Extract

Background and study aims Patients for hip and knee replacement are referred by general practitioners (GPs) in primary care to secondary care (hospital) when it is felt patients’ symptoms are severe, unremitting (no change in symptoms) and disabling. In secondary care patients have further assessment and a decision to proceed to surgery is made. UK data shows widespread regional variation in the way patients are selected for surgery. In addition, 15% of patients having these interventions are dissatisfied with their outcome. One of the reasons suggested for the variation and dissatisfaction is the way in which patients are deemed suitable for hip or knee surgery. An evidence-based system, developed from a currently used assessment tool, could be introduced for GPs and hospital teams to use. Using the system, patients who are highly likely to benefit from surgery could be identified and referred, whilst those who would not benefit from surgery can be guided to other treatment options. We will meet explore which established hip and knee assessment tools can be used to determine safe, cost-effective thresholds for treatment, based on patients’ capacity to improve. In doing this, our aim is to provide the NHS with a universal, valid, cost-effective and fair system for selecting patients for joint replacement. We will achieve this by creating the Arthroplasty Candidacy Help Engine (ACHE) tool. The ACHE tool will consist of a combination of a currently available clinical questionnaire and a set of thresholds, by which patients who would benefit from surgery are identified and referred on to secondary care. Who can participate? Patients over 18 with knee or hip osteoarthritis. What does the study involve? Our research programme involves three stages. In the first stage, work package (WP) 1, we will conduct a comprehensive literature review and assessment of measurement properties of current clinical tools used for assessing patients with osteoarthritis and/or undergoing joint replacement surgery. In the second stage, WP2, we will calculate preoperative threshold levels for three short-listed candidate tools to identify patients who are candidates for surgery which will be the best at identifying which patients can benefit most from surgery and to find the optimum cost effectiveness. In the third stage we will evaluate the effect of the ACHE tool and its acceptance by stakeholders, such as patients, GPs, doctors and commissioners. We will evaluate the impact of the new ACHE tool by applying it to a series of patients being considered for referral to secondary care, via our hub referral centre in Oxford. We estimate that the tool will demonstrate its effectiveness by identifying patients who have been appropriately referred, but also a group of patients who would not benefit from surgery and who should not have been referred. In the second part of WP3 we will obtain, via questionnaires, the views of a large number of GPs and patients as to the acceptability of the ACHE tool. Thirdly, in WP3, we will formally consult with an extended group of stakeholders who are involved in the pathway for hip and knee surgery within the NHS (patients, healthcare professionals and commissioners of services) and present the evidence we have compiled. Across each stage a USER Group consisting of stakeholder representatives (patients, public, GPs, secondary care health care workers, surgeons and commissioners) will be actively involved in the research process. What are the possible benefits and risks of participating? There are no risks or immediate benefits to participants in this study. Where is the study run from? This study is a collaboration between the University of Oxford, the University of Bristol and Peninsula Medical School. The research will be led from Oxford (Nuffield Orthopaedic Centre) but workers will be based in the Avon Orthopaedic Centre (Bristol) and Peninsula. When is the study starting and how long is it expected to run for? The study will start in December 2013 and will run for 36 months. Who is funding the study? National Institute for Health Research, UK. Who is the main contact? Kristina Harris [email protected]

Inclusion criteria

• hip and knee osteoarthritis

Links

• ictrp
• isrctn