The Study of Physical Activity Rewards After Knee Surgery

N/ACompletedNCT01970631

Brigham and Women's Hospital202 enrolled

Overview

The objectives of this research are to conduct a proof of concept randomized controlled trial with 200 patients undergoing primary total knee replacement (TKR) at Brigham and Women's Hospital (BWH). The trial will compare levels of physical activity in subjects in the behavioral and economic interventions versus "Usual Care" post TKR.

Physical activity (PA) has been shown to improve pain and function in persons with knee osteoarthritis (OA), reduce obesity, and prevent the onset and progression of heart disease, diabetes, and chronic pulmonary disease. The US Department of Human and Health Services (DHHS) guidelines recommend that adults engage in \>150 minutes of moderate physical activity per week. However, adherence to PA guidelines is poor in the general population, particularly in persons with knee OA. Total knee replacement (TKR) is widely used in patients with symptomatic, advanced knee OA. While the vast majority of persons undergoing TKR experience considerable reduction in pain and improvement in functional capacity, far fewer take this opportunity to become more physically active. Since physical activity has a direct relationship with quality of life and with prevention and amelioration of many chronic conditions, many TKR recipients do not derive maximum benefits from the procedure. The focus of this proposal is to conduct a proof of concept RCT to establish the efficacy of a behavioral economics-based intervention that would facilitate engagement in physical activity and improve adherence to PA guidelines in the growing population of TKR recipients. We address the innovative hypothesis that the period following TKR presents a window of opportunity to fundamentally change attitudes and beliefs regarding PA, and that tangible economic incentives will effectively induce behavior change and facilitate adherence to PA guidelines.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

202

Conditions

Osteoarthritis Degenerative Joint Disease

Interventions

Motivational Interviewing (MI)BEHAVIORAL

The motivational interviewing arms of SPARKS will consist of Health Educators trained in Motivational Interviewing (MI) techniques contacting participants at regular intervals over the course of the nine months following participants' total knee replacement (TKR).

Financial IncentivesOTHER

The financial intervention arms of SPARKS will provide compensation to participants for completing physical activity logs weekly/bi-weekly and reaching pre-specified physical activity goals.

Eligibility

Sex: ALLMin age: 40 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Scheduled to undergo primary TKA at BWH * Osteoarthritis is the principal underlying diagnosis * Age \>=40 at the projected date of TKA * English-speaking * Willing and able to access the internet to complete study related questionnaires Exclusion Criteria: * Osteoarthritis is not the principal underlying diagnosis (e.g. inflammatory arthritis) * Dementia (can not fill out forms) * Psychological issues that preclude participation, as identified by participating surgeons * Does not have access to a computer and/or the internet. * Non-English speaker (instruments are not validated in Spanish); very few non-English speakers (\<5%) are otherwise eligible * Age \<40 at the projected date of TKA (TKA is usually due to major trauma, juvenile onset or congenital disease) * Lives in a nursing home (difficult to track costs) * Implantation of Unicompartamental Knee Arthroscopy (different clinical features and different costs) * Bilateral TKA in same admission (simultaneous), staged or within 6 months * Uses a wheelchair or walker to ambulate * Has been told by a physician that he/she has a heart condition and should only do physical activity recommended by a doctor * Has pain in his/her chest when doing physical activity * Loses balance because of dizziness * Loses consciousness * Unable/unwilling to wear Fitbit® accelerometer for 5 or more days during baseline visit

Locations (1)

Brigham and Women's Hospital

Boston, Massachusetts, United States

Outcomes

Primary Outcomes

number of steps

The primary outcome is the average number of steps over 7 days as measured by accelerometer at 6 months post-TKR.

Time frame: 6 months

Secondary Outcomes

Adherence to PA guidelines

The secondary outcome will be adherence to PA guidelines, defined by the DHHS as \>150 minutes of moderate or greater intensity PA occurring in bouts of 10 minutes or more per week.

Time frame: 6-months

Data from ClinicalTrials.gov

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