Optimizing Osteoarthritis Care through Clinical and Community Partnership

许多研究证明，膝关节和髋关节骨关节炎(OA)的护理质量存在缺陷，尤其是 关于生活方式(例如，体重管理和锻炼)和康复部分，它们是 “强烈推荐，”一线治疗。这些护理不足的主要驱动因素是缺乏 办公自动化管理的标准化模型和常规诊所就诊期间可用的有限时间 骨关节炎护理的非药理学方面。我们研究的长期目标是进行严格的、多方面的 建立在临床-社区基础上的符合指南的骨性关节炎护理模式的现场随机对照试验 合作伙伴关系并为在美国广泛实施和可持续发展而设计。 社区护理模式(OA护理)将解决膝盖/髋关节OA护理的所有推荐组件， 包括对患者和初级保健提供者(PCP)的干预，并利用量身定制的方法 有效地将治疗与患者的需求相匹配。OA护理的患者部分将包括证据- 所有参与者的体重管理和锻炼计划(通过基督教青年会提供)，以及 与睡眠相关的物理治疗、额外体重管理或营养服务的量身定制转介 服务和心理服务。OA CARE的PCP部分将包括基于视频的摘要 目前的骨性关节炎治疗指南(强调实际应用)，就患者转介到 上述具体服务，以及登记患者的进展报告。这项探索性的临床试验将 采取关键步骤，开展多站点的骨性关节炎护理RCT。我们将招募60名患者 有症状的膝关节或髋关节骨性关节炎和超重/肥胖，目前不适应体力活动 建议。参与者将被随机分为OA护理组或普通护理对照组。我们会 完成以下具体目标：目标1。评估OA护理的可行性和可接受性。 可行性指标将包括招聘率、减肥完成率和锻炼计划访问量 基督教青年会、量身定制服务的利用情况以及参与者完成后续评估的比例。 将从患者和初级保健医生的角度评估对骨性关节炎护理的可接受性。目标2.获得初步的 与安大略省西部和西部地区变化的主要结果有关的OA护理有效性的数据 麦克马斯特大学骨关节炎指数(WOMAC)评分。WOMAC将按基线管理，6- 6个月和12个月，以及包括体重、体力活动、体力活动在内的次要结果 功能、睡眠和心理测量。结果将在不同组之间进行统计分析 后续时间点采用一般线性混合模型。

Many studies have documented deficiencies in quality of care for knee and hip osteoarthritis (OA), particularly with respect to lifestyle (e.g., weight management and exercise) and rehabilitative components, which are “strongly recommended,” first-line treatments. Primary drivers of these deficiencies in care are the lack of standardized models for OA management and the limited time available during routine clinic visits to address non-pharmacological aspects of OA care. The long-term goal of our research is to conduct a rigorous, multi- site randomized controlled trial (RCT) of a guideline-concordant OA care model, built on clinic-community partnership and designed for widespread implementation and sustainability in the U.S. The OA Clinic- Community CARE Model (OA CARE) will address all recommended components of knee / hip 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. This exploratory clinical trial will achieve critical steps toward conducting a multi-site RCT of OA CARE. We will enroll 60 patients with symptomatic knee or hip OA and overweight / obesity who are not currently meeting physical activity recommendations. Participants will be randomized to OA CARE or a usual care control group. We will accomplish the following specific aims: Aim 1. Assess the feasibility and acceptability of OA CARE. Feasibility metrics will include recruitment rate, completion rates for weight loss and exercise program visits to the YMCA, utilization of tailored services and proportion of participants completing follow-up assessments. Acceptability of OA CARE will be evaluated from both patient and PCP perspectives. Aim 2. Obtain preliminary data on the efficacy of OA CARE with respect to the primary outcome of change in total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The WOMAC will be administered at baseline, 6- months and 12-months, along with secondary outcomes including body weight, physical activity, physical function, sleep and psychological measures. Outcomes will be statistically analyzed between groups across the follow-up time points using general linear mixed models.