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Randomized Controlled Trial
. 2022 May 31;12(5):e061373.
doi: 10.1136/bmjopen-2022-061373.

Randomised controlled trial of a behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: the PEP-TALK trial

Toby O Smith  1   2 , Scott Parsons  3 , Alexander Ooms  3   4 , Susan Dutton  3   4 , Beth Fordham  3 , Angela Garrett  3 , Caroline Hing  5 , Sarah Lamb  6 ; PEP-TALK Trial Collaborators
Collaborators, Affiliations
Randomized Controlled Trial

Randomised controlled trial of a behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: the PEP-TALK trial

Toby O Smith et al. BMJ Open. .

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.

Keywords: adult orthopaedics; hip; knee; rheumatology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CONSORT flowchart. CONSORT, Consolidated Standards of Reporting Trials.
Figure 2
Figure 2
UCLA Activity Score boxplots. UCLA, University of California Los Angeles.
See this image and copyright information in PMC

References

    1. National Joint Registry . 18Th annual report. NJR 18th annual report 2021.pdf. Available: (njrcentre.org.uk) [Accessed 19 Dec 2020].
    1. Dailiana ZH, Papakostidou I, Varitimidis S, et al. . Patient-Reported quality of life after primary major joint arthroplasty: a prospective comparison of hip and knee arthroplasty. BMC Musculoskelet Disord 2015;16:366. 10.1186/s12891-015-0814-9 - DOI - PMC - PubMed
    1. Papakostidou I, Dailiana ZH, Papapolychroniou T, et al. . Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord 2012;13:116. 10.1186/1471-2474-13-116 - DOI - PMC - PubMed
    1. Withers TM, Lister S, Sackley C. Is there a difference in physical activity levels in patients before and up to one year after unilateral total hip replacement? A systematic review and meta-analysis. Clin Rehabil 2017;316:39–50. 10.1177/0269215516673884 - DOI - PMC - PubMed
    1. Smith TO, Hilton G, Mansfield M. Does physical activity change following hip and knee arthroplasty? an analysis of data from the osteoarthritis initiative. Physiotherapy 2018;104:80–90. 10.1016/j.physio.2017.02.001 - DOI - PubMed

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