To 1) develop and assess face-validity of the digital triage tool Adherence to OA Guidelines Instrument (AtOAGI) for patients with hip or knee OA who have been referred for orthopaedic consultation and 2) identify the proportion of patients who have not completed first-line treatment before being referred for orthopaedic consultation.
To develop the digital triage tool AtOAGI and assess its face validity, items were based on national guidelines and an existing medical history template. An expert group of three PTs, one orthopaedic surgeon, and a patient representative contributed to the development of the first versions. AtOAGI was then presented for a patient council and to two experienced PTs for feedback on AtOAGI’s comprehensiveness and relevance. The AtOAGI was revised four times before a final version was established. The AtOAGI is used in an ongoing randomized controlled trial of which a subgroup analysis of patients included during 2023 is reported here. Eligible patients with hip or knee OA referred for orthopaedic consultation were contacted through a digital platform. A PT-led paper triage, based on the results of AtOAG, were then carried out.
The final version of the AtOAGI included ten questions, of which four were related to first-line treatment and were used to categorize whether patients had completed it or not. The expert panel, along with the patient council and the two PTs, agreed that the constructs within the AtOAGI were appropriate for the target patient group and aligned with the instrument objectives.
During 2023, 844 patients received the AtOAGI whereof 93% completed it. Of these, 28% (n=214) were assessed not to have completed first-line treatment. During the PT-led paper triage it was discovered that 6,5% of these patients were incorrectly identified by AtOAGI.
Approximately one-fourth of the patients referred for orthopaedic consultation for their hip or knee OA had not completed first-line treatment, as determined by the digital AtOAGI tool and PT-led paper triage. By introducing a AtOAGI, patients who have not completed first-line treatment can be identified earlier and referred back to primary care to initiate or continue first-line treatment.
PTs are responsible for first-line treatment for OA patients and to identify when the treatment might not be enough. Nevertheless, in most cases it’s a GP that refers the patient for an orthopaedic consultation. Implementing the AtOAGI together with PT-led paper triage can identify patients with hip or knee OA who have not completed first-line treatment and guide them to the most suitable level of care.
Triage
Guidlines
