Qualitative findings from the Hip Injection Trial (HIT): experiences of living with hip osteoarthritis and receiving trial treatments

Abstract

Background
The HIT trial compared ultrasound-guided intra-articular hip injection (USGI) of triamcinolone acetonide and 1% lidocaine hydrochloride combined with best current treatment (BCT) with (i) BCT alone and (ii) an USGI of 1% lidocaine only combined with BCT (EudraCT: 2014-003412-37). BCT included verbal and written advice on exercise, weight loss and pain management. This nested qualitative study explored participants’ experiences of living with hip osteoarthritis (OA) and of the treatment they received.

Methods
Semi-structured interviews were completed with purposefully sampled trial participants after 2-month follow-up. Interviewers knew whether participants had received an injection within the trial, but not which injection. Thematic analysis was undertaken blind to the clinical trial results to facilitate an interpretive and inductive approach. Sampling ceased on inductive thematic saturation.

Results
34 trial participants were interviewed across all arms (USGI of triamcinolone acetonide and lidocaine plus BCT = 13, BCT alone = 8, USGI of lidocaine plus BCT = 11). Interviewees were males (n = 13) and females, of varying ages (53 - 83 years), with varying self-reported improvement. Participants described how hip OA impacted on many aspects of their life. It caused pain and physical limitations, difficulties at work, lowered mood, and commonly disrupted sleep. Participants who received BCT alone reported receiving an examination, information/explanation and exercises. Despite this, most felt that they had not received ‘treatment’ and reported limited exercise adherence. They described little or no benefit from BCT, and thoughts about the future tended to focus on inevitable decline. In contrast, participants in both injection groups experienced marked improvements in pain and other aspects of life, including sleep. Participants described getting their “life back” and having “a new lease of life”. Perceived benefit appeared greater among those randomised to USGI of triamcinolone acetonide and lidocaine plus BCT, however length of benefit varied in both injection groups. Despite uncertainty about the longer-term benefits of injection and the possibility of having repeated injections, there was more hope and optimism about the future among participants who had received an injection in comparison to those who had received BCT alone.

Conclusion
Hip OA is burdensome, affecting many different aspects of life. Participants perceived little or no benefit from BCT alone but reported marked improvements when combined with an USGI of triamcinolone and lidocaine or lidocaine alone. This complements the clinical trial results which demonstrated superiority of USGI of triamcinolone and lidocaine plus BCT over 6 months compared with BCT alone, but no significant difference in hip pain intensity between the injection groups. Together these findings raise the possibility of a degree of placebo effect. Varying duration of response to injection between individuals and reported uncertainty regarding effectiveness and safety of future injections, suggest these areas as important for future research.

Citation

Paskins, Holden, Mallen, Jinks, Hawarden, & Roddy. (2020). Qualitative findings from the Hip Injection Trial (HIT): experiences of living with hip osteoarthritis and receiving trial treatments. Rheumatology, https://doi.org/10.1093/rheumatology/keaa111.125

• Acceptance Date: Apr 20, 2020
• Publication Date: Apr 20, 2020
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Series Title: British Society for Rheumatology Annual Conference 2020
• DOI: https://doi.org/10.1093/rheumatology/keaa111.125
• Publisher URL: https://academic.oup.com/rheumatology/article/59/Supplement_2/keaa111.125/5822519