Protocol for the comparison of remote versus face-to-face osteoarthritis management programs (COASTAL): A randomized implementation trial

doi:10.1016/j.ocarto.2025.100647

. 2025 Jul 8;7(3):100647.

doi: 10.1016/j.ocarto.2025.100647. eCollection 2025 Sep.

Protocol for the comparison of remote versus face-to-face osteoarthritis management programs (COASTAL): A randomized implementation trial

Shiwen Yuan^{1

2}, Jocelyn L Bowden^{1

3}, Jillian P Eyles^{1

3}, Vicky Duong^{1

3}, Stephen Messier⁴, Elena Losina⁵, Jean Frederic Levesque⁶, Andrew M Briggs⁷, Michelle M Dowsey⁸, Leticia Alle Deveza^{1

3}, Nicole M Rankin⁹, Christian J Barton^{10

11}, Blake F Dear¹², Carin Pratt¹³, Jonathan Smithers¹⁴, Louise Hardy¹⁴, Caroline Bills¹⁵, Julia Thompson⁶, Tom Buttel¹⁶, Daniel Ewald¹⁷, Kevin Cheng¹⁸, Nicola Ware¹⁹, Daniel Richardson²⁰, Erica Morgan²¹, Monique Strelnikow²², Venkatesha Venkatesha¹³, Alexandra Warhurst²³, Vineeta Kurien^{1

3}, Scott Chery^{1

3}, David J Hunter^{1

3}

Affiliations

¹ Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Department of Rheumatology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China.
³ Department of Rheumatology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
⁴ Wake Forest University, Winston-Salem, North Carolina, USA.
⁵ Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ NSW Agency for Clinical Innovation, Sydney, NSW, Australia.
⁷ Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
⁸ University of Melbourne Department of Surgery, St. Vincent's Hospital, Fitzroy, VIC, Australia.
⁹ Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, VIC, Australia.
¹⁰ Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
¹¹ La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
¹² School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.
¹³ Northern Sydney Local Health District, Royal North Shore Hospital, Sydney, NSW, Australia.
¹⁴ Arthritis Australia, Sydney, NSW, Australia.
¹⁵ HealthChange Associates, Melbourne, Vic, Australia.
¹⁶ Consumer Investigator, Sydney, NSW, Australia.
¹⁷ University Centre for Rural Health School of Medicine, University of Sydney, Sydney, NSW, Australia.
¹⁸ Osana, Sydney, NSW, Australia.
¹⁹ Ramsay Health Research Foundation, Sydney, NSW, Australia.
²⁰ Northern Sydney Local Health District, Hornsby Hospital, Sydney, NSW, Australia.
²¹ South Eastern Sydney Local Health District, The Sutherland Hospital, Sydney, NSW, Australia.
²² Southern NSW Local Health District, South East Regional Hospital. Bega, NSW, Australia.
²³ Remedy Healthcare, Melbourne, VIC, Australia.

PMID: 40697621
PMCID: PMC12281381
DOI: 10.1016/j.ocarto.2025.100647

Protocol for the comparison of remote versus face-to-face osteoarthritis management programs (COASTAL): A randomized implementation trial

Shiwen Yuan et al. Osteoarthr Cartil Open. 2025.

. 2025 Jul 8;7(3):100647.

doi: 10.1016/j.ocarto.2025.100647. eCollection 2025 Sep.

