Determining the Impact of a Physiotherapist-Led Primary Care Model for Hip and Knee Pain - A Pilot Trial

A full trial will be feasible if the investigators are able to recruit 1.5 participants per week per site over 20 weeks

The investigators consider ≥80% of all assessment items completed and a mean time for completion of ≤60 minutes acceptable.

The investigators consider an attrition rate of ≤20% at 12-month follow-up successful. ≤35% attrition will be considered partially successful; however, additional retention strategies would be required for the full trial based on evidence that ≥20% attrition threatens trial validity

Treatment fidelity will be measured through an audit of a PT fidelity checklist and electronic medical record (EMR) to determine the consistency of the care provided. An acceptable level of fidelity will be considered ≥80% for each intervention component.

Self-report using the Lower Extremity Functional Scale (0-80 score with higher score representing higher function)

Measured using a numeric pain rating scale from 0 to 10 with higher scores indicating greater pain intensity.

Measured using the EuroQoL-5D-5L (0 to 100 with greater scores indicating greater self-reported health related quality of life)

Confidence in abilities to participate in usual activities using the Pain Self Efficacy Questionnaire

Measured using the Pain Catastrophizing Scale (0 to 52 with higher scores indicating greater catastrophic thinking)

Measured using the Tampa Scale of Kinesiophobia (an 11-item questionnaire)

Measured using the 2-Item Patient Health Questionnaire

Measured using an 11-point scale (-5 to +5 with negative scores indicating a worsening of physical functioning and positive scores indicating an improvement of physical functioning)

Measured using an 11-point scale(-5 to +5 with negative scores indicating a dissatisfaction with health care received and positive scores indicating satisfaction with health care received)

Measured using an adverse events questionnaire that asks 1) if the participant has experienced any adverse events as a result of the treatments received (yes/no); 2) how long the event lasted (hours or days); 3) how severe the adverse event was (0-10 scale); 4) what adverse events were experienced.

Percentage of participants assessed within 48 hours of calling for an appointment

Number of consultations with primary care team members for hip or knee pain (e.g., physicians, nurse practitioners, nurses, social workers, occupational therapists)

Survey questions related to hip or knee pain: number of visits to health professionals outside the primary care team (e.g., chiropractors, massage therapists, occupational therapists, physiotherapists, chronic pain clinics)

Survey questions related to hip or knee pain: number of medications taken. Includes type of medication, dose, frequency

Survey questions related to hip or knee pain: number of walk-in clinic visits outside of primary care centre

Survey questions related to hip or knee pain: number of emergency department visits

Survey questions related to hip or knee pain: number of overnight hospital stays

Survey questions related to hip or knee pain: number of surgeries, procedures, and injections

Survey questions related to hip or knee pain: number of visits to specialists

Survey questions related to hip or knee pain: number of diagnostic images received

Collected from the EMR: medications prescribed for hip or knee pain. Includes the type of medication prescribed

Collected from the EMR: diagnostic images ordered for hip or knee pain

Collected from the EMR: exercises prescribed for hip or knee pain

Collected from the EMR: education provided for hip or knee pain

Collected from the EMR: referrals to other HCPs (both internal and external to the primary health care team) for hip or knee pain

Collected from the EMR: visits to the primary care team for hip or knee pain

Collected from the EMR: notes provided to employers or insurers for hip or knee pain

Self-reported time lost from work, volunteering, homemaking, and educational activities

Self-reported assistance needed, due to hip or knee pain, for self-care, housework, shopping, or transportation

Any extra expenses incurred as a result of hip or knee pain. Self-report

Costs associated with all health utilization, self-reported time lost, assistance needed, and extra expenses. Will be presented as aggregate and time-specific costs

To describe the study population, the investigators will capture the following through the survey: age, sex, gender, duration of musculoskeletal pain, locations of pain, medications, comorbidities, current work status, income, rurality, and ethnicity.

Measured at baseline using the Functional Comorbidity Index (an 18-item list of comorbidities that are associated with physical functioning).

Self-reported length of time since current and first incidence of hip or knee pain

Self-report adherence to PT advice