Promotion and Support for Physical Activity Maintenance Post Total Hip Arthroplasty (PANORAMA). A Pragmatic, Randomized, Controlled, Trial.
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Bispebjerg Hospital
- Enrollment
- 192
- Locations
- 2
- Primary Endpoint
- The number of participants that complete ≥ 8,000 steps per day
Study Overview
Brief Summary
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.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Masking Description
All outcome assessors will be blinded to group allocation and previous results and the participants are requested not to disclose their allocation when outcomes are assessed 6 and 12 months after surgery.
The biostatistician who perform the data analyses and validate the results will also be blinded to group allocation.
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
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
Outcomes
Primary Outcomes
The number of participants that complete ≥ 8,000 steps per day
Time Frame: 6 months after THA
The mean number of steps completed per day assessed by an accelerometer during a 7-day period.
Secondary Outcomes
- Change from baseline in hip pain(6 months after THA)
- The number of participants that complete ≥ 10,000 steps per day(6 months after THA)
- Change from baseline in self-reported physical function(6 months after THA)
- The number of participants that complete ≥ 5,000 steps per day(6 and 12 months after THA)
- Health-related quality of life(6 and 12 months after THA)
- Change from baseline in the 6-minute walk test(6 months after THA)
- Change from baseline in the 30-s chair-stand test(6 months after THA)
- Change from baseline in the stair-climb test(6 months after THA)
- Change from baseline in the patients' assessment of global perceived effect(6 months after THA)
- The mean number of steps per day(6 months after THA)
Investigators
Theresa Bieler
Research Therapist
Bispebjerg Hospital