A new research project aims to tackle low value care for knee osteoarthritis in the areas that need it most.
Researchers from the Kolling Institute at the University of Sydney have been awarded $2.6 million from the Medical Research Future Fund to prevent unnecessary knee procedures and reshape how care is provided in knee osteoarthritis.
Two-thirds of Australians with osteoarthritis do not receive the effective treatments recommended in clinical guidelines (e.g., education, exercise and weight management in the first instance).
These individuals are sometimes sent for tests and treatments that offer little benefit and can cause harm, such as unnecessary imaging, specialist appointments and arthroscopic knee procedures.
The pursuit of unnecessary or low-value treatments significantly adds to the overall financial burden of knee OA, with estimates suggesting the condition costs Australia $4.3 billion each year.
But the new research project – Assessing a multicomponent strategy designed to reduce low-value care for knee osteoarthritis – aims to support GPs and physiotherapists in parts of the country where low value care is more common by providing them with tools and other practical supports to confidently deliver evidence-based care.
Dr Jillian Eyles, a physiotherapist and clinician-researcher who will lead the new study alongside rheumatologist Professor David Hunter, said the inspiration for the project came from the Nudge vs Superbugs trial, which involved sending personalised letters to high-prescribing GPs signed by Australia’s chief medical officer in an attempt to reduce unnecessary antibiotic prescribing where safe and appropriate.
“It was a really effective study. I believe they reduced [antibiotic] prescriptions by 15%, which is quite a large percentage for an intervention like that. And we thought, there’s still a lot of people with osteoarthritis who are having arthroscopic knee procedures – could we do a similar thing?,” she said.
“Things grew from there, because we realised there’s a slippery slope to this low value care. It tends to start at the GPs office or at the physio when they’re sent off for imaging that they don’t really need, and then they get a report back that says all sorts of terrible things.
“And it makes people think, ‘oh, I really need to see a surgeon. My next-door neighbour’s brother’s cousin had a great outcome when they had an arthroscopic knee procedure so maybe I should do the same thing. So, they tend to expect – and want – to go along and see a specialist.”
The team will use mapping data to identify areas where low value care, such as the arthroscopic knee procedures, is most frequently used for people with osteoarthritis. Both health professionals who work and people with osteoarthritis who live in these areas will receive specially designed education, resources and other support.
Outcomes, including surgery rates as well as imaging and specialist referrals, will be tracked over a two-year period.
“It’s a bit more complicated than just sending an audit and some feedback letter to any particular set of healthcare professionals. It’s more about raising awareness and supporting health professionals, as well as consumers, that they should expect different things – that they should expect high value care,” Dr Eyles explained.
“We’ve been doing a lot of work over several years to develop all sorts of educational resources and training and support programs, including a very comprehensive e-learning program for health professionals that goes through everything you ever need to know about osteoarthritis and rheumatoid arthritis.
“We’ve [also] got a digital app that supports self-management for people with knee osteoarthritis that we’ve developed and are testing in a trial at the moment, so [the study] may also involve providing access to that platform, where people can access remotely delivered treatments.
“We’re also really lucky to be working with Associate Professor Samantha Bunzli from Queensland, who has expertise in working with culturally diverse patient populations. The consumer education component is going to be crucial to bring into the trial.
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“We will also co-design some new resources that are locally appropriate based on what clinicians and consumers tell us that they need, but we’ll also be co-adapting some of the resources that we’ve already got. We’re going to be asking people that we’ll be doing the trial with what they think will be helpful and [figuring out] how we can help them.”
The project will involve a variety of collaborators and stakeholders, including the Australian Orthopaedic Association, the Australian Knee Society, the Royal Australian College of General Practitioners, the Australian Physiotherapy Association, Arthritis Australia, Private Healthcare Australia, consumer groups and various Primary Health Networks.
“We had some early adopters in this project, specifically some wonderful philanthropic organisations called the Girgensohn Foundation and the NORTH Foundation,” Dr Eylesa said.
“They came to talk to David and myself about the projects that we were working on, and this one particularly piqued their interest. From very early on they could see the value of reducing low value care and trying to give people the care that they deserve.
“And they supported us and provided seed funding for three years while we tried to develop this project and did some of the background work to achieve success with this larger MRFF application. We’re very grateful for this support.”
Dr Eyles said that rheumatologists were another important partner in the new research.
“I know that osteoarthritis is not every rheumatologist’s cup of tea, but they’ve been incredibly supportive,” she said.
“In fact, a few years ago the Australian Rheumatology Association listed arthroscopy for knee osteoarthritis as one of the top low value care procedures that needed to stop in Australia, so it’s very much something that we should try and reduce.”
The research team have also partnered with the Australian Commission for Safety and Quality in Healthcare, who released a new clinical care standard for knee osteoarthritis in August 2024.
They plan to co-design strategies that will implement the recommendations included within the standard as part of the broader aim to reduce low value care while boosting high value care.
Work on the new trial is expected to officially start in September, with finalising the protocol, obtaining ethics approval and undertaking data linkage to identify the parts of Australia where low value OA care is most rife.
The various interventions and resources will most likely be rolled out in 2027, before a two-year follow-up period to see whether the intervention reduces the rate of arthroscopies and referrals to specialists and for medical imaging.
