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

HOLDEN, M.A., CALLAGHAN, M., FELSON, D., BIRRELL, F., NICHOLLS, E., JOWETT, S., KIGOZI, J., MCBETH, J., BORRELLI, B., JINKS, C., FOSTER, N.E., DZIEDZIC, K., MALLEN, C., INGRAM, C., SUTTON, A., LAWTON, S., HALLIDAY, N., HARTSHORNE, L., WILLIAMS, H., BROWELL, R., HUDSON, H., MARSHALL, M., SOWDEN, G., HERRON, D., ASAMANE, E. and PEAT, George (2021). Clinical and cost-effectiveness of bracing in symptomatic knee osteoarthritis management: Protocol for a multicentre, primary care, randomised, parallel-group, superiority trial. BMJ Open, 11 (3): e048196.

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Official URL: https://bmjopen.bmj.com/content/11/3/e048196
Open Access URL: https://bmjopen.bmj.com/content/bmjopen/11/3/e0481... (Published version)
Link to published version:: https://doi.org/10.1136/bmjopen-2020-048196
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    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.

    Item Type: Article
    Uncontrolled Keywords: musculoskeletal disorders; primary care; rheumatology; Activities of Daily Living; Cost-Benefit Analysis; Humans; Multicenter Studies as Topic; Osteoarthritis, Knee; Primary Health Care; Quality of Life; Randomized Controlled Trials as Topic; Single-Blind Method; Treatment Outcome; Wales; Humans; Osteoarthritis, Knee; Treatment Outcome; Activities of Daily Living; Single-Blind Method; Quality of Life; Cost-Benefit Analysis; Primary Health Care; Wales; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; 1103 Clinical Sciences; 1117 Public Health and Health Services; 1199 Other Medical and Health Sciences
    Identification Number: https://doi.org/10.1136/bmjopen-2020-048196
    SWORD Depositor: Symplectic Elements
    Depositing User: Symplectic Elements
    Date Deposited: 09 Sep 2022 09:20
    Last Modified: 09 Sep 2022 09:20
    URI: http://shura.shu.ac.uk/id/eprint/30538

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