OA Clinic-Community CARE Model

Study Overview
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Brief Summary
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The purpose of this study is to test the OA Clinic-Community CARE Model (OA CARE) which will address all recommended components of knee/hip (osteoarthritis) OA care, include interventions for both patients and primary care providers (PCPs), and utilize a tailored approach that efficiently matches treatments with patients' needs. The patient component of OA CARE will include evidence-based weight management and exercise programs for all participants (delivered through the YMCA), as well as tailored referrals to physical therapy, additional weight management or nutrition services, sleep-related services and psychological services. The PCP component of OA CARE will include a video-based summary of current OA treatment guidelines (with emphasis on practical application), collaboration on patients' referrals to specific services described above, and progress reports on enrolled patients.

Detailed Description
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This study will be a randomized pilot trial of OA CARE among n=60 patients with knee and/or hip osteoarthritis (OA) and overweight/obesity who are not currently meeting physical activity recommendations. Participants will be randomly assigned to OA CARE or a usual care (UC) group. Assessments will be conducted at baseline, 6 months and 12 months. Primary endpoint of the trial will be self-reported pain and function and secondary endpoint will be objectively assessed physical activity (PA), measured via accelerometer.

Official Title
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Optimizing Osteoarthritis Care Through Clinical and Community Partnership

Conditions
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Osteoarthritis, Knee, Osteoarthritis, Hip, Overweight, Obesity, Physical Inactivity, Weight Loss

Intervention / Treatment
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* Behavioral: OA CARE Intervention
* Behavioral: Usual Care control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinician diagnosis of knee or hip OA Self-reported knee or hip pain of ≥3 (scale of 0-10) on most days of the week Current Weekly Physical Activity <150 minutes per week Body mass index (BMI) ≥27 kg/m^2 Exclusion Criteria: No internet access and a device (computer, tablet, smartphone) to access the virtual weight loss intervention Pain in chest when performing physical activity Pain in chest when not performing physical activity No documented diagnosis of knee or hip OA Total knee or hip replacement surgery, meniscus tear, ligament tear, or other significant lower extremity injury or surgery in the last 6 months Dementia or other memory loss condition Active diagnosis of psychosis Active Substance abuse disorder Severe hearing or visual impairment Serious/terminal illness as indicated by referral to hospice or palliative care Hospitalization for cardiovascular event in last 6 months History of ventricular tachycardia Unstable chronic obstructive pulmonary disease (2 hospitalizations within the previous 6 months and/or on oxygen) Stroke with moderate to severe aphasia Recent history (last 6 months) of three or more falls Planning total joint replacement in next 6 months Any other health conditions determined by the study team to be contraindications to a home exercise program or weight loss Current participation in other study related to knee or hip osteoarthritis or physical activity Unable to speak English

