Title: Clinical osteoarthritis and joint pain in older people: optimal management in primary care
Funder: Department of Health (England)

Abstract: Aims: To improve primary care management of osteoarthritis (OA) and the health of patients with OA. Linked studies will i) determine the extent to which evidence-based core primary care management could improve clinical, social and economic outcomes; ii) develop and evaluate new models for delivery of core treatments and support for self-management among primary care consulters with OA, and investigate prioritisation and dissemination of OA care among the public, patients, health care professionals (HCPs) including general practitioners, and Primary Care Trusts (PCTs); iii) determine effectiveness of strategies to optimise specific components of core treatment, using the example of exercise; iv) investigate the effect of interventions to tackle barriers to core treatment, using the example of co-morbid anxiety and depression in persons with OA. Background: Clinical OA is a common syndrome of joint pain and stiffness in older people. It is a major cause of disability, and the commonest long-term condition managed in UK general practice. There is evidence for short-term effectiveness of simple interventions to relieve pain and improve activity in OA sufferers. However there is a gap between current clinical practice and the potential of primary care to prevent and reduce the prevalence of chronic joint pain and disability in the older population. Most sufferers do not receive optimal care and there is little evidence about how to achieve and maintain effective interventions in practice in the long-term. Research plan: Our programme links four research themes to address the four objectives. Theme 1 builds statistical models to estimate the effectiveness and cost effectiveness of different choices about care for treatment and prevention, using reviews and analysis of published literature and secondary analysis of original cohort and trials data. Theme 2 uses mixed qualitative (interviews, consensus, training and evaluation) and quantitative methods to i) develop and test a “model OA consultation” for primary care HCPs (practitioner communication; evidence-based interventions; supported self-management; monitoring) to optimise delivery of core treatment for persons with OA, ii) evaluate the effect on practice and patient outcomes of implementing the “model OA consultation” in a parallel-group study, and iii) investigate ways to achieve prioritisation and dissemination of optimal core primary care for OA among patients, HCPs and PCTs. Theme 3 develops and investigates in a randomised controlled trial (RCT) how to optimise the effect of one core OA treatment, namely exercise, by tailoring it to the individual and improving adherence. Theme 4 develops and investigates in a cluster RCT how to address one barrier to effective core OA treatment, namely the extent to which treating co-morbid illness (using the example of anxiety and depression) can improve OA outcomes. The Research team is based on a long-standing collaboration between NHS organisations in North Staffordshire and Cheshire, and Keele University, for delivering observational and interventional research programmes, and draws on well-developed user involvement, Keele’s strength in applied musculoskeletal research and epidemiological, qualitative, and trials methodology, and an established collaboration with the Birmingham University Health Economics Facility.The Research environment is orientated towards supporting clinical practitioners to engage in research, with a strong record of successful recruitment and follow-up of study participants, and a well-developed ethos of work and training across academic and clinical partners involved in large mixed-method cohort and trials studies. Main outputs will be clear methods for ensuring optimal treatment of older patients presenting with joint pain in primary care, including training and educational materials, strategies and targets for intervention and supported self-management, and monitoring schemes for ensuring optimal long-term outcomes of clinical care; and clear information about the process, benefits and costs of more intensive methods to optimise components of OA care (based on the examples of improving exercise adherence, and screening and managing comorbid anxiety and depression in OA patients). Strategies for dissemination and evidence for decision-making about best policy and practice to gain long-term reductions in joint pain and disability will be identified for PCTs and primary care practitioners. Public engagement is planned at all levels – individual patients from our User Group Forum have been involved in developing the proposal and will be members of the project steering and analysis groups. An OA Forum will be established, using our existing successful model, and involving public, patient, health professional, social care and researcher representatives, to debate and discuss the results and to formulate proposals for their wider implementation and dissemination.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MUSCULOSKELETAL