{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:01Z","timestamp":1787754901702,"version":"build-2784847793"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>Musculoskeletal disorders are common and can profoundly affect the survival, mobility, and independence of patients. The overall objective of the Musculoskeletal Adaptive Platform Trial (MAPT) is to incrementally compare the effectiveness of available interventions to improve outcomes for adult patients with health conditions affecting physical mobility. The MAPT framework is flexible, allowing the detection of varying levels of meaningful benefit or harm (or equivalence) on the basis of the burden of disease and the available treatments. Treatment comparisons will be evaluated as intervention domains on the platform in order to achieve the overarching objective. Specific objectives for each intervention domain will be included in intervention domain-specific protocol appendices. The primary outcome is a hierarchically assessed composite of death within 120 days, ambulation status at 120 days, and days alive and out of the hospital within 120 days of randomization. Secondary outcomes will include the components of the composite outcome and patient-reported outcomes. Participants will be contacted at 6 weeks, 4 months, 8 months, and 12 months after randomization to ascertain trial outcomes. The MAPT will enable researchers to efficiently evaluate multiple treatment options for patients with musculoskeletal impairments, which may improve patient care and outcomes globally.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>The MAPT is clinically relevant because it provides a practical framework for rapidly identifying which treatments improve survival, mobility, and recovery in patients with musculoskeletal conditions. It can directly guide better treatment decisions regarding a leading cause of disability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.01436","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T18:00:25Z","timestamp":1779904825000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Reimagining Orthopaedic Research: The Musculoskeletal Adaptive Platform Trial (MAPT) Design Rationale"],"prefix":"10.2106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0537-3474","authenticated-orcid":false,"given":"Nathan N.","family":"O\u2019Hara","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-8063","authenticated-orcid":false,"given":"Sheila A.","family":"Sprague","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-7366","authenticated-orcid":false,"given":"Joseph P.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1778-9813","authenticated-orcid":false,"given":"Vitaly","family":"Druker","sequence":"additional","affiliation":[{"name":"West End Statistics, LLC, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason T.","family":"Connor","sequence":"additional","affiliation":[{"name":"Confluence Stat, LLC, Cooper City, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0983-8630","authenticated-orcid":false,"given":"Debra","family":"Marvel","sequence":"additional","affiliation":[{"name":"MAPT Trial Patient Stakeholder, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-9239","authenticated-orcid":false,"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"issue":"7","key":"bib2-20260527","doi-asserted-by":"crossref","first-page":"e2221140","DOI":"10.1001\/jamanetworkopen.2022.21140","article-title":"Economic evaluation of cost and time required for a platform trial vs conventional trials","volume":"5","author":"Park","year":"2022","journal-title":"JAMA Netw Open."},{"issue":"16","key":"bib3-20260527","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1001\/jama.2015.2316","article-title":"The platform trial: an efficient strategy for evaluating multiple treatments","volume":"313","author":"Berry","year":"2015","journal-title":"JAMA."},{"issue":"1","key":"bib4-20260527","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1056\/NEJMra1510062","article-title":"Master protocols to study multiple therapies, multiple diseases, or both","volume":"377","author":"Woodcock","year":"2017","journal-title":"N Engl J Med."},{"issue":"10","key":"bib5-20260527","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1038\/s41573-019-0034-3","article-title":"Adaptive platform trials: definition, design, conduct and reporting considerations","volume":"18","year":"2019","journal-title":"Nat Rev Drug Discov."},{"issue":"1","key":"bib6-20260527","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1001\/jama.2021.22507","article-title":"How to use and interpret the results of a platform trial: users\u2019 guide to the medical literature","volume":"327","author":"Park","year":"2022","journal-title":"JAMA."