166658
Enhancing contextual effect of treatment
in osteoarthritis
- People
- Led by Weiya Zhang
- Led by Weiya Zhang
- Programme Grant
- Outline
- Background
- Only a minority of patients with chronic pain
due to osteoarthritis (OA) show measurable
benefits from any of the treatments commonly
given for this condition including opioid,
non-opioid analgesics, injections and surgery
- Treatment effects largely
depend on the context
- Our current research demonstrates that in OA, for example,
60% of treatment benefit is attributable to the contextual
effect. Even for opioids the contextual effect reaches 35%.
- Only a minority of patients with chronic pain
due to osteoarthritis (OA) show measurable
benefits from any of the treatments commonly
given for this condition including opioid,
non-opioid analgesics, injections and surgery
- Aim
- To enhance the contextual effect of
treatment in a clinical practice setting
- To enhance the contextual effect of
treatment in a clinical practice setting
- Objectives
- 1. To identify key contextual factors that have
therapeutic effects; 2.To examine current contextual
standards in the NHS primary and secondary settings;
3. To develop a simple and deliverable contextual
package 4. To test the feasibility of delivering the
package 5. To evaluate the efficacy of the package in
knee OA 6. To implement the package and evaluate
its cost-effectiveness from the NHS perspectives
- 1. To identify key contextual factors that have
therapeutic effects; 2.To examine current contextual
standards in the NHS primary and secondary settings;
3. To develop a simple and deliverable contextual
package 4. To test the feasibility of delivering the
package 5. To evaluate the efficacy of the package in
knee OA 6. To implement the package and evaluate
its cost-effectiveness from the NHS perspectives
- Methods
- 1. Systematic review: to identify contextual factors
with therapeutic effects
- 2. Questionnaire survey: in primary and secondary care in
one or two Nottingham CCGs to examine current clinical
practice in utilising the contextual factors that have
therapeutic effects
- 4. Focus groups: to identify the barriers and
facilitators for utilising the effective contextual
factors in consultation
- 3. Delphi exercise: to develop a package of less that 10 key
elements of contextual care (based on 1 and 2 above) in
delivering the effective contextual factors
- 5. Feasibility test: the contextual package will be delivered
in different care settings, generic & individualised, with pre
and post consultation surveys for PROMs, post survery
with practitioners.
- 6. RCT to evaluate the clinical effectiveness
and cost-effectiveness of the package.
- 7. Implementation: in primary care setting to evaluate the efficacy of the package in people with knee
osteoarthritis, with patients randomised to one of 3 groups: [1] generic contextual package; [2]
individualised contextual package; and [3] usual consultation. Followed up at 6 and 12 months for
pain, function, stiffness and quality of life measures, while the same type of consultation will be
repeated.The package will be applied to a random sample of CCGs in Nottingham. Audit will be
undertaken annually for 3 years to reinforce the package and to check the change of the contextual
standards. Patients with OA and other chronic conditions may be sampled and quality of life may be
measured at baseline and follow-up to provide outcome measures. Number of GP visits, referrals and
medications will also be collected. Cost data will be collected and cost effectiveness model will be
developed based on the RCT and Audit data.
- Clarify that comparison is to be made
between trial's arms and not between
CCGs in and out of trial
- Clarify that comparison is to be made
between trial's arms and not between
CCGs in and out of trial
- 7. Implementation: in primary care setting to evaluate the efficacy of the package in people with knee
osteoarthritis, with patients randomised to one of 3 groups: [1] generic contextual package; [2]
individualised contextual package; and [3] usual consultation. Followed up at 6 and 12 months for
pain, function, stiffness and quality of life measures, while the same type of consultation will be
repeated.The package will be applied to a random sample of CCGs in Nottingham. Audit will be
undertaken annually for 3 years to reinforce the package and to check the change of the contextual
standards. Patients with OA and other chronic conditions may be sampled and quality of life may be
measured at baseline and follow-up to provide outcome measures. Number of GP visits, referrals and
medications will also be collected. Cost data will be collected and cost effectiveness model will be
developed based on the RCT and Audit data.
- 1. Systematic review: to identify contextual factors
with therapeutic effects
- Background
- Outline
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