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Clinical and cost-effectiveness of bracing in symptomatic knee osteoarthritis management: protocol for a multicentre, primary care, randomised, parallel-group, superiority trial.

Holden, MA; Callaghan, M; Felson, D; Birrell, F; Nicholls, E; Jowett, S; Kigozi, J; McBeth, J; Borrelli, B; Jinks, C; Foster, NE; Dziedzic, K; Mallen, C; Sutton, A; Ingram, C; Lawton, S; Hartshorne, L; Williams, H; Browell, R; Hudson, H; Marshall, M; Sowden, G; Herron, D; Halliday, N; Asamane, E; Peat, G

Clinical and cost-effectiveness of bracing in symptomatic knee osteoarthritis management: protocol for a multicentre, primary care, randomised, parallel-group, superiority trial. Thumbnail


Authors

M Callaghan

D Felson

F Birrell

S Jowett

J Kigozi

J McBeth

B Borrelli

NE Foster

A Sutton

C Ingram

S Lawton

L Hartshorne

H Williams

R Browell

H Hudson

G Sowden

D Herron

N Halliday

E Asamane

G Peat



Abstract

BACKGROUND: Brace effectiveness for knee osteoarthritis (OA) remains unclear and international guidelines offer conflicting recommendations. Our trial will determine the clinical and cost-effectiveness of adding knee bracing (matched to patients' clinical and radiographic presentation and with adherence support) to a package of advice, written information and exercise instruction delivered by physiotherapists.

METHODS AND ANALYSIS: A multicentre, pragmatic, two-parallel group, single-blind, superiority, randomised controlled trial with internal pilot and nested qualitative study. 434 eligible participants with symptomatic knee OA identified from general practice, physiotherapy referrals and self-referral will be randomised 1:1 to advice, written information and exercise instruction and knee brace versus advice, written information and exercise instruction alone. The primary analysis will be intention-to-treat comparing treatment arms on the primary outcome (Knee Osteoarthritis Outcomes Score (KOOS)-5) (composite knee score) at the primary endpoint (6 months) adjusted for prespecified covariates. Secondary analysis of KOOS subscales (pain, other symptoms, activities of daily living, function in sport and recreation, knee-related quality of life), self-reported pain, instability (buckling), treatment response, physical activity, social participation, self-efficacy and treatment acceptability will occur at 3, 6, and 12 months postrandomisation. Analysis of covariance and logistic regression will model continuous and dichotomous outcomes, respectively. Treatment effect estimates will be presented as mean differences or ORs with 95% CIs. Economic evaluation will estimate cost-effectiveness. Semistructured interviews to explore acceptability and experiences of trial interventions will be conducted with participants and physiotherapists delivering interventions.

ETHICS AND DISSEMINATION: North West Preston Research Ethics Committee, the Health Research Authority and Health and Care Research in Wales approved the study (REC Reference: 19/NW/0183; IRAS Reference: 247370). This protocol has been coproduced with stakeholders including patients and public. Findings will be disseminated to patients and a range of stakeholders. TRIAL REGISTRATION NUMBER: ISRCTN28555470.

Journal Article Type Article
Acceptance Date Feb 12, 2021
Online Publication Date Mar 26, 2021
Publication Date 2021-03
Publicly Available Date Mar 29, 2024
Journal BMJ open
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 11
Issue 3
Article Number e048196
DOI https://doi.org/10.1136/bmjopen-2020-048196
Keywords rheumatology; primary care; musculoskeletal disorders
Publisher URL https://doi.org/10.1136/bmjopen-2020-048196
PMID 33771832
Additional Information Protocol paper