Actively Recruiting
Which Model of Care is the Most Cost-effective in the Treatment of Musculoskeletal Disorders?
Led by Laval University · Updated on 2025-02-18
369
Participants Needed
1
Research Sites
182 weeks
Total Duration
On this page
AI-Summary
What this Trial Is About
As musculoskeletal disorders (MSKDs) reach epidemic proportions in Canada, access to the public health system for those who suffer from them is increasingly difficult. One of the main barriers is the delays to see a publicly funded health professional. New models of care must therefore be developed to ensure better access. We have previously shown that not all patients with a MSKD need to be closely followed by a health professional as for a large proportion of patients simply educating them is enough to resolve their MSKD. A stepped care model where education would be given first before deciding if patients need a more extensive follow-up should be explored. This project will compare the effectiveness of a Stepped Care Model to that of the two most widely used models of care: Usual Medical Care and Usual Rehabilitation Care. We think that a Stepped Care Model will be as effective to reduce functional limitations, but will lead to lower healthcare costs. Adults (n=369) with a MSKD will be randomly assigned to one of the intervention groups: Stepped Care, Usual Medical Care (physician-led intervention: e.g., advice/education, pharmacological pain management), or Usual Rehabilitation Care (physiotherapist-led intervention: e.g., advice/education, exercises). Participants in the Stepped Care Group will take part in two education sessions during the first 6 weeks. After 6 weeks, those who still have clinically important symptoms will receive follow-up rehabilitation interventions, while those who don't will be considered recovered and will have no further intervention. Primary (functional limitations) and secondary (e.g., pain, quality of life) outcomes will be assessed at baseline, and at 6, 12 and 24 weeks, and costs estimate will be established for each model of care. Knowing the urgent need for an overhaul of services to reduce wait times, the Stepped Care Model proposed could be a solution to improve access to health services without compromising quality of care.
CONDITIONS
Official Title
Which Model of Care is the Most Cost-effective in the Treatment of Musculoskeletal Disorders?
Who Can Participate
Eligibility Criteria
You may qualify if you...
- Present with one of the four targeted MSKDs: low back pain, neck pain, anterior knee pain, or rotator cuff-related shoulder pain
- Have had pain for at least 6 weeks
- For low back pain: non-specific low back pain with or without radiation to lower limbs and a minimum score of 15 on the Oswestry Disability Index
- For neck pain: non-specific neck pain with or without radiation to upper limbs and a minimum score of 21 on the Neck Disability Index
- For anterior knee pain: anterior knee pain during walking, running, stairs, or at least two activities among kneeling, squatting, and resisted knee extension, and maximum score of 79 on the Knee Outcome Survey - Activities of Daily Living Scale
- For rotator cuff-related shoulder pain: minimum score of 15 on the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and shoulder pain attributed to rotator cuff-related pain following diagnostic guidelines of the British Elbow and Shoulder Society
You will not qualify if you...
- Unavailable to participate during the 24 weeks of the study
- Do not understand French or English
- Diagnosis of rheumatoid, inflammatory, or neurodegenerative diseases
- Received a corticosteroid injection in the previous 3 months
- Cognitive problems interfering with participation (Mini-Mental State Examination score less than 24)
- Less than 6 weeks since an intervention for their condition, including prescribed exercises or medication
- For low back pain: related to specific conditions such as vertebral fracture, infections, neuropathic pain (DN4 questionnaire score greater than 4), history of spine surgery, or signs of upper motor neuron lesions
- For neck pain: related to specific conditions such as vertebral fracture, infections, neuropathic pain (DN4 questionnaire score greater than 4), history of spine surgery, or signs of upper motor neuron lesions
- For anterior knee pain: history of knee surgery or patellar dislocation, or pain believed to originate from meniscus or any knee ligament
- For rotator cuff-related shoulder pain: history of shoulder surgery, dislocations, fractures, or capsulitis, or full thickness rotator cuff tear identified by imaging or clinical tests
AI-Screening
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Trial Site Locations
Total: 1 location
1
Centre for interdisciplinary research in rehabilitation and social integration (Cirris)
Québec, Quebec, Canada, G1M2S8
Actively Recruiting
Research Team
J
Jean Tittley, PT, MSc
CONTACT
How is the study designed?
Study Type
INTERVENTIONAL
Masking
DOUBLE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
3
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