Abstract
OBJECTIVE: This parallel cohort-implementation study, termed MonitOring the health Trajectory of patients with kNee osteoarthritis (MOTION), aims to understand treatment pathways and outcomes for people with knee osteoarthritis referred to Australian public hospitals for orthopaedic assessment (Part A cohort study), and how improving access to first-line care might improve outcomes (Part B implementation study). METHODS AND ANALYSIS: We will recruit approximately 400 adults with knee osteoarthritis referred for orthopaedic opinion to one of four public hospitals in Victoria, Australia. A subgroup enrolled in the study (n = 109) will receive improved access to community-based first-line care. Outcomes will be evaluated at baseline, 4-, 8-, 12- (primary end point), 24- and 60-months. The primary outcome will divide the cohort into 1's (willing to undergo, waitlisting for, or undergone, TKR surgery) or 0's (not willing to undergo, not undergone, and not waitlisted for, TKR surgery). Secondary outcomes include pain, knee- and health-related quality of life, physical activity participation and health care utilisation. Surgical and health trajectories will be reported descriptively, with factors associated with outcomes explored. The effectiveness of improving access to first-line care will be determined through propensity score methods. The cost-effectiveness of improving access to first-line care will be also be determined, and semi-structured interviews (1:1 and focus groups) involving participants, health professionals, administrators, and research team will inform a comprehensive process evaluation. ETHICS AND DISSEMINATION: Approved by St Vincent's Hospital Melbourne Human Research Ethics Committee (HREC 251/21). Findings will be disseminated to stakeholders including via conferences, peer-reviewed journals, and social and mainstream media.