PRevention of OsTEoporotiC FracTure 2 Pilot Study

Study Overview
=================
Brief Summary
-----------------
With the aging of the world population, osteoporosis and fragility fractures have become global public health concerns. It has been estimated the population of people ≥60 years of age will increase from 229 million (16.2%) in 2017 to 479 million (35.1%) by 2050 in China. Because age is an important predictor of osteoporosis and fragility fracture, the incidence of fragility fracture has increased dramatically in China over the past decades. Timely treatment of osteoporosis is an effective way to decrease additional fracture risk among patients with fragility fractures, but anti-osteoporosis treatment rate is relatively low in China. Effective fracture prevention intervention is urgently needed in China. As a potential way to achieve effective risk communication, shared decision-making allows patients to be active participants in the management of osteoporosis. The investigators designed a multifaceted intervention, which was named as Precise Education + Shared Decision-Making program for the secondary prevention of fragility fractures based on behavioral theories, and assessed the effectiveness for fracture prevention using a pilot cluster randomized controlled trial among several hospitals in China. The aim of this pilot study is to test the acceptability and feasibility as well as preliminary efficacy of this program in patients with fragility fractures.

Official Title
-----------------
The Application of Precise Education + Shared Decision-Making Program for the Secondary Prevention of Fragility Fractures Based on Behavioral Theories: A Pilot Cluster Randomized Controlled Trial

Conditions
-----------------
Fragility Fracture

Intervention / Treatment
-----------------
* Behavioral: Multifaceted Intervention


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Local residents (live in the city where the hospital is located for half a year or more); Hospitalized patients with fractures aged 50 years and above; First fracture, without history of fracture; Never diagnosed as osteoporosis before admission; No fracture history, and never receive any bone mineral density test, and never take anti-osteoporosis medication in the 4 years before admission; Hospitalized patients with the following fractures: hip fracture, thoracic spine fracture, and lumbar spine fracture; New fragility fracture: fracture that occurs after minor trauma or daily activities, such as a fracture caused by a fall from standing height or less; fracture happened within 6 weeks; Not living in a nursing or rehabilitation institution before fracture; Possess reading ability, and can read and understand informed consent forms or medical materials independently. Exclusion Criteria: Patients with pathological fractures caused by tumor or infection; Patients with cognitive dysfunction or mental disorder; AIDS patients; Patients who refuse to follow-up, or have poor compliance for follow-up, or fail to understand and cooperate for follow-up; Hearing or visual impairment, and unable to communicate or read materials; Patients who have participate in other studies; Other conditions that the investigator considered inappropriate to enroll.

Ages Eligible for Study
-----------------
Minimum Age: 50 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Multifaceted Intervention<br>Group in the intervention arm will receive a multicomponent intervention at the clinician- and patient-level, with a shared decision-making booklet as well as a mobile application to promote osteoporosis management and fracture practice. | Behavioral: Multifaceted Intervention<br>* The multicomponent intervention elements include education for clinicians and patients as well as a shared decision-making program among clinicians and patients. A shared decision-making booklet and a mobile application will be used to promote osteoporosis management and fracture practice.<br>|
| No Intervention: Usual-care Control<br>Group in the control arm will receive a leaflet and routine medical care per their existing health care providers. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Trial feasibility - Recruitment | Number or N (%) participants recruited within 3 months of trial initiation at each centre. | 3 months | 
| Trial feasibility - Acceptability of the multicomponent program component | Participants will be asked to evaluate the program with a questionnaire with questions about frequency, length, content, delivery, and duration of the booklet and the mobile application using a 5-point Likert scale. | 30 days after study recruitment | 
| Trial feasibility - Acceptability of the shared decision-making process | Both clinicians and patients will be asked to evaluate the shared decision-making process once they completed it. A survey will be administered to evaluate the content and comprehension of the program using a 5-point Likert scale. | 7 days after study recruitment | 
| Trial feasibility - Retention | The retention rates will be assessed as the 30-day follow-up rate. | 30 days after study recruitment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anti-osteoporosis treatment rate | The patients will be followed up and asked whether they accept any anti-osteoporosis medication. | 1 month follow-up; 3 month follow-up; 6 month follow-up; 12 month follow-up; 24 month follow-up | 
| Shared decision-making process | Standardized questionnaires will be used to evaluated the shared decision-making process. | 7 days after study recruitment | 
| Bone mineral density test | The patients will be followed up and asked whether they accept bone mineral density test. | 3 month follow-up; 6 month follow-up; 12 month follow-up; 24 month follow-up | 
| Adherence of anti-osteoporosis medication | Adherence of anti-osteoporosis medication will be assessed with medication possession ratio and self-reported question. | 1 month follow-up; 3 month follow-up; 6 month follow-up; 12 month follow-up; 24 month follow-up | 
| Diagnosis, education, and follow-up practice of osteoporosis | The patients will be followed up with questionnaires about diagnosis, education, and follow-up of osteoporosis. | 1 month follow-up; 3 month follow-up; 6 month follow-up; 12 month follow-up; 24 month follow-up | 
| Refracture | The patients will be followed up and asked whether they have refracture. | 1 month follow-up; 3 month follow-up; 6 month follow-up; 12 month follow-up; 24 month follow-up | 
| Survival | The patients will be followed up about their survival status. | 1 month follow-up; 3 month follow-up; 6 month follow-up; 12 month follow-up; 24 month follow-up | 
| Patients' knowledge and attitude about osteoporosis and fragility fracture | Patients' knowledge and attitude about osteoporosis and fragility fracture will be evaluated with standardized questionnaires. | baseline; 1 month follow-up; 6 month follow-up | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Osteoporosis, Fragility Fracture, Shared Decision-Making, Education