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A randomised controlled feasibility trial of trak musculoskeletal digital self-management physiotherapy intervention (TRAK-MSK)

Button, Kate ORCID: https://orcid.org/0000-0003-1073-9901 2024. A randomised controlled feasibility trial of trak musculoskeletal digital self-management physiotherapy intervention (TRAK-MSK). Presented at: Osteoarthritis Research Society International Congress, Vienna, 17 - 21 April 2024. Osteoarthritis and Cartilage. , vol.32 (Supp 1) Elsevier, S571-S572. 10.1016/j.joca.2024.02.845

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Abstract

Purpose (the aim of the study): TRAK-MSK is a co-produced theory-based digital physiotherapy self-management intervention. It is intended to help people with joint pain have the knowledge, confidence and skills to self-manage their condition so that they are more physically active and experience less pain. Our aim was to evaluate the feasibility and acceptability of conducting a multi-centre randomised controlled trial of TRAK MSK compared to usual care. Methods: e conducted a two-arm randomised feasibility trial with embedded process evaluation across 3 sites in Wales. The recruitment target was eighty adults aged 18 and over with self-reported activity related joint pain of more than one month seeking physiotherapy. Recruitment was via waiting lists, during clinic attendance or self-referral. Randomisation was 1:1 to TRAK MSK or usual care. The intervention was up to five online consultations delivered over 16 weeks with support from a physiotherapist who had received bespoke training in self-management support. Participants had access to an associated website, that included information, on pain, physical activity and healthy lifestyle, a goal setting function and access to a suite of exercises. The comparator was usual care physiotherapy delivered online, via telephone or face-to-face. The primary outcomes were feasibility of recruitment, which included; willingness to be randomised, follow up rates, fidelity of intervention delivery and acceptability of TRAK MSK. Secondary outcomes were confidence intervals for patient rated outcome measures (PROMS) between the arms at follow-up and Resource Use. Regression was used to obtain estimates of differences between arms and 95% confidence intervals. Post intervention interviews were analysed using a process evaluation framework. Results: The flow of participants through the study is illustrated in Figure 1. The TRAK MSK intervention was found to be feasible to deliver based on achieving pre-defined progression criteria (Table 1) with both participants and physiotherapists indicating that the intervention was acceptable and had a place in future ways of working. Inclusion of an initial in-person consultation to check eligibility will ensure these targets can be met in a future trial. After 16 weeks of treatment changes in patient rated pain, physical activity, confidence in managing pain and health related quality of life favoured the TRAK MSK intervention (Table 2). Interview findings suggest that self-management training was not fully integrated into practice. For example, physiotherapists reported there being a ‘right patient type’. Patients identified needing to be willing for remote treatment, confidence to exercise and digital literacy. Concerns were expressed around feelings of anxiety and loneliness with an online approach. Patients reported more satisfaction with TRAK MSK when physiotherapists took a collaborative approach. Healthcare resource used was well reported. Primary care had the most reported use and should be the health economics focus on a future trial. Conclusions: Progression of TRAK MSK to a full trial is recommended with minor modifications. TRAK MSK was perceived to be easy to use and of potential benefit by both patients and physiotherapists. A future trial needs to be designed to better understand and resolve how the TRAK MSK intervention is implemented, sustained, and embedded beyond the scope of a trial.

Item Type: Conference or Workshop Item (Other)
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Additional Information: Part of a special issue - Abstracts from the 2024 OARSI World Congress on Osteoarthritis
Publisher: Elsevier
ISSN: 1063-4584
Funders: Health and Care Research Wales
Last Modified: 14 May 2024 09:45
URI: https://orca.cardiff.ac.uk/id/eprint/168716

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