Authors

Affiliations

¹ Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Department of Rheumatology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China.
³ Department of Rheumatology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
⁴ Wake Forest University, Winston-Salem, North Carolina, USA.
⁵ Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ NSW Agency for Clinical Innovation, Sydney, NSW, Australia.
⁷ Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
⁸ University of Melbourne Department of Surgery, St. Vincent's Hospital, Fitzroy, VIC, Australia.
⁹ Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, VIC, Australia.
¹⁰ Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
¹¹ La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
¹² School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.
¹³ Northern Sydney Local Health District, Royal North Shore Hospital, Sydney, NSW, Australia.
¹⁴ Arthritis Australia, Sydney, NSW, Australia.
¹⁵ HealthChange Associates, Melbourne, Vic, Australia.
¹⁶ Consumer Investigator, Sydney, NSW, Australia.
¹⁷ University Centre for Rural Health School of Medicine, University of Sydney, Sydney, NSW, Australia.
¹⁸ Osana, Sydney, NSW, Australia.
¹⁹ Ramsay Health Research Foundation, Sydney, NSW, Australia.
²⁰ Northern Sydney Local Health District, Hornsby Hospital, Sydney, NSW, Australia.
²¹ South Eastern Sydney Local Health District, The Sutherland Hospital, Sydney, NSW, Australia.
²² Southern NSW Local Health District, South East Regional Hospital. Bega, NSW, Australia.
²³ Remedy Healthcare, Melbourne, VIC, Australia.

PMID: 40697621
PMCID: PMC12281381
DOI: 10.1016/j.ocarto.2025.100647

Abstract

Objective: To determine the comparative effectiveness of three evidence-informed approaches to delivering osteoarthritis (OA) care in real-world settings: face-to-face services, telehealth services or a mobile application (app).

Design: COASTAL (ACTRN12624000996561) comprises two aims: the primary aim is a three-arm, non-inferiority, comparative-effectiveness, type I hybrid implementation RCT; and the secondary aim is a superiority trial to compare the three interventions separately to an untreated, non-randomized control group. We will recruit 1348 participants (primary aim:1011 interventions; secondary aim:1011 interventions, 337 controls) with knee OA referred to a NSW public Osteoarthritis Chronic Care Program (OACCP). Eligible participants who consent to OACCP participation will be randomized 1:1:1 to receive care through the face-to-face OACCP, a telehealth service, or the "OA Coach" app, over 6-months. All participants will receive a standardized needs assessment; OA education; collaboratively developed, personalized management plan with a focus on therapeutic exercise, physical activity, pain management, and weight-management, according to each arm's mode of delivery. People who have declined OACCP participation will be eligible for the control group. The primary outcome is change in average knee pain during walking at 6-months (11-point NRS). Secondary, implementation, and economic evaluation outcomes will be collected at 6 and 12-months.The protocol was co-developed with people with knee OA, clinicians delivering the services, and other stakeholders. Ethical approval granted by the Northern Sydney Local Health District (2024/ETH01461).

Conclusion: The results of this trial will provide critical evidence to help people with OA, clinicians, service planners and policymakers choose between different modes of delivering care for knee OA.

Keywords: Implementation; Knee; Management programs; Osteoarthritis; Randomized controlled trial.

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Conflict of interest statement

DJH is employed by the University of Sydney and Royal North Shore Hospital. His salary support for the University of Sydney is provided by Arthritis Australia and an NHMRC Investigator Grant Leadership 2 (#1194737). In addition, DJH is the editor of the osteoarthritis section for UpToDate, co-Editor in Chief of Osteoarthritis and Cartilage and board member of Osteoarthritis Research Society International. DJH provides consulting advice on scientific advisory boards for Pfizer, Lilly, TLCBio, Novartis, Tissuegene, and Biobone. JLB is supported by an unrestricted Fellowship from Haleon Australia, which has no relationship to this project. JPE is supported by a National Health and Medical Research Council Investigator Grant (#2025504). BFD is a member of the Senior Leadership Team of the MindSpot Clinic. He has developed several remotely-delivered psychological programs for a range of conditions, however receives no payment or royalties for their use. AMB is supported, in part, by an NHMRC-funded MRFF grant (#2016567). MMD is the recipient of a University of Melbourne Dame Kate Campbell Fellowship. In addition, MMD receives research support for investigator-initiated studies, paid to her institution, from the Medical Research Future Fund, NHMRC, Eli Lilly, Victorian Orthopedic Foundation, Australian Orthopaedic Association Research Foundation, HCF Foundation, University of Melbourne, St. Vincent's Hospital Research Foundation, and Arthritis & Osteoporosis Western Australia. MMD also reports receiving payment for provision of advice on guideline development for the Royal Australian College of GPs; sitting fees as a member of the Osteoarthritis Clinical Research Group Data & Safety Monitoring Board; and reported being a Board Director of the Australian Orthopaedic Association Research Foundation. LD receives royalties from UptoDate. CB is the Director of HealthChange Associates that provides HealthChange® Methodology training and consulting services.

