MulTI-domain Self-management in older People wiTh OstEoarthritis with Multi-Morbidities (TIPTOE)

Knee and hip osteoarthritis (OA) affect 1 in 2 adults aged over 70 years with nearly 7 in 10 OA sufferers having more than one medical condition, resulting in complex health needs. Demand for treatment is high but care across services is often fragmented and not based on individual user needs and preferences. Holistic personalised treatments for older adults that help them live well alongside managing their OA and multiple health conditions are urgently needed.

In the TIPTOE trial we will test a personalised self-management treatment in 824 adults aged 70+ living with OA and at least one other medical condition in the community. Participants will be encouraged to take part with a friend, family member or carer who can support them. This treatment will involve up to six, one-to-one consultations with a health practitioner trained in self-management. The consultations will focus on helping people make sense of the interplay between their health, medications, activity and nutrition. They will be supported to find solutions to managing their health based on their personal needs. The consultations will be supported with a book and digital resources, to help participants learn from the experience of others.

We will recruit individuals with knee and/or hip OA and at least one other medical condition and randomly allocate them to an intervention or control group. The control group will continue their usual care, as currently provided by the NHS, and the intervention group will receive the new resources and up to six, one-to-one personalised consultations with trained health practitioners. We will estimate the cost of the intervention and test its effects on how participants feel and cope with everyday activities. Longer term, we will measure if this leads to fewer clinic visits, hospital admissions and operations, by studying information routinely collected when using NHS services.

Individuals living with, or those caring for individuals with, knee and/or hip OA, and a large PPI panel from diverse backgrounds have helped us shape the TIPTOE project. To make it easier for people to engage with the research we will offer participants a range of options such as completing the trial questionnaires online or over the telephone, taking part in the trial with a carer or friend or by receiving the intervention at home or in a clinic. We will share our findings through accessible communications designed with our PPI group, academic publications and conferences.

Evaluate the clinical and cost effectiveness of TIPTOE, a personalised multi-dimensional self-management intervention, in addition to treatment as usual (TAU), compared to NHS TAU alone as measured by the Musculoskeletal Health Questionnaire (MSK-HQ).