Implementing a Group Physical Therapy Program for Veterans (GroupPT): Function QUERI 3.0
Purpose
Implementing Group Physical Therapy for Veterans with Knee Osteoarthritis (Group PT): Function QUERI 3.0 aims to compare two implementation approaches for implementing Group PT in 20 VA facilities using a type III effectiveness-implementation hybrid study framework and parallel cluster randomized trial (CRT) design.
Condition
- Knee Osteoarthritis
Eligibility
- Eligible Ages
- All ages
- Eligible Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
Sites are eligible to participate if they have: - 2 outpatient PT clinicians (one primary and one back-up) for delivering Group PT - space to conduct group sessions (if delivering Group PT in person) or ability to conduct visits via telehealth (video) Patients will be eligible for Group PT if they have a clinician diagnosis of symptomatic knee OA.
Exclusion Criteria
- Site will be ineligible to participate if they are already conducting a group physical therapy class for patients with knee OA. - Patients will be ineligible for Group PT if they have a substantial fall risk or co-occurring health conditions that would make participation in a group exercise class unsafe.
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Intervention Model Description
- Parallel cluster-randomized trial (parallel-CRT): used in pragmatic evaluations of health program or policy interventions, where half the clusters (in this case, VA sites) are randomly assigned to two interventions: Foundational Arm (active comparator) vs. Reach Equity And Collective Health (REACH) arm (experimental).
- Primary Purpose
- Health Services Research
- Masking
- None (Open Label)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Active Comparator Foundational Arm |
Foundational Arm uses the Replicating Effective Program (REP) implementation strategy and includes 3 elements that were developed and tested in our prior Function QUERI work: program initiation, self-guided resources, and technical assistance. |
|
|
Experimental REACH (Reach Equity And Collective Health) Arm |
The REACH Arm will include the same activities as the foundational arm plus REACH activities: 1) external facilitation and 2) equity-focused data-driven monitoring. |
|
Recruiting Locations
Durham, North Carolina 27705-3875
More Details
- Status
- Recruiting
- Sponsor
- VA Office of Research and Development
Detailed Description
Background/Purpose. Exercise-based PT is a key component of guideline concordant knee OA management. However, PT is underutilized for knee OA, resulting in missed opportunities to improve outcomes for the many Veterans with this health condition. A key challenge is the high demand for PT services for knee OA, paired with limited availability of PT services, which can lead to long wait times for Veterans or high community care costs for the VA. Group-based delivery of PT for knee OA can enhance access and efficiency. Following an RCT that supported the effectiveness of Group PT relative to individual PT, the Durham Veterans Affairs Healthcare System (DVAHCS) offered Group PT as a clinical service, and found that patients achieved clinically relevant improvements in pain and functional outcomes that were comparable to those observed in the RCT. Most recently, the investigators conducted a 19-site trial comparing implementation strategies to support delivery of Group PT in the VA. Overall, 16 sites successfully delivered a Group PT program, enrolling a total of 366 Veterans. There were clinically relevant improvements in pain interference and functional outcomes among participating Veterans. The overall goal of this trial is to evaluate implementation of Group PT with a foundational arm versus the Reach Equity and Collective Health (REACH) arm. Methodology. To evaluate implementation of Group PT, the investigators will randomize sites (n=20) 1:1 to either the foundational arm or the REACH arm. Implementation activities will occur over a 12-month period. The Group PT program includes 6 sessions that include exercise and educational content. Patients will be eligible for Group PT if they have a clinician diagnosis of symptomatic knee OA and ineligible if they have a substantial fall risk or co-occurring health conditions that would make participation in a group exercise class unsafe. The primary follow-up outcome time-point will be 18 months; metrics will also be evaluated at 12 months (reach, patient engagement). Implementation outcomes include 1) Reach (primary), defined as the number of patients initiating Group PT, 2) Patient Engagement, defined as the average number of sessions attended by patients who initiate the EBP, and 3) Time to Adoption, defined as the time from baseline to launching a Group PT program and enrolling 5 Veterans. Generalized linear models will be used to examine the effect of Foundational vs. REACH arms on reach and patient engagement.