To compare the clinical and cost effectiveness of the Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT), a community-based, stratified, multidisciplinary intervention consisting of exercise, education, psychological and nutrition delivered through a chronic care model to usual hospital care in adults with knee osteoarthritis (OA). Pragmatic, parallel-arm, single-blinded superiority RCT trial. Community-dwelling, ambulant adults with knee OA (Kellgren-Lawrence grade > 1; Knee Injury and OA Outcome Score (KOOS) ≤75) were enrolled. Primary outcome was KOOS at 12-months; secondary outcomes included: quality of life, physical performance measures, symptom satisfaction, psychological outcomes, dietary habits, and global perceived effect. Intention-to-treat analysis using generalized linear model (GLM) and regression modeling were conducted. Economic evaluation through a societal approach was embedded. 110 participants (55 control, 55 intervention) were randomized. No between-group difference found for the primary outcome (MD [95%CI]: −1.86 [−9.11. 5.38]), although both groups demonstrated within-group improvement over 12-months. Among the secondary outcomes, the CONNACT group demonstrated superior dietary change (12 months) and physical performance measures (3 months), and global perceived effect (6 months). While there was no between-group difference in total cost, significant productivity gains (reduced indirect cost) were seen in the CONNACT group. CONNACT was not superior to usual care at 1 year. Further efforts are needed to understand the underlying contextual and implementation factors in order to further improve and refine such community-based, stratified care models moving forward. Clinicaltrials.gov Identifier: NCT03809975. Registered January 18, 2019.

中文翻译：

---

骨科和专职医疗保健专业人员 (CONNACT) 之间治疗膝骨关节炎的协作护理模式：基于社区、多学科、分层干预的有效性实施混合随机对照试验


比较骨科和联合医疗保健专业人员之间的协作护理模式 (CONNACT) 的临床和成本效益，这是一种基于社区的分层多学科干预措施，包括通过慢性护理模式向普通医院提供的运动、教育、心理和营养成人膝骨关节炎 (OA) 的护理。务实、平行、单盲优势随机对照试验试验。患有膝关节 OA（Kellgren-Lawrence 分级 > 1；膝关节损伤和 OA 结果评分 (KOOS) ≤ 75）的社区居住、可活动的成年人被纳入研究。主要结局为 12 个月时 KOOS；次要结局包括：生活质量、身体机能测量、症状满意度、心理结果、饮食习惯和整体感知效果。使用广义线性模型（GLM）和回归模型进行意向治疗分析。通过社会方法进行经济评估已被纳入其中。 110 名参与者（55 名对照，55 名干预）被随机分配。尽管两组在 12 个月内均表现出组内改善，但主要结局未发现组间差异（MD [95%CI]：−1.86 [−9.11.5.38]）。在次要结局中，CONNACT 组表现出优异的饮食改变（12 个月）和身体机能指标（3 个月）以及整体感知效果（6 个月）。虽然总成本没有组间差异，但 CONNACT 组的生产率显着提高（间接成本降低）。 1 年时，CONNACT 并不优于常规护理。需要进一步努力了解潜在的背景和实施因素，以便进一步改进和完善这种基于社区的分层护理模式。临床试验。政府标识符：NCT03809975。 2019 年 1 月 18 日注册。