},{"issue":"4","key":"bib7-20260527","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1302\/2633-1462.64.BJO-2024-0240","article-title":"The World Hip Trauma Evaluation (WHiTE) platform trial: a framework for randomized comparisons of interventions for fragility hip fracture","volume":"6","author":"Costa","year":"2025","journal-title":"Bone Jt Open."},{"key":"bib9-20260527","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jclinepi.2020.04.025","article-title":"An overview of platform trials with a checklist for clinical readers","volume":"125","author":"Park","year":"2020","journal-title":"J Clin Epidemiol."},{"issue":"5","key":"bib10-20260527","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1002\/ejhf.2853","article-title":"The win ratio method in heart failure trials: lessons learnt from EMPULSE","volume":"25","author":"Pocock","year":"2023","journal-title":"Eur J Heart Fail."},{"issue":"32","key":"bib11-20260527","doi-asserted-by":"crossref","first-page":"E901","DOI":"10.1503\/cmaj.200077","article-title":"Development of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN) in randomized controlled trials and meta-analyses","volume":"192","author":"Schandelmaier","year":"2020","journal-title":"CMAJ."},{"issue":"1","key":"bib12-20260527","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1186\/s12874-019-0885-7","article-title":"A patient-centered composite endpoint weighting technique for orthopaedic trauma research","volume":"19","author":"Udogwu","year":"2019","journal-title":"BMC Med Res Methodol."},{"issue":"6","key":"bib13-20260527","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/BOT.0000000000002794","article-title":"Patient preferences for operative versus nonoperative treatment of LC1 pelvis fracture: a discrete choice experiment","volume":"38","author":"Patterson","year":"2024","journal-title":"J Orthop Trauma."},{"key":"bib14-20260527","doi-asserted-by":"crossref","first-page":"21514593241236647","DOI":"10.1177\/21514593241236647","article-title":"Fix or replace? Patient preferences for the treatment of geriatric lower extremity fractures: a discrete choice experiment","volume":"15","author":"Richards","year":"2024","journal-title":"Geriatr Orthop Surg Rehabil."},{"issue":"10","key":"bib15-20260527","doi-asserted-by":"crossref","first-page":"e072583","DOI":"10.1136\/bmjopen-2023-072583","article-title":"Patient preferences for physical therapy programs after a lower extremity fracture: a discrete choice experiment","volume":"13","author":"McKibben","year":"2023","journal-title":"BMJ Open."},{"issue":"17","key":"bib16-20260527","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1056\/NEJMp1607206","article-title":"Days spent at home \u2014 a patient-centered goal and outcome","volume":"375","author":"Groff","year":"2016","journal-title":"N Engl J Med."},{"issue":"3","key":"bib17-20260527","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1002\/ana.26714","article-title":"Design and statistical innovations in a platform trial for amyotrophic lateral sclerosis","volume":"94","author":"Quintana","year":"2023","journal-title":"Ann Neurol."},{"issue":"1","key":"bib18-20260527","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/nrd1927","article-title":"Bayesian clinical trials","volume":"5","author":"Berry","year":"2006","journal-title":"Nat Rev Drug Discov."},{"issue":"7","key":"bib19-20260527","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1513\/AnnalsATS.202003-192SD","article-title":"The REMAP-CAP (Randomized Embedded Multifactorial Adaptive Platform for Community-acquired Pneumonia) Study. Rationale and Design","volume":"17","author":"Angus","year":"2020","journal-title":"Ann Am Thorac Soc."},{"issue":"5 Pt 2","key":"bib20-20260527","doi-asserted-by":"crossref","first-page":"416","DOI":"10.7326\/0003-4819-139-5_Part_2-200309021-00007","article-title":"Trajectories of health for older adults over time: accounting fully for death","volume":"139","author":"Diehr","year":"2003","journal-title":"Ann Intern Med."},{"issue":"11","key":"bib21-20260527","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.jclinepi.2005.05.002","article-title":"Methods for incorporating death into health-related variables in longitudinal studies","volume":"58","author":"Diehr","year":"2005","journal-title":"J Clin Epidemiol."},{"issue":"2","key":"bib22-20260527","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/biom.12594","article-title":"Inference in randomized trials with death and missingness","volume":"73","author":"Wang","year":"2017","journal-title":"Biometrics."},{"issue":"1","key":"bib23-20260527","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/ALN.0000000000002701","article-title":"Days alive and out of hospital: validation of a patient-centered outcome for perioperative medicine","volume":"131","author":"Jerath","year":"2019","journal-title":"Anesthesiology."},{"issue":"8","key":"bib24-20260527","doi-asserted-by":"crossref","first-page":"e015828","DOI":"10.1136\/bmjopen-2017-015828","article-title":"Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia","volume":"7","author":"Myles","year":"2017","journal-title":"BMJ Open."},{"issue":"2","key":"bib25-20260527","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1302\/0301-620X.107B2.BJJ-2024-0846.R1","article-title":"Facilitating clinical trials in hip fracture in the UK :the role and potential of the National Hip Fracture Database and routinely collected data","volume":"107-B","author":"Webster","year":"2025","journal-title":"Bone Joint J."},{"issue":"22","key":"bib26-20260527","doi-asserted-by":"crossref","first-page":"4249","DOI":"10.1002\/cncr.33817","article-title":"Healthy days at home: A population-based quality measure for cancer patients at the end of life","volume":"127","author":"Lam","year":"2021","journal-title":"Cancer."},{"issue":"1","key":"bib27-20260527","doi-asserted-by":"crossref","first-page":"100378","DOI":"10.1016\/j.hjdsi.2019.100378","article-title":"Healthy Days at home: A novel population-based outcome measure","volume":"8","author":"Burke","year":"2020","journal-title":"Healthc (Amst)."},{"issue":"9","key":"bib28-20260527","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1001\/jamacardio.2021.1651","article-title":"Comparison of days alive out of hospital with initial invasive vs conservative management: a prespecified analysis of the ISCHEMIA trial","volume":"6","author":"White","year":"2021","journal-title":"JAMA Cardiol."},{"issue":"4","key":"bib29-20260527","first-page":"201","article-title":"Iron and erythropoietin to heal and recover after intensive care (ITHRIVE): A pilot randomised clinical trial","volume":"25","author":"Litton","year":"2023","journal-title":"Crit Care Resusc."},{"issue":"11","key":"bib30-20260527","doi-asserted-by":"crossref","first-page":"e203754","DOI":"10.1001\/jamasurg.2020.3754","article-title":"Patient-Centered Time-at-Home Outcomes in Older Adults After Surgical Cancer Treatment","volume":"155","author":"Chesney","year":"2020","journal-title":"JAMA Surg."},{"issue":"3","key":"bib31-20260527","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1302\/0301-620X.97B3.35738","article-title":"Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation\u2014a prospective cohort study","volume":"97-B","author":"Griffin","year":"2015","journal-title":"Bone Joint J."},{"issue":"6","key":"bib32-20260527","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1056\/NEJMoa2108337","article-title":"WHiTE 5 Investigators. Cemented or uncemented hemiarthroplasty for intracapsular hip fracture","volume":"386","author":"Fernandez","year":"2022","journal-title":"N Engl J Med."},{"issue":"7","key":"bib33-20260527","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.injury.2012.01.027","article-title":"A qualitative approach to recovery after open tibial fracture: the road to a novel, patient-derived recovery scale","volume":"43","author":"Trickett","year":"2012","journal-title":"Injury."},{"issue":"10","key":"bib34-20260527","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res."},{"issue":"3","key":"bib35-20260527","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1302\/2046-3758.33.2000250","article-title":"Outcome assessment after hip fracture: is EQ-5D the answer?","volume":"3","author":"Parsons","year":"2014","journal-title":"Bone Joint Res."},{"issue":"11","key":"bib36-20260527","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1097\/00005650-199711000-00002","article-title":"Modeling valuations for EuroQol health states","volume":"35","author":"Dolan","year":"1997","journal-title":"Med Care."},{"issue":"1","key":"bib37-20260527","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1037\/pas0000037","article-title":"Measuring treatment differentiation for implementation research: the Therapy Process Observational Coding System for Child Psychotherapy Revised Strategies scale","volume":"27","author":"McLeod","year":"2015","journal-title":"Psychol Assess."},{"issue":"16","key":"bib39-20260527","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1056\/NEJMoa2100433","article-title":"Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19","volume":"384","author":"Gordon","year":"2021","journal-title":"N Engl J Med."},{"issue":"2","key":"bib40-20260527","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1093\/eurheartj\/ehr352","article-title":"The win ratio: a new approach to the analysis of composite endpoints in clinical trials based on clinical priorities","volume":"33","author":"Pocock","year":"2012","journal-title":"Eur Heart J."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:34:39Z","timestamp":1787751279000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":37,"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.01436","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}