POST - Primary care Osteoarthritis Screening Trial
|Funder name / reference number:||NIHR Programme Grant for Applied Research RP-PG-0407-10386 (Lead Prof Elaine Hay)|
POST is a cluster randomised clinical trial that compared pain intensity and interference outcomes over a 12-month period in OA / joint pain patients screened for depression and anxiety (intervention arm) to those who received only usual care (control arm; screened only for pain intensity).
As a cluster randomised trial the GP practices were randomised (to one of the 2 arms) rather than the patients. We aim to recruit 44 GP practices in total in order to screen and contact 1745 patients. Recruitment of patients from GP practices took place over a 12 month period. Following their initial consultation patients received a baseline questionnaire to complete. Those who consented to take part were also followed-up with further postal questionnaires at 3, 6 and 12 months after completing their baseline questionnaire. The questionnaires contained detailed questions on pain intensity and interference (primary outcome data) and further questions on anxiety, depression, pain catastrophising, health economics and demographics. A medical record review of treatments, diagnoses and referrals was also conducted in those participants who provided consent for this.
Does prompting GPs to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis improve pain outcomes?
The effects of implementing a point of care electronic template to promote routine anxiety and depression case finding in patients consulting with clinical osteoarthritis.
To determine whether prompting the holistic management of OA by screening for depressive and anxiety symptoms in patients who consult their GP with joint pain or OA results in an improvement in their self-reported pain intensity and pain interference ratings during the 12 months following their consultation, compared to patients in the control arm.
The intervention is point-of-care anxiety and depression case-finding by the GP, prompted by an automated electronic template in intervention practices comprising 5 questions: PHQ-2 depression screen, GAD-2 anxiety screen, and current pain intensity (0-10 NRS). The template sign-posts GPs to follow NICE clinical guidelines and is supported by a brief training package. The template in control practices prompts GPs to ask the pain intensity question only.