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Use case: Predicting the best treatment for patients with hip or knee arthritis

The aim of this possible future project is to provide objective outcome measures that enable to determine the best treatment.

Aim of a possible future project

Providing objective outcome measures that enable to determine the best treatment. This helps to decide whether an expensive operation is better than much less expensive physiotherapy. Costs of an operation in which a patient gets an artificial knee or hip are 10,000 euros, while twelve sessions of physical therapy cost 800 euros. Other interesting questions: do patients without an artificial knee or hip need more physical therapy? And does physical therapy help to delay an operation?

Medical relevance

Improving existing treatment protocols, as defined by the Nederlandse Orthopaedische Vereniging (NOV) and the Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF), ultimately yielding better outcomes at reduced cost.

Description: why would PHT be helpful?

Many clinical studies continue to question the effectiveness of conservative therapy as compared to surgical interventions, such as total knee or hip replacement. To find out whether too many patients in the Netherlands get an artificial knee, it would be best to analyse two available databases.

Currently surgeons  track patient data in their own national database, called LROI. Physiotherapists use another national database, called LDF. Many patients with knee or hip arthritis have their data stored in both databases,  but neither contain all the information of one patient. Combining these existing national databases would give researchers better real-world evidence as to which treatment is most effective, accounting for patient-specific factors.

However, combining all data of one patient by connecting these two databases,   is currently not possible, both due to privacy issues and uncertainty about data governance.

The Personal Health Train could overcome these problems, because in this approach each database administrator can decide for themselves whether their data will be used for this research question. In this case the data - like pain levels and how well the knee works - are already standardised using an international standard, which makes it easy to compare the treatment results collected from both databases. However, PHT does need to be improved to make it possible to connect patient data from databases at different locations.

Possible positioning of the project

The proposed project would fit into the so-called ‘Zorgevaluatie en Gepast Gebruik’ programme, which is part of the so-called Hoofdlijnakkoorden: agreements between the government, patient organizations, health professionals and health insurers.  This programme focuses on improving the outcome of interventions whilst reducing costs at the same time.

Lessons learned

It’s very important to register standardised treatment outcomes. The surgeons have already been doing this for more than five years, whilst the physiotherapists are increasingly using the same standardised tests and scoring rates to measure outcomes.

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