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: OA CARE<br>Participants assigned to the OA CARE intervention will receive a 12-month Medical Membership to a local YMCA and participate in a 12-week weight loss program. Participants will also work with an OA CARE Navigator, who, in partnership with their primary care provider (PCP), will identify any additional programs or resources that may help them manage their osteoarthritis (OA) symptoms. | Behavioral: OA CARE Intervention<br>* Once assigned, participants will be contacted by the OA CARE Navigator to coordinate initiating a YMCA Medical Membership. Then, YMCA personnel will contact the participant to schedule the first Weight Loss Program (Program) group session. The Program will be delivered in groups with other OA CARE participants. Participants will also have access to all exercise facilities and programs at the YMCA during the study, and will be assigned a YMCA health coach. After initiation of the YMCA Medical Membership, the OA CARE Navigator will discuss participant's interests in referrals to other services related to osteoarthritis (OA) management. The Navigator will provide the participant's primary care provider (PCP) with a summary of this discussion and help the participant connect to any programs or resources that do not require provider referrals.<br>|
| Placebo Comparator: Usual Care<br>Participants assigned to this group will receive no additional treatment from the study for about 12 months. | Behavioral: Usual Care control group<br>* Participants assigned to the usual care group will receive no additional treatment from the study for about 12 months. However, this group will be offered a 12-month Medical Membership to a local YMCA after completing the final assessment.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline to Month 6 in Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Total Score | For the WOMAC total score, the test questions are scored on a scale of 0-4. The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. The overall WOMAC score is determined by summing the scores for all three subscales and the score ranges include 0-96 (derived from a 0-4 Likert scale), with higher scores indicating worse pain, stiffness, and functional limitations. | Baseline, Month 6 (Follow-up) | 
| Change From Baseline to Month 12 in Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Total Score | For the WOMAC total score, the test questions are scored on a scale of 0-4. The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. The overall WOMAC score is determined by summing the scores for all three subscales and the score ranges include 0-96 (derived from a 0-4 Likert scale), with higher scores indicating worse pain, stiffness, and functional limitations. | Baseline, Month 12 (Follow-up) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline to Month 6 in Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Pain Subscale | The WOMAC Pain Subscale is a measure of lower extremity pain. It includes 5 items rated on a Likert scale of 0 (no pain) to 4 (extreme pain), with a total range of 0-20 with higher scores indicating worse symptoms and function. | Baseline, Month 6 (Follow-up) | 
| Change From Baseline to Month 12 in Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Pain Subscale | The WOMAC Pain Subscale is a measure of lower extremity pain. It includes 5 items rated on a Likert scale of 0 (no pain) to 4 (extreme pain), with a total range of 0-20 with higher scores indicating worse symptoms and function. | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 6 in Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Function Subscale | The WOMAC function subscale includes 17 items rated on a Likert scale of 0 (no difficulty) to 4 (extreme difficulty), with ranges of 0-68 for the function subscale with higher scores indicating worse symptoms and function. | Baseline, Month 6 (Follow-up) | 
| Change From Baseline to Month 12 in Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Function Subscale | The WOMAC function subscale includes 17 items rated on a Likert scale of 0 (no difficulty) to 4 (extreme difficulty), with ranges of 0-68 for the function subscale with higher scores indicating worse symptoms and function. | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 6 in Objectively Assessed Physical Activity (accelerometer) | Minutes of moderate to vigorous intensity physical activity (MVPA) per week measured via accelerometer | Baseline, Month 6 (Follow-up) | 
| Change From Baseline to Month 12 in Objectively Assessed Physical Activity (accelerometer) | Minutes of moderate to vigorous intensity physical activity (MVPA) per week measured via accelerometer | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 6 in steps per day | Step counts measured via accelerometer | Baseline, Month 6 (Follow-up) | 
| Change From Baseline to Month 12 in steps per day | Step counts measured via accelerometer | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 6 in minutes of any physical activity (PA) | Minutes of any PA measured via accelerometer | Baseline, Month 6 (Follow-up) | 
| Change From Baseline to Month 12 in minutes of any physical activity (PA) | Minutes of any PA measured via accelerometer | Baseline, Month 12 (Follow-up) | 
| Change from Baseline to Month 6 in Self-Reported Physical Activity | Self-Reported Physical Activity will be assessed using the Modified version of the CHAMPS (Community Health Activities Model Program for Seniors) Physical Activity Measure. Data from the questionnaire is used to determine variety, frequency, and minutes per week from physical activity. Separate scores are derived for physical activities of moderate or greater intensity (metabolic equivalents MET ≥ 3.0) and for all activities listed (light, moderate, and vigorous). Estimates of frequency (days per week) range from 0 to 7 days per week. Estimates of Variety (# different activities), while open, generally ranges from 0 to 5, values above 5 are checked. Estimates of minutes, generally range from 0 to 180 per day. Individuals reporting more than 180 minutes per day are checked. For all physical activity outcomes higher values equal a greater amount of activity. | Baseline, Month 6 (Follow-up) | 
| Change from Baseline to Month 12 in Self-Reported Physical Activity | Self-Reported Physical Activity will be assessed using the Modified version of the CHAMPS (Community Health Activities Model Program for Seniors) Physical Activity Measure. Data from the questionnaire is used to determine variety, frequency, and minutes per week from physical activity. Separate scores are derived for physical activities of moderate or greater intensity (metabolic equivalents (MET) ≥ 3.0) and for all activities listed (light, moderate, and vigorous). Estimates of frequency (days per week) range from 0 to 7 days per week. Estimates of Variety (# different activities), while open, generally ranges from 0 to 5, values above 5 are checked. Estimates of minutes, generally range from 0 to 180 per day. Individuals reporting more than 180 minutes per day are checked. For all physical activity outcomes higher values equal a greater amount of activity. | Baseline, Month 12 (Follow-up) | 
| Change from Baseline to Month 6 in sedentary minutes | Sedentary minutes measured via accelerometer | Baseline, Month 6 (Follow-up) | 
| Change from Baseline to Month 12 in sedentary minutes | Sedentary minutes measured via accelerometer | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 12 in Body Weight | Body weight assessed using a research / clinical grade scale (e.g., Tanita) that will be calibrated regularly. | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 12 in 30-second chair stand test | Assessed to test participant leg strength and endurance. Measured by total number of chair stands (up and down equals one stand) completed in 30 seconds. | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 12 in timed up-and-go (TUG) test | Assessed to measure participant functional mobility. Measured by how many seconds it takes for participant to stand up, walk to the mark, turn around, return & sit back into a chair with their back resting on the back of the chair. | Baseline, Month 12 (Follow-up) | 
| Change From Baseline to Month 12 in 2-minute march test | Assessed to evaluate participant functional aerobic endurance. Measured by number of steps completed in 2 minutes. | Baseline, Month 12 (Follow-up) |