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Simpson AHRW, Clement ND, Simpson SA, Pandit H, Smillie S, Leeds AR, Conaghan PG, Kingsbury SR, Hamilton D, Craig P, Ray D, Keerie C, Kinsella E, Bell-Higgs A, McGarty A, Beadle C, Howie CR, Norrie J. A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, and topical and oral analgesia (OPPORTUNITY): a two-centre, open-label, randomised controlled feasibility trial. Lancet Rheumatol 2024; 6:e237-e246. [PMID: 38423028 DOI: 10.1016/s2665-9913(23)00337-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Osteoarthritis of the knee is a major cause of disability worldwide. Non-operative treatments can reduce the morbidity but adherence is poor. We hypothesised that adherence could be optimised if behavioural change was established in the preoperative period. Therefore, we aimed to assess feasibility, acceptability, and recruitment and retention rates of a preoperative package of non-operative care in patients awaiting knee replacement surgery. METHODS We did an open-label, randomised controlled, feasibility trial in two secondary care centres in the UK. Eligible participants were aged 15-85 years, on the waiting list for a knee arthroplasty for osteoarthritis, and met at least one of the thresholds for one of the four components of the preoperative package of non-operative care intervention (ie, weight loss, exercise therapy, use of insoles, and analgesia adjustment). Participants were randomly assigned (2:1) to either the intervention group or the standard of care (ie, control) group. All four aspects of the intervention were delivered weekly over 12 weeks. Participants in the intervention group were reviewed regularly to assess adherence. The primary outcome was acceptability and feasibility of delivering the intervention, as measured by recruitment rate, retention rate at follow-up review after planned surgery, health-related quality of life, joint-specific scores, and adherence (weight change and qualitative interviews). This study is registered with ISRCTN, ISRCTN96684272. FINDINGS Between Sept 3 2018, and Aug 30, 2019, we screened 233 patients, of whom 163 (73%) were excluded and 60 (27%) were randomly assigned to either the intervention group (n=40) or the control group (n=20). 34 (57%) of 60 participants were women, 26 (43%) were men, and the mean age was 66·8 years (SD 8·6). Uptake of the specific intervention components varied: 31 (78%) of 40 had exercise therapy, 28 (70%) weight loss, 22 (55%) analgesia adjustment, and insoles (18 [45%]). Overall median adherence was 94% (IQR 79·5-100). At the final review, the intervention group lost a mean of 11·2 kg (SD 5·6) compared with 1·3 kg (3·8) in the control group (estimated difference -9·8 kg [95% CI -13·4 to -6·3]). A clinically significant improvement in health-related quality o life (mean change 0·078 [SD 0·195]) were reported, and joint-specific scores showed greater improvement in the intervention group than in the control group. No adverse events attributable to the intervention occurred. INTERPRETATION Participants adhered well to the non-operative interventions and their health-related quality of life improved. Participant and health professional feedback were extremely positive. These findings support progression to a full-scale effectiveness trial. FUNDING Versus Arthritis.
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Affiliation(s)
- A Hamish R W Simpson
- Edinburgh Orthopaedics, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK.
| | - Nicholas D Clement
- Edinburgh Orthopaedics, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Sharon A Simpson
- MRC/SCO Social and Public Health Sciences Unit and School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hemandt Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Biomedical Research Centre-Leeds, University of Leeds, Leeds, UK
| | - Susie Smillie
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Anthony R Leeds
- Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Biomedical Research Centre-Leeds, University of Leeds, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Biomedical Research Centre-Leeds, University of Leeds, Leeds, UK
| | - David Hamilton
- Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Peter Craig
- MRC/SCO Social and Public Health Sciences Unit and School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David Ray
- Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Elaine Kinsella
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Arlene McGarty
- MRC/SCO Social and Public Health Sciences Unit and School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Christine Beadle
- Edinburgh Orthopaedics, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Edinburgh Orthopaedics, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Simpson AHRW, Howie CR, Kinsella E, Hamilton DF, Conaghan PG, Hankey C, Simpson SA, Bell-Higgs A, Craig P, Clement ND, Keerie C, Kingsbury SR, Leeds AR, Ross HM, Pandit HG, Tuck C, Norrie J. Osteoarthritis Preoperative Package for care of Orthotics, Rehabilitation, Topical and oral agent Usage and Nutrition to Improve ouTcomes at a Year (OPPORTUNITY); a feasibility study protocol for a randomised controlled trial. Trials 2020; 21:209. [PMID: 32075663 PMCID: PMC7031939 DOI: 10.1186/s13063-019-3709-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background Patients’ pre-operative health and physical function is known to influence their post-operative outcomes. In patients with knee osteoarthritis, pharmacological and non-pharmacological options are often not optimised prior to joint replacement. This results in some patients undergoing surgery when they are not as fit as they could be. The aim of this study is to assess the feasibility and acceptability of a pre-operative package of non-operative care versus standard care prior to joint replacement. Methods/design This is a multicentre, randomised controlled feasibility trial of patients undergoing primary total knee replacement for osteoarthritis. Sixty patients will be recruited and randomised (2:1) to intervention or standard care arms. Data will be collected at baseline (before the start of the intervention), around the end of the intervention period and a minimum of 90 days after the planned date of surgery. Adherence will be reviewed each week during the intervention period (by telephone or in person). Participants will be randomised to a pre-operative package of non-operative care or standard care. The non-operative care will consist of (1) a weight-loss programme, (2) a set of exercises, (3) provision of advice on analgesia use and (4) provision of insoles. The intervention will be started as soon as possible after patients have been added to the waiting list for joint replacement surgery to take advantage of the incentive for behavioural change that this will create. The primary outcomes of this study are feasibility outcomes which will indicate whether the intervention and study protocol is feasible and acceptable and whether a full-scale effectiveness trial is warranted. The following will be measured and used to inform study feasibility: rate of recruitment, rate of retention at 90-day follow-up review after planned surgery date, and adherence to the intervention estimated through review questionnaires and weight change (for those receiving the weight-loss aspect of intervention). In addition the following information will be assessed qualitatively: analysis of qualitative interviews exploring acceptability, feasibility, adherence and possible barriers to implementing the intervention, and acceptability of the different outcome measures. Discussion The aims of the study specifically relate to testing the feasibility and acceptability of the proposed effectiveness trial intervention and the feasibility of the trial methods. This study forms the important first step in developing and assessing whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the design of the effectiveness trial. Trial registration ISRCTN registry, ID: ISRCTN96684272. Registered on 18 April 2018.
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Affiliation(s)
- A Hamish R W Simpson
- Department of Trauma and Orthopaedics, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Colin R Howie
- Department of Trauma and Orthopaedics, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Elaine Kinsella
- Edinburgh Clinical Trials Unit, University of Edinburgh, Usher Institute, Level 2, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - David F Hamilton
- Department of Trauma and Orthopaedics, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Catherine Hankey
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
| | - Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
| | - Anna Bell-Higgs
- Counterweight Ltd, 85 Great Portland Street, First Floor, London,, W1W 7LT, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
| | - Nicholas D Clement
- Department of Trauma and Orthopaedics, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Usher Institute, Level 2, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Anthony R Leeds
- The Parker (arthritis) Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Frederiksberg, Denmark
| | - Hazel M Ross
- Counterweight Ltd, 85 Great Portland Street, First Floor, London,, W1W 7LT, UK
| | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Chris Tuck
- Edinburgh Clinical Trials Unit, University of Edinburgh, Usher Institute, Level 2, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Usher Institute, Level 2, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
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