Promotion and Support for Physical Activity Maintenance Post Total Hip Arthroplasty

Study Overview
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Brief Summary
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Total hip arthroplasty (THA) is considered an efficacious procedure for relieving pain and disability in patients with hip osteoarthritis. However, 6-12 months post-surgery physical activity level is unchanged compared to pre-surgery and still considerably lower than that of healthy peers. Increasing physical activity after THA may enhance the outcome of the THA because a graded relationship between physical activity level and functional performance has been documented. Six-8 months after THA physical function is only recovered to about 80% of that of healthy peers and older adults still seem to be at increased risk of frailty. Furthermore, these patients continue to impose higher healthcare costs than an age- and sex-matched reference population which potentially could be related to the functional status that is not completely regained. Finally, patients with hip osteoarthritis can have extensive comorbidity thus increasing physical activity after THA could be a simple and relatively inexpensive method for improving general health, which in turn may decrease healthcare costs. The reasons for the lack of increase in physical activity despite increased capability after THA are unknown but it may be related to the sedentary behavior adopted by the patients prior to surgery and uncertainty. A systematic review has illuminated that patient-reported barriers to engaging in physical activity after THA are largely related to limited or inadequate information or education culminating in uncertainty about 'doing the right thing' for both the individual's recovery and the longevity of the joint replacement. Few studies have investigated the effects of specific interventions to increase physical activity after THA. Promising results have been shown from physical activity sensors in combination with e.g. goal setting. None of these studies have addressed the patient-reported barriers to physical activity regarding uncertainty and limited education. This trial aims to investigate the effect of adding a pedometer-driven, behavior change intervention to usual rehabilitation care 3 months after THA to increase physical activity compared to usual rehabilitation care alone (control). Outcomes are taken 3 (baseline), 6 (after the intervention period) and 12 months after THA (follow-up). Hypothesis: the behavior change intervention will increase the proportion that completes ≥8,000 steps per day 6-month post-surgery to 50% versus 30% in the control group.

Official Title
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Promotion and Support for Physical Activity Maintenance Post Total Hip Arthroplasty (PANORAMA). A Pragmatic, Randomized, Controlled, Trial.

Conditions
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Arthroplasty, Replacement, Hip

Intervention / Treatment
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* Behavioral: Behavior change intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Home dwelling, independent and self-reliant adults Patients who has received primary total hip arthroplasty because of hip osteoarthritis Informed consent to participate Exclusion Criteria: Planned joint arthroplasty in the lower extremities within the next 6 months Patients who are unable to read, understand and speak Danish Complications in relation to total hip arthroplasty e.g. dislocation, fracture or infection Any other condition that in the opinion of the investigator makes a potential participant unfit for participation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is a pragmatic, randomized, controlled, assessor- and statistician- blinded trial with two parallel groups; an intervention group receiving a behavior change intervention and a control group receiving no intervention.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Behavior change intervention<br>A 3-month behavior change intervention i.e. one initial, face-to-face, physical activity counselling and two telephone-assisted counselling. | Behavioral: Behavior change intervention<br>* It is a 3-month, multimodal, minimal contact, pedometer-driven, behavior change intervention to promote and support physical activity, that is initiated 3 months after THA. There is one initial, physiotherapist-led, face-to-face, physical activity counselling including 1) a brief motivational interviewing regarding physical activity, 2) patient education regarding physical activity after THA including recommendations and safety based on an orthopedic surgeon guided video and leaflet, 3) handling out pedometer and educational material i.e. a practice-oriented leaflet with advice on how to use a pedometer, a step-calendar and goal setting as well as strategies to incorporate physical activity into daily life. This initial counselling is followed by two, physiotherapist-led, telephone-assisted counselling after respectively three and seven weeks.<br>|
| No Intervention: Control<br>No attention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The number of participants that complete ≥ 8,000 steps per day | The mean number of steps completed per day assessed by an accelerometer during a 7-day period. | 6 months after THA | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The number of participants that complete ≥ 10,000 steps per day | The mean number of steps completed per day assessed with an accelerometer during a 7-day period. | 6 months after THA | 
| Change from baseline in the 6-minute walk test | The 6-minute walk test is a performance-based test of physical function which covers the domain ability to walk over longer distances. It is also a proxy measure of endurance/aerobic capacity. This test measures the walking distance completed in 6 minutes on a 30-m flat course. The participant is instructed to walk as far as possible in 6 minutes. The 6-minute walk test is included in a set of performance-based test recommended by the Osteoarthritis Research Society International that represents typical activities relevant to individuals following total joint arthroplasties. | 6 months after THA | 
| Change from baseline in the 30-s chair-stand test | The 30-s chair-stand test is a performance-based test of physical function which covers the domains: sitting and getting in/out of a seated position. It is also a proxy measure for assessing lower body muscle strength and power. This test measures number of chair stands completed in 30 seconds. The participant is instructed to complete as many chair stands as possible in 30 seconds with arms across the chest. The 30-s chair-stand test is included in a set of performance-based test recommended by the Osteoarthritis Research Society International that represents typical activities relevant to individuals following total joint arthroplasties. | 6 months after THA | 
| Change from baseline in the stair-climb test | The stair-climb test is a performance-based test of physical function which covers the domains: mobility and climbing. It is also a proxy measure for assessing lower extremity muscle strength and power and balance. This test measures the time (best of two trials) to ascend and descend a flight of 10 steps. The participant is instructed to ascend and descend the flight of stairs as fast as possible. The stair-climb test is included in a set of performance-based test recommended by the Osteoarthritis Research Society International that represents typical activities relevant to individuals following total joint arthroplasties. | 6 months after THA | 
| Change from baseline in self-reported physical function | Assessed by the Hip disability and Osteoarthritis Outcome Score (HOOS), the function in daily living (ADL) subscale. The last week is taken into consideration when answering the 17 questions (5 Likert boxes) included in this subscale. A normalized score (0-100, worst to best) can be calculated. | 6 months after THA | 
| Change from baseline in hip pain | Assessed by the Hip disability and Osteoarthritis Outcome Score (HOOS), the pain subscale. The last week is taken into consideration when answering the 10 questions (5 Likert boxes) included in this subscale. A normalized score (0-100, worst to best) can be calculated. | 6 months after THA | 
| Change from baseline in the patients' assessment of global perceived effect | The participants will be asked to compare their current global wellbeing with the pre-surgery state on a 200 mm visual analog scale with anchors being: -100 = Much worse; 0 = No changes; 100 = Much better. | 6 months after THA | 
| The mean number of steps per day | The mean number of steps completed per day assessed with an accelerometer during a 7-day period. | 6 months after THA | 
| The number of participants that complete ≥ 5,000 steps per day | The mean number of steps completed per day assessed with an accelerometer during a 7-day period. | 6 and 12 months after THA | 
| Health-related quality of life | Assessed by the EuroQol 5-Dimension Questionnaire (EQ-5D-3L), a generic instrument with 5 questions that comprises 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with 3 levels: no problems, some problems, and extreme problems | 6 and 12 months after THA | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exercise, Motivation