Better Before - Better After: Prehabilitation Program for Older Patients Awaiting Total Hip Replacement

Study Overview
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Brief Summary
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Health professions need to prepare for the large increase in the number of older people with OA requiring health services including TJA surgery. Older age and poor physical function influences the postoperative prognosis of TJA. At discharge from hospital after TJA, studies have shown that gait speed can be severely impaired among older patients. The investigators hypothesize that an exercise program of 6-12 weeks will be beneficial for patients that are undergoing TJA.

Detailed Description
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More than 300.000 Norwegians above 20 years of age have osteoarthritis (OA) . There has been a significant increase in the prevalence of OA over the decades. In the United States knee OA affects 19% of adults aged 45 years or older. OA is associated with an extensive high economic and personal burden, largely attributable to the effects of disability, comorbid disease, and the expense of treatment. Given the aging population, the number of total joint arthroplasty procedures (TJA) for hip and knee is likely to increase substantially. In light of poor physical function prior to surgery among older patients and the likelihood of an added decrease during hospitalization and risk of poorer outcome after surgery, it is hypothesised that prehabilitation (preoperative exercise) would improve outcomes after surgery, however evidence for its efficacy is still lacking

Official Title
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Better Before - Better After: Prehabilitation Program for Older Patients Awaiting Total Hip Replacement. A Randomised Controlled Trial

Conditions
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Arthritis of Hip

Intervention / Treatment
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* Behavioral: Exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants 70 years or older living at home with residential address in the county of Oslo or Akershus scheduled for elective primary total hip replacement due to end-stage osteoarthritis. Harris Hip Score >60. Participants must also be capable in Norwegian and be able to follow exercise sessions. Exclusion Criteria: Patients with known rheumatoid arthritis or medical contraindications or those who are scheduled for revision of hip arthroplasty Unable to speak and understand the Norwegian language. Patients with neurological disorders affecting gait Medical contraindications for exercise

Ages Eligible for Study
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Minimum Age: 70 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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Intervention group<br>Exercise interventions for 6-12 weeks. Adherence is monitored with day journals | Behavioral: Exercise<br>* Exercises in group and/or individually<br>|
| No Intervention: Control group<br>Care as usual | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in gait speed | 40 meters Fast-Paced Walk test | Change measure: Baseline, within one week after intervention, 6 weeks after intervention, 3 months after intervention, 6 months after intervention and 12 months after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in physical function | 30 second sit-to stand test | Change measure: Baseline, within one week after intervention, 6 weeks after intervention, 3 months after intervention, 6 months after intervention and 12 months after intervention | 
| Change in aerobic capacity | 6 min walk test | 1 week before intervention, directly after intervention as well as 6 and 12 weeks after TJA-surgery | 
| Change in transitional ambulation | Timed-up and go Test (TUG) | Change measure: Baseline, within one week after intervention, 6 weeks after intervention, 3 months after intervention, 6 months after intervention and 12 months after intervention | 
| Change in pain measured with numeric rating scale (NRS) | NRS - Single score, low score indicates low pain, high score indicated high levels of pain | Change measure: Baseline, within one week after intervention, 6 weeks after intervention and 3 months after intervention | 
| Length of stay in hospital | Number of days | From date of hospital admission until the date of hospital discharge, assessed up to 12 months | 
| Change in the ability to climb stairs | Stair-climb test. Timed performance from start to stop | Change measure: Baseline, within one week after intervention, 6 weeks after intervention, 3 months after intervention, 6 months after intervention and 12 months after intervention | 
| Change in Health Status measured with EuroQol-5 dimensions (EQ-5D) | EQ-5D, five dimensions of health scored from 1-5, with 1 being no problem and 2-5 indicate increasing problem (higher score = increase in problem) | Change measure: Baseline, within one week after intervention, 6 weeks after intervention, 3 months after intervention, 6 months after intervention and 12 months after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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exercise, prehabilitation, arthritis, quality of life, osteoarthritis, rehabilitation