Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Evidence of the effectiveness of intra-articular corticosteroid injection for hip osteoarthritis (OA) is limited and conflicting. The HIT trial compared the clinical effectiveness of an ultrasound-guided intra-articular hip injection (USGI) of triamcinolone acetonide and 1% lidocaine hydrochloride combined with best current treatment (BCT) with (i) BCT alone (primary objective) and (ii) an USGI of 1% lidocaine only combined with BCT (EudraCT: 2014–003412-37). BCT comprised advice and written information on exercise, weight loss, footwear, walking aids and pain management. This qualitative study investigated patient experiences of hip OA and impact of trial treatments.
Methods: Semi-structured interviews were undertaken with a purposeful sample of participants in each arm after 2-month follow-up. Interviewers knew whether participants had received an injection but were unaware of which injection (to minimise patients becoming un-blinded to treatment allocation). Sampling ceased when inductive thematic saturation had been achieved. Thematic analysis was undertaken blind to the clinical results to facilitate an interpretive and inductive approach.
Results: 34 trial participants were interviewed (males n=13, females n=19, aged 53 to 83 years). 13 participants were in USGI triamcinolone/lidocaine group, 11 in the lidocaine only arm and 8 in BCT. Preliminary findings indicate wide-ranging impacts of living with hip OA. Participants in all arms talked of physical, social, psychological and work-related impacts and difficulties with sleep and undertaking valued activities. Participants in BCT reported receiving an examination, information/explanation and exercises, providing evidence of intervention fidelity in this arm. Despite this, most felt that they had not received any treatment indicating that advice/exercise was not perceived as treatment for hip pain. Adherence was low in this group. Participants described little or no benefit in pain or function. Thoughts about the future were negative, focusing on inevitable decline and future need for surgery.
Experiences of having an injection were positive overall, and impacts described in both injection groups included “getting my life back” and having “a new lease of life”. Perceived benefit appeared to be greater in the triamcinolone/lidocaine group, although length of benefit varied in both injection groups and there was uncertainty about the longer-term benefits of injection. Participants in the injection groups were more hopeful and optimistic about the future than those in BCT only.
Conclusion: Hip OA remains burdensome, affecting many aspects of life. The findings complement the trial results that showed superiority of USGI of triamcinolone/lidocaine combined with BCT over 6 months compared with BCT alone, but no significant difference between injection groups raising the possibility of a placebo effect. Participants’ narratives outlined benefit in pain and function in both injection groups, strengthening the interpretations of the trial clinical results. Importantly, participants in BCT reported receiving BCT but did not feel they had treatment, indicating the need for future work highlighting the value of self-management.
To cite this abstract in AMA style:Jinks C, Hawarden A, Roddy E, Paskins Z, Mallen C, Holden M. “If It Was Unicorn Dust I’d Have It Again.” Patient Experiences of Hip Osteoarthritis and Treatments in the Hip Injection Trial [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/if-it-was-unicorn-dust-id-have-it-again-patient-experiences-of-hip-osteoarthritis-and-treatments-in-the-hip-injection-trial/. Accessed November 15, 2019.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/if-it-was-unicorn-dust-id-have-it-again-patient-experiences-of-hip-osteoarthritis-and-treatments-in-the-hip-injection-trial/