Knowledge Translation and Exercise for Degenerative Meniscal Pathology and Early Osteoarthritis (KNEE-DEeP): Protocol for a Single Arm Feasibility Study

Overview

Journal HRB Open Res

Specialty Biomedical Engineering

Date 2025 Mar 3

PMID 40028467

Authors

Helen OLeary

Clodagh Toomey

Liam G Ryan

Katie Robinson

Liam Glynn

Helen P French

Karen McCreesh

Affiliations

Soon will be listed here.

Abstract

Background: The Knowledge Translation and Exercise for Degenerative Meniscal Pathology and Early Knee Osteoarthritis (KNEE-DEeP) intervention was designed to promote greater uptake of evidence-based non-surgical treatments for knee pain attributed to degenerative meniscal pathology and early knee osteoarthritis (OA) in primary care, by tackling barriers at a service, clinician and patient level. Evidence indicates that patients frequently do not access first-line treatments, namely exercise and patient education, prior to specialist referral. The KNEE-DEeP intervention supports general practitioners (GPs) and physiotherapists to enhance their skills and confidence in managing patients with this type of knee pain through professional development workshops. In turn, patients will receive an 'enhanced consultation' from their GP and be referred to an early 'best practice' physiotherapy session. Physiotherapists will work with patients to develop a collaborative action plan focussing on self-management and exercise.

Methods: This protocol outlines a single arm non-randomised feasibility study with a mixed method process evaluation. The study intends to recruit 15 GPs, five physiotherapists and 36 patients from general practices in the South-West of Ireland. Eligible patients, will be aged between 35 years and 69 years inclusive, and attend their GP with an episode of non-traumatic knee pain attributed to a degenerative meniscal tear (DMT) or early OA. Physiotherapists and GPs will be trained in intervention delivery. Within two weeks of receiving an 'enhanced consultation' from their participating GP, patients will attend the one-hour 'best practice' physiotherapy session. Patient data will be collected via online questionnaires at baseline, 12 weeks and 6 months. Qualitative interviews to assess the feasibility and acceptability of the intervention will be conducted with a purposive sample of GPs, physiotherapists and their enrolled patients.

Ethics And Dissemination: Approved by Clinical Research Ethics Committee of the Cork Teaching Hospitals. Results will be presented in peer-reviewed journals and at international conferences.

Registration: clinicaltrials.gov ( NCT06576557).

References

Avery K, Williamson P, Gamble C, OConnell Francischetto E, Metcalfe C, Davidson P . Informing efficient randomised controlled trials: exploration of challenges in developing progression criteria for internal pilot studies. BMJ Open. 2017; 7(2):e013537. PMC: 5318608. DOI: 10.1136/bmjopen-2016-013537. View

Oppong R, Jowett S, Lewis M, Clarkson K, Paskins Z, Croft P . Cost-effectiveness of a model consultation to support self-management in patients with osteoarthritis. Rheumatology (Oxford). 2018; 57(6):1056-1063. PMC: 5965099. DOI: 10.1093/rheumatology/key037. View

Nicholas M, McGuire B, Asghari A . A 2-item short form of the Pain Self-efficacy Questionnaire: development and psychometric evaluation of PSEQ-2. J Pain. 2014; 16(2):153-63. DOI: 10.1016/j.jpain.2014.11.002. View

Keavy R, Horton R, Al-Dadah O . The prevalence of musculoskeletal presentations in general practice: an epidemiological study. Fam Pract. 2022; 40(1):68-74. DOI: 10.1093/fampra/cmac055. View

Bunzli S, Taylor N, OBrien P, Wallis J, Caneiro J, Woodward-Kron R . Broken Machines or Active Bodies? Part 2. How People Talk About Osteoarthritis and Why Clinicians Need to Change the Conversation. J Orthop Sports Phys Ther. 2023; 53(6):325-330. DOI: 10.2519/jospt.2023.11880. View

Petron D, Greis P, Aoki S, Black S, Krete D, Sohagia K . Use of knee magnetic resonance imaging by primary care physicians in patients aged 40 years and older. Sports Health. 2012; 2(5):385-90. PMC: 3445052. DOI: 10.1177/1941738110377420. View

Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M . Surgical Management of Degenerative Meniscus Lesions: The 2016 ESSKA Meniscus Consensus. Joints. 2017; 5(2):59-69. PMC: 5672871. DOI: 10.1055/s-0037-1603813. View

Johnston B, Burke S, Barry S, Normand C, Fhalluin M, Thomas S . Private health expenditure in Ireland: Assessing the affordability of private financing of health care. Health Policy. 2019; 123(10):963-969. DOI: 10.1016/j.healthpol.2019.08.002. View

Keene D, Soutakbar H, Hopewell S, Heine P, Jaggi A, Littlewood C . Development and implementation of the physiotherapy-led exercise interventions for the treatment of rotator cuff disorders for the 'Getting it Right: Addressing Shoulder Pain' (GRASP) trial. Physiotherapy. 2020; 107:252-266. DOI: 10.1016/j.physio.2019.07.002. View

10.

Bennell K, Keating C, Lawford B, Kimp A, Egerton T, Brown C . Better Knee, Better Me™: effectiveness of two scalable health care interventions supporting self-management for knee osteoarthritis - protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2020; 21(1):160. PMC: 7068989. DOI: 10.1186/s12891-020-3166-z. View

11.

OLeary H, Robinson K, Glynn L, Lenehan B, McCreesh K . "You're stuck in the middle here": a qualitative study of GPs' experiences of managing knee pain attributed to a degenerative meniscal tear. BMC Prim Care. 2023; 24(1):127. PMC: 10286499. DOI: 10.1186/s12875-023-02075-9. View

12.

McHugh C, Matzkin E, Katz J . Mechanical symptoms and meniscal tear: a reappraisal. Osteoarthritis Cartilage. 2021; 30(2):178-183. PMC: 8792212. DOI: 10.1016/j.joca.2021.09.009. View

13.

Weiner B, Lewis C, Stanick C, Powell B, Dorsey C, Clary A . Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017; 12(1):108. PMC: 5576104. DOI: 10.1186/s13012-017-0635-3. View

14.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M . Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008; 337:a1655. PMC: 2769032. DOI: 10.1136/bmj.a1655. View

15.

. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA. 2024; 333(1):71-74. DOI: 10.1001/jama.2024.21972. View

16.

Katz J, Brophy R, Chaisson C, de Chaves L, Cole B, Dahm D . Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013; 368(18):1675-84. PMC: 3690119. DOI: 10.1056/NEJMoa1301408. View

17.

Murphy A, Yelverton B, Clesham K, Hassell K, Kavanagh E, Eustace S . Does MRI Knee in Those over 50 Years with Knee Pain in Osteoarthritis Alter Management? A Retrospective Review. J Knee Surg. 2021; 36(6):584-590. DOI: 10.1055/s-0041-1740390. View

18.

Hohmann E, Angelo R, Arciero R, Bach B, Cole B, Cote M . Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy. 2020; 36(2):501-512. DOI: 10.1016/j.arthro.2019.08.014. View

19.

Sihvonen R, Paavola M, Malmivaara A, Itala A, Joukainen A, Nurmi H . Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013; 369(26):2515-24. DOI: 10.1056/NEJMoa1305189. View

20.

Lin I, Wiles L, Waller R, Caneiro J, Nagree Y, Straker L . Patient-centred care: the cornerstone for high-value musculoskeletal pain management. Br J Sports Med. 2020; 54(21):1240-1242. DOI: 10.1136/bjsports-2019-101918. View