Research evidence

The CHAIN programme

Since it’s creation, a number of rigorous evaluations have demonstrated the efficacy of the CHAIN programme for improving function and pain in people with hip osteoarthritis. In addition, we have reported the methodology behind the design of the CHAIN programme and CLEAT trial. These reports are summarised below.

A cycling and education programme for the treatment of hip osteoarthritis: a quality improvement study

International Journal of Orthopaedic and Trauma Nursing – 2016

This article reports the results of the first CHAIN programme, delivered from 2013 until 2015 at a leisure centre in Bournemouth, Dorset. All participants were referred from primary care (either through their GP or through self-referral). Participants completed six weeks of cycling and education, delivered by a physiotherapist and exercise specialist. Participants reported significant improvements to pain and function from pre to post-programme. Objectively measured function also demonstrated a significant improvement in sit-to-stand and Timed Up and Go scores. In addition, participants reported an increase in confidence in managing their hip pain, and an increase in motivation to exercise.

Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education.

BMJ Case Reports – 2015

This article reports the results of the CHAIN programme for a 71-year-old man presenting with hip osteoarthritis, in addition to a complex range of comorbidities. The gentleman made significant improvements to his Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score (HOOS) function, sit-to-stand score, Timed Up and Go score, pain and hip flexion, in addition to a weight loss of 2.1kg. The gentleman reported an ‘amazing difference’ to his affected hip, leg and improved fitness.

The CHAIN programme

More than just ticking a box…how patient and public involvement improved the research design and funding application for a project to evaluate a cycling intervention for hip osteoarthritis

Research Involvement and Engagement – 2015

This article reports how patients and members of the public were involved in the design of the CLEAT study, a randomised controlled trial comparing the CHAIN programme to standard care physiotherapy, in the treatment of hip osteoarthritis. A patient and public involvement consultation group provided invaluable feedback and suggestions which impacted on the design and quality of the research project and the intervention. Key changes to the intervention included extending the duration of the cycling programme from 6 to 8 weeks, and inclusion of an exercise diary to promote adherence to the intervention. Key feedback regarding the design of the research and funding application included suggestions for methods of dissemination, and confirmation of the primary outcome measure.

Snapshot survey of physiotherapy practice for patients with hip osteoarthritis in the public sector

European Journal of Physiotherapy – 2017

This online survey was conducted to gain a snapshot view of physiotherapy practice within the public sector in the UK. Sixty-two physiotherapists from 25 counties in the UK and Wales responded. The median waiting time from referral to physiotherapy treatment was 5 weeks and patients were seen a median of 3 times. The median total number of hours treated was 2 hours, and the median duration time for treatment was 8 weeks. All respondents used strengthening exercises, 73% stretches, 50% cardiovascular exercise, 73% balance exercises and 26% proprioceptive exercises. Thirty-nine percent of respondents use both strengthening and cardiovascular exercises, and provide an education leaflet, as contained within National Institute for Health and Clinical Excellence (NICE) guidance.

CHAIN – 5 year follow up

Self-management of hip osteoarthritis five years after a cycling and education treatment pathway

Healthcare – 2020

This article reports the results from a cross-sectional survey, conducted to collect data from participants who completed the CHAIN programme between 2013 and 2015.  The questionnaire was designed to collect data on whether participants on the CHAIN programme had continued to self-manage their hip osteoarthritis, five years after completing the course. Eighty-three participants (87%) responded to the survey. Five years (range 4–6) after completion of a six-week cycling and education programme, 37 (45%) participants had not returned to their GP for further treatment of their hip pain, and 47 (57%) had not pursued surgical intervention. All participants were still engaged in at least one physical activity per week. Eighty (96%) participants reported an increase in knowledge of self-managing their symptoms. The findings from this study suggest that many patients are motivated to self-manage their hip osteoarthritis, five years following a six-week cycling and education treatment pathway that encourages lifestyle change.

The CHAIN programme

A cycling and education intervention for the treatment of hip osteoarthritis: A quality improvement replication programme

SAGE Open Medicine – 2020

This article reports the findings from the second CHAIN programme, delivered in Bournemouth, Dorset between February 2018 and September 2019. Following completion of the initial programme, the local National Health Service (NHS) trust, a secondary care provider, commissioned the CHAIN programme for a further 18 months. Patients with hip pain who were referred to the local NHS hospital for surgical opinion were assessed for eligibility by an orthopaedic surgeon in the outpatient department. The CHAIN programme was offered to patients who were judged to be not suitable for surgical intervention. The findings from this evaluation suggest that a six week cycling and education intervention for the treatment of hip osteoarthritis can provide benefits to function, pain and quality of life for patients referred to secondary care for surgical opinion of their hip pain. Full article in preparation.

What are the clinical, methodological, logistical and operational challenges when designing and conducting a randomised controlled trial of a group based intervention for the treatment of osteoarthritis and how can they be managed?

2020 World Congress on Osteoarthritis

This abstract reports some of the methodological challenges that should be considered in the design of randomised controlled trials of group based versus one-to-one interventions in the treatment of osteoarthritis. These challenges highlight the tension between methodological ideals and practical limitations, and the importance of designing a pragmatic trial which models the real-world scenario within our local health care setting. Full paper in preparation.