment for young to middle-aged ... This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8555237/

Physiotherapist-led rehabilitation for patients with chronic ... Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on ...

7. withpower.com withpower.com/trial/phase-osteoarthritis-4-2023-250c8

Physiotherapist-Led Care for Osteoarthritis Trial Overview The study is testing a new way of treating hip and knee pain where physiotherapists lead the care instead of doctors. It's set up as a pilot test ...

8. clinicaltrial.be clinicaltrial.be/en/details/258870?per_page=20&only_recruiting=0&only_eligible=0

Determining the Impact of a Physiotherapist-Led Primary C... This study aims to determine the feasibility of conducting a cluster randomized trial in primary care settings in Ontario to evaluate the ...