Comparison of Osteoarthritis Management Programs: remote versus face-to-face care (COASTAL)

We will compare three services delivery approaches to osteoarthritis (OA) care. The three interventional approaches are the Osteoarthritis Chronic Care Program (OACCP) face-to-face hospital clinical approach, a telehealth approach, and an app (OA Coach). Participants randomised to the treatment arms will receive the interventions over 6-months. Appropriate to the mode of delivery, the interventions will deliver a standardised participant needs assessment; OA education; develop a collaborative management plan for each individual that selects appropriate self-management behaviours for therapeutic exercise, physical activity, pain management, and/or weight management. A report to each participant's referring health professional using a standardised template will be prepared after randomisation, and at trial conclusion. Each intervention arm will receive: • OACCP arm: participants will receive the OACCP model of care, as currently delivered through hospitals in NSW Australia. The delivery of the model will vary depending on the host hospital’s capacity/services, but will typically comprise of participant visits with a multidisciplinary team (e.g. physiotherapists, occupational therapists, dietitians), with care overseen by an OACCP Musculoskeletal Coordinator (usually a physiotherapist). There will be 3 sessions (~1-2 hrs each) over the 6 months approximately every 2 months during months 1, 3/4 and 6. Adherence will be monitored by participant self-reported monthly surveys and session attendance checklists. • Telehealth arm: participants will receive a remotely delivered telehealth service delivered by Ramsay Connect. This model is based upon the Optimising primary care management of knee osteoarthritis (PARTNER) PARTNER model of service delivery, tested previously. The Care Support Team (CST) will be an allied health team with members from a range of professions (e.g. Physiotherapists, Dietitians), trained in behaviour change techniques and OA management and will provide participants tailored OA educational materials, exercise programs, or weight-loss programs, as appropriate. There will be ~6-10 sessions (approx. one hour for the first session, and then subsequent sessions approx. 10-15 minutes each) delivered to participants by phone call over 6-months, ideally at least one phone session per month. Adherence will be monitored by participant self-reported monthly surveys and session attendance checklists. • OA Coach arm: participants will be guided in their care through a smartphone app. Interaction with the app will be at the participants' discretion, but they will be encouraged to login at least daily. Participants will complete assessments involving the input of anthropometric measurements and completion of pain scales, be able to set their own goals, be provided a display of their progress including steps (participants will be provided a Fitbit activity tracker to wear during the trial alongside the app), weight loss and pain levels. The learning page will cover core components of OA management, including physical activity, exercise, weight management, sleep hygiene, mood, and flare management. The duration off each app interaction is expected to take approx. 10-15 minutes each. Adherence will be monitored by participant self-reported monthly surveys and back-end monitoring progress (e.g. steps being uploaded).