Acute flares of knee osteoarthritis in primary care: a feasibility and pilot case-crossover study

Thomas, MJ; Butler-Walley, S; Rathod-Mistry, T; Mayson, Z; Parry, EL; Pope, C; Neogi, T; Peat, G

Abstract

Background: Osteoarthritis (OA) is a leading cause of persistent pain and disability. Traditionally viewed as a slowly progressive disease, the impact of symptom variability on prognosis remains unclear. 'Acute-on-chronic' episodes are a well-recognised feature of many long-term conditions but only recently formally described in OA. This study aimed to develop a web-based data collection platform and establish key methodological design parameters, to develop a larger community-based study investigating acute flares of knee OA in England. Methods: The study is a 9-week feasibility and pilot web-based observational case-crossover study. Adults aged =?40 years registered with two general practices who had consulted their general practitioner for knee pain/OA in the last 2 years were recruited. Participants completed a baseline questionnaire and scheduled (control-period) questionnaires at follow-up weeks 1, 5, and 9. Participants were invited to self-declare via the website on any occasion they experienced a knee pain flare-up lasting =?24 h. Upon notification, an event-driven (case-period) questionnaire comparable to the scheduled questionnaires was completed and daily measurements on the course and consequences were taken until resolution. A sub-study of 10 participants logged daily pain measurements. The analysis estimated key parameters including recruitment (selective non-participation, eligibility, consent), retention, and flare-up capture processes. Questionnaire completeness and website usability were evaluated. Results: Of 442 patients invited, 14 completed baseline questionnaires. Eligibility rate was 26.9% (95% CI 19.3, 36.2), consent rate 53.6% (35.8, 70.5), and overall recruitment rate 3.2% (1.9, 5.2). Compared to those mailed, baseline responders were more likely to be male and =?65 years, as were those reporting =?1 flare-up. Eleven scheduled questionnaires were completed (mean response 35%). Although seven participants (50%) self-declared 11 flare-ups, only one event-driven questionnaire was completed and three participants contributed daily flare measurement for four flares. Missing data was =?3.7% across completed baseline, scheduled, and event-driven questionnaires. Aspects of website usability require minor refinement. Conclusions: Recruitment was not feasible with the current strategy. An evaluation of processes has suggested several substantial changes in design that may enhance recruitment, retention, and data quality in a future full-scale study.

Citation

Thomas, M., Butler-Walley, S., Rathod-Mistry, T., Mayson, Z., Parry, E., Pope, C., Neogi, T., & Peat, G. (2018). Acute flares of knee osteoarthritis in primary care: a feasibility and pilot case-crossover study. Pilot and Feasibility Studies, 4, Article 167. https://doi.org/10.1186/s40814-018-0359-4

• Journal Article Type: Article
• Acceptance Date: Oct 16, 2018
• Online Publication Date: Nov 5, 2018
• Publication Date: 2018-12
• Publicly Available Date: May 26, 2023
• Journal: Pilot and Feasibility Studies
• Print ISSN: 2055-5784
• Electronic ISSN: 2055-5784
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Article Number: 167
• DOI: https://doi.org/10.1186/s40814-018-0359-4
• Keywords: knee; osteoarthritis; flare; web-based; case-crossover
• Public URL: https://keele-repository.worktribe.com/output/412197
• Publisher URL: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-018-0359-4