Can ambulance paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients that fall?

ISRCTN ISRCTN36245726
DOI https://doi.org/10.1186/ISRCTN36245726
Secondary identifying numbers 14057
Submission date
13/03/2014
Registration date
13/03/2014
Last edited
12/10/2018
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Injury, Occupational Diseases, Poisoning
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Shane Clarke
Scientific

Rheumatology Unit
The Courtyard
Old Building, Bristol Royal Infirmary
Marlborough Street
Bristol
BS2 8HW
United Kingdom

Email s.clarke@bristol.ac.uk

Study information

Study designRandomised; Interventional; Design type: Screening, Treatment
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)GP practice
Study typeTreatment
Scientific titleCan ambulance paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients that fall?
Study objectivesBroken bones are painful, often disabling, and cost the NHS £2 billion annually. Tablets reduce the risk of having a fracture in the most vulnerable but the number of people at high risk taking the right treatment (about 1 in 3) is unacceptably low.

Part of the problem is poor communication between healthcare providers; for example, GPs are seldom told about their patients who fall by the attending ambulance service. Falls and fracture are closely linked. Each fall that results in an ambulance call might represent an important opportunity to assess a patient’s fracture risk using a computer programme called FRAX®.

The proposed project is a feasibility study to help us design a full trial. The full trial will find out if ambulance crew can collect information from people that fall and help GPs target treatment for osteoporosis at those patients most likely to have a future fracture.

In this feasibility study we want to find out whether ambulance staff can obtain the necessary information to estimate a patient’s fracture risk, and if the GPs will act on the information given to them. We also require information to help us work out how many patients we will need to recruit, and might be at a high risk of fracture. It is also essential to ensure the study methods are acceptable to patients, ambulance staff and GPs before we plan the main trial.

Our study involves ambulance staff asking patients additional questions after they have fallen over, and the design includes a control group, whose members will not be informed of their fracture risk. These ethical issues were considered by members of the public.

The proposal was felt to be acceptable, with real potential to improve osteoporosis care. A large Medical Research Council study has already successfully used a similar approach.

More details can be found at: http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=14057

On 04/06/2014 the anticipated end date was changed from 28/03/2014 to 01/07/2014.
Ethics approval(s)12/SC/0604
Health condition(s) or problem(s) studiedTopic: Primary Care Research Network for England, Injuries and Emergencies; Subtopic: Not Assigned, Injuries and Emergencies (all Subtopics); Disease: Injuries and Emergencies, All Diseases
InterventionCalculate future fracture risk: Paramedics will calculate future fracture risk in patients that fall; Transmit fracture risk GP, Paramedics will transmit calculated future fracture risk to patients GPs; Follow Up Length: 3 month(s); Study Entry : Single Randomisation only
Intervention typeOther
Primary outcome measurePatients on treatment; Timepoint(s): Proportion of patients taking new treatment to reduce future fracture risk
Secondary outcome measuresAppropriate investigations; Timepoint(s): The proportion of patients in control and intervention group that are referred for DXA or blood test
Overall study start date28/06/2013
Completion date01/07/2014

Eligibility

Participant type(s)Patient
Age groupSenior
SexBoth
Target number of participantsPlanned Sample Size: 100; UK Sample Size: 100; Description: 50 control 50 intervention
Key inclusion criteriaMen and women aged over 50 who fall (inside or outside their place of residence), call an ambulance, and are attended by study paramedics
Key exclusion criteria1. Patients who, in the paramedic’s opinion, are medically unstable and for whom it would not be appropriate to delay treatment to ask study questions (for example where the paramedics suspect a cardiac incident).
2. Patients who have fallen in a public place and n the opinion of the treating paramedics should be conveyed without delay.
3. Patients who are deemed to lack capacity (according to the Mental Health Act [2005]) but for whom there is no available carer or consultee.
4. Patients who are admitted to hospital for 24 hours or more. These patients will need to be excluded by the RF prior to consent (pre-existing service arrangements cover inpatients and our principal target population is in primary care).

We will continue to monitor patients who fall twice or more during the study period, but count the first fall as the index event. Only the first eligible fall will trigger entry to the study.
Date of first enrolment28/06/2013
Date of final enrolment01/07/2014

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

Rheumatology Unit
Bristol
BS2 8HW
United Kingdom

Sponsor information

University Hospitals Bristol NHS Foundation Trust (UK)
Hospital/treatment centre

Research & Development
Upper Maudlin Street
Bristol
BS2 8AE
England
United Kingdom

ROR logo "ROR" https://ror.org/04nm1cv11

Funders

Funder type

Government

NIHR Research for Patient Benefit (RfPB); Grant Codes: PB-PG-0711-25070

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 03/09/2014 Yes No
Results article results 20/04/2015 Yes No

Editorial Notes

12/10/2018: Publication reference added.