Figures

**Fig. 1**
Overall study design and participant flow. NB: The OACCP delivery may vary slightly depending on specific procedures and services provided at each hospital.

See this image and copyright information in PMC

References

1. Runciman W.B., Hunt T.D., Hannaford N.A., Hibbert P.D., Westbrook J.I., Coiera E.W., et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med. J. Aust. 2012;197(2):100–105. - PubMed
1. Hunter D.J., Bowden J.L. Therapy: are you managing osteoarthritis appropriately? Nat. Rev. Rheumatol. 2017;13(12):703–704. - PubMed
1. Meneses S.R., Goode A.P., Nelson A.E., Lin J., Jordan J.M., Allen K.D., et al. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthr. Cartil. 2016;24(9):1487–1499. - PubMed
1. Hunter D.J., Schofield D., Callander E. The individual and socioeconomic impact of osteoarthritis. Nat. Rev. Rheumatol. 2014;10(7):437–441. - PubMed
1. Brand C.A., Harrison C., Tropea J., Hinman R.S., Britt H., Bennell K. Management of osteoarthritis in general practice in Australia. Arthritis Care Res. (Hoboken) 2014;66(4):551–558. - PubMed

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[1] Runciman W.B., Hunt T.D., Hannaford N.A., Hibbert P.D., Westbrook J.I., Coiera E.W., et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med. J. Aust. 2012;197(2):100–105. - PubMed

[2] Runciman W.B., Hunt T.D., Hannaford N.A., Hibbert P.D., Westbrook J.I., Coiera E.W., et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med. J. Aust. 2012;197(2):100–105. - PubMed

[3] Hunter D.J., Bowden J.L. Therapy: are you managing osteoarthritis appropriately? Nat. Rev. Rheumatol. 2017;13(12):703–704. - PubMed

[4] Hunter D.J., Bowden J.L. Therapy: are you managing osteoarthritis appropriately? Nat. Rev. Rheumatol. 2017;13(12):703–704. - PubMed

[5] Meneses S.R., Goode A.P., Nelson A.E., Lin J., Jordan J.M., Allen K.D., et al. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthr. Cartil. 2016;24(9):1487–1499. - PubMed

[6] Meneses S.R., Goode A.P., Nelson A.E., Lin J., Jordan J.M., Allen K.D., et al. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthr. Cartil. 2016;24(9):1487–1499. - PubMed

[7] Hunter D.J., Schofield D., Callander E. The individual and socioeconomic impact of osteoarthritis. Nat. Rev. Rheumatol. 2014;10(7):437–441. - PubMed

[8] Hunter D.J., Schofield D., Callander E. The individual and socioeconomic impact of osteoarthritis. Nat. Rev. Rheumatol. 2014;10(7):437–441. - PubMed

[9] Brand C.A., Harrison C., Tropea J., Hinman R.S., Britt H., Bennell K. Management of osteoarthritis in general practice in Australia. Arthritis Care Res. (Hoboken) 2014;66(4):551–558. - PubMed

[10] Brand C.A., Harrison C., Tropea J., Hinman R.S., Britt H., Bennell K. Management of osteoarthritis in general practice in Australia. Arthritis Care Res. (Hoboken) 2014;66(4):551–558. - PubMed

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Protocol for the comparison of remote versus face-to-face osteoarthritis management programs (COASTAL): A randomized implementation trial

Affiliations

Protocol for the comparison of remote versus face-to-face osteoarthritis management programs (COASTAL): A randomized implementation trial

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Abstract

Conflict of interest statement

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