Reimagining Orthopaedic Research: The Musculoskeletal Adaptive Platform Trial (MAPT) Design Rationale

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. Clinical Relevance: 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.