Osteoarthritis (OA), leading to hip replacement, is a leading contributor to global mobility impairment. Given the boom in the older demographic it is not surprising that there is an 11% increased demand for replacement every 5 years in Canada. Health promotion interventions, such as prehabilitation, defined as pre-surgical education, are vital to optimizing surgical outcomes, reducing hospitalization costs, accelerating rehabilitation, and reducing patient discomfort and pre-operative anxiety. HIPPER is a 2-year randomized controlled trial (RCT) that will assess feasibility indicators and clinical outcomes of online prehab education modules compared to online educational webinars. The feasibility indicators (process, resource, management, and treatment issues) and clinical outcomes (physical function, anxiety, depression, pain, daily activities, self-efficacy, and health related quality of life) will be assessed among Vancouver-dwelling older adults aged \> 50 years, with advanced hip osteoarthritis. The findings will lead to the refinement of the design protocol in order to evaluate a contemporary, standardized, and geographically accessible prehab education program in a large multi-site RCT.
This feasibility study will use a single-site, parallel group evaluator blind RCT. Subjects (N=40) will be randomly assigned to the experimental (HIPPER n=20) or control (n=20) groups.The experimental group will receive the interactive online HIPPER intervention consisting of 12 modules (\~20 mins/module). The control group is usual practice consisting of a 2 hr online large group educational webinar. Feasibility indicators (i.e. recruitment and retention; subject burden; safety; intervention administration/adherence; perceived benefit) will be evaluated as binary outcomes against pre-set parameters reflecting viability for a multi-site large-scale RCT. The primary clinical outcome of interest when assessing effect size for the eventual RCT is the Hospital Anxiety and Depression Scale-Anxiety. Secondary clinical outcomes include measures of pain, function, daily activities, self-efficacy, equipment checklist, system usability scale, environmental setup, physical activity, and health related quality of life. Upon successful screening/enrollment and baseline data collection (T1) the Study Coordinator will contact the statistician by telephone or email and obtain group assignment within 48 hours. Subjects will be randomized using a 1:1 allocation ratio between groups. A central computerized randomization process will be designed by the statistician, with an undisclosed block size. To address bias, subjects will be instructed not to discuss their program and Testers will reinforce this point at each session. T1 data will be collected at our clinic while the follow up data collected 7-10 days prior to surgery (T2), and 30 days post-surgery (T3). The findings from the study will be summarized and mailed to each participant upon study completion. HIPPER and control group assessments will be held at GF Strong Rehabilitation Centre and at subject's homes. The outcome will lead to the refinement of the design protocol in order to robustly evaluate a contemporary, standardized, and geographically accessible prehabilitation education program. Ultimately, HIPPER may be found to have significant individual and social (health system level) benefits.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
51
Participants can complete the online educational modules at home or another location with internet access. The total time to complete all of the modules is about 2 hours and 30 minutes.
2-hour online educational large group sessions
GF Strong Rehabilitation Centre
Vancouver, British Columbia, Canada
Hospital Anxiety and Depression Scale - Anxiety Subscale (HADS-A)
The Hospital Anxiety and Depression Scale (HADS-A) measures anxiety symptoms. The anxiety subscale (HADS-A) has 7 items, each rated 0-3 and summed to a total of 0-21. Higher scores indicate worse outcomes (greater anxiety).
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Hospital Anxiety and Depression Scale - Depression Subscale (HADS-D)
The Hospital Anxiety and Depression Scale (HADS-D) measures depression symptoms. The depression subscale (HADS-D) has 7 items, each rated 0-3 and summed to a total of 0-21. Higher scores indicate higher levels of depression.
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Oxford Hip Score (OHS)
The Oxford Hip Score (OHS) measures pain and function in patients with hip osteoarthritis. It has 12 items, each rated 0-4, summed to a total of 0-48. Higher scores indicate lower levels of disability.
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Change in Self-Efficacy for Rehabilitation Outcome Scale (SER)
The Self-Efficacy for Rehabilitation Outcome Scale (SER) measures confidence in performing rehabilitation activities. It has 12 items, each rated 0-10, summed to a total of 0-120. Higher scores indicate greater self-efficacy.
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
System Usability Scale (SUS)
The System Usability Scale (SUS) measures perceived usability of a system. It has 10 items rated on a 5-point scale; item scores are converted, summed, and multiplied by 2.5 to give a total of 0-100. Higher scores indicate better perceived usability.
Time frame: T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery); Completed only by participants in the HIPPER group.
Hip Disability and Osteoarthritis Outcome Score - Activities of Daily Living Subscale (HOOS-ADL)
The Hip Disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living (ADL) subscale measures difficulty with daily activities in patients with hip osteoarthritis. It has 17 items, each rated on a five-point Likert scale (0 = none to 4 = extreme difficulty), summed to a total ranging from 0 to 68. Higher scores indicate greater difficulty with daily activities.
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Physical Activity Scale for the Elderly (PASE)
The Physical Activity Scale for the Elderly (PASE) measures self-reported physical activity over the past 7 days in older adults. Scores are a weighted sum of time spent across activity types, ranging from 0 to 400 or more. Higher scores indicate greater physical activity.
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index Score
The EuroQol 5-Dimension 5-Level (EQ-5D-5L) measures health-related quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Responses were converted to a single utility index ranging from -0.285 to 1 (extreme problems on all dimensions) to 1 (full health). Higher scores indