Clinical trial NCT04001699: Interprofessional Preoperative Geriatric Assessment for Older Arthroplasty Patients With Multimorbidity
Official title: Interprofessional Preoperative Geriatric Assessment for Older Arthroplasty Patients With Multimorbidity - a Randomized Clinical Trial
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Multimorbidity
Knee Arthrosis
Hip Arthrosis
Keywords: preoperative
geriatric assessment
interprofessional team
Lead sponsor: University of Eastern Finland
Sponsor class: OTHER
Collaborators: name: Kuopio University Hospital
First posted: 2019-06-28
Enrollment: 140
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: The objective of this randomized control trial is to investigate effects and cost effectiveness of interprofessional preoperative assessment among older knee or hip arthroplasty patients. The main hypothesis is that preoperative assessment and optimization have a positive impact on the patents' quality of life and expenditure of social and health care services.

Detailed description: Knee and hip arthrosis are common conditions among older adults. Progression of arthrosis often leads to worsening of symptoms and decreased mobility, daily functioning and quality of life. Total joint arthroplasty improves pain in end-stage arthrosis but accustomed postoperative care and rehabilitation alone may not guarantee optimal regain of functioning for frail and vulnerable older arthroplasty patients. Preoperative optimization of older patients with multimorbidity and functional limitations may improve benefits of the arthroplasty even at lower costs. Patients randomized into intervention arm of the present study receive preoperative assessment with treatment and prehabilitation plan. The focuses of the intervention are patient's chronic conditions, nutritional status, medication and physical activity. The intervention is delivered by multiprofessional team (geriatrician, registered nurse, physiotherapist and pharmacist).

Older adults undergoing surgery are a rapidly growing but vulnerable patient group. Knowledge on effects of preoperative evaluation and optimization is sparse, especially on the effects of multi-domain interventions.

Eligibility criteria: Inclusion Criteria:

* Place of residence: Kuopio or Vesanto municipality
* Age ≥ 65 years
* Clinical decision for knee or hip arthroplasty, elective operation with more than one month waiting time, primary arthroplasty of the index joint.
* Multimorbidity: the patient has at least two chronic diseases with potential to affect functioning, diseases are defined according to the Function Comorbidity Index (FCI)

Additional inclusion criteria, at least two of the following:

* 5 or more medicines taken regularly (polypharmacy)
* continuous walking distance less than 500 m
* needs help in dressing and/or washing oneself
* needs help when visiting or taking care of businesses outside home
* body mass index ≤ 23 or ≥ 34

Exclusion Criteria:

- does not meet the above inclusion criteria

Primary outcomes:
measure: Health-related quality of life (15-D)
timeFrame: Preoperative measurement at baseline, postoperative measurements 3 and 9 months after the arthroplasty.
measure: Costs of social and health care services
timeFrame: Changes in costs of care are evaluated for a period starting from one year before and ending two years after the baseline examinations.
Secondary outcomes:
Other outcomes:
Locations:
city: Kuopio
country: Finland
facility: University of Eastern Finland
Study officials:
affiliation: University of Eastern Finland, Institute of Public Health and Clinical Nutrition
name: Eija Lönnroos
role: PRINCIPAL_INVESTIGATOR
References: