Randomised controlled trial of a behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: the PEP-TALK trial. Issue 5 (31st May 2022)

• Record Type: Journal Article
• Authors: Smith, Toby O; Parsons, Scott; Ooms, Alexander; Dutton, Susan; Fordham, Beth; Garrett, Angela; Hing, Caroline; Lamb, Sarah
• Other Names: author non-byline.; Algar Steve author non-byline.; Hansen Zara author non-byline.; Barber Vicki author non-byline.; Hart Malcolm author non-byline.; Png MayEe author non-byline.; Barker Karen author non-byline.; Smith Ian author non-byline.; McNamara Iain author non-byline.; Dunn Michael author non-byline.; Lockey Dawn author non-byline.; Driver Sonny author non-byline.; Kassam Jamila author non-byline.; Penny Peter author non-byline.; Woodhouse Celia author non-byline.; Potter Tracey author non-byline.; Daniell Helena author non-byline.; Herring Alex author non-byline.; Cunningham Yan author non-byline.; Afzal Irrum author non-byline.; Matharu Maninderpal author non-byline.; Hughes Tamsin author non-byline.; Hannink Erin author non-byline.; Moynihan Michelle author non-byline.
• Is Part Of: BMJ open. Volume 12:Issue 5(2022)
• Publication Date: 2022-05-31
• Subjects: rheumatology -- adult orthopaedics -- hip -- knee; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-061373
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To test the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after total hip replacement (THR) or total knee replacement (TKR). Design: Multicentre, pragmatic, two-arm, open, randomised controlled, superiority trial. Setting: National Health Service providers in nine English hospitals. Participants: 224 individuals aged ≥18 years, undergoing a primary THR or TKR deemed 'moderately inactive' or 'inactive'. Intervention: Participants received either six, 30 min, weekly, group-based exercise sessions (usual care) or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour discussion group aimed at challenging barriers to physical inactivity following surgery (experimental). Randomisation and blinding: Initial 75 participants were randomised 1:1 before changing the allocation ratio to 2:1 (experimental:usual care). Allocation was based on minimisation, stratifying on comorbidities, operation type and hospital. There was no blinding. Main outcome measures: Primary: University of California Los Angeles (UCLA) Activity Score at 12 months. Secondary: 6 and 12-month assessed function, pain, self-efficacy, kinesiophobia, psychological distress and quality of life. Results: Of the 1254 participants assessed for eligibility, 224 were included (139 experimental: 85 usual care). Mean age was 68.4 years (SD: 8.7), 63% were women, 52% underwent TKR. There was no between-group difference in UCLA score (mean difference: −0.03 (95% CI −0.52 to 0.45, p=0.89)). There were no differences observed in any of the secondary outcomes at 6 or 12 months. There were no important adverse events in either group. The COVID-19 pandemic contributed to the reduced intended sample size (target 260) and reduced intervention compliance. Conclusions: There is no evidence to suggest attending usual care physiotherapy sessions plus a group-based behaviour change intervention differs to attending usual care physiotherapy alone. As the trial could not reach its intended sample size, nor a proportion of participants receive their intended rehabilitation, this should be interpreted with caution. Trial registration number: ISRCTN29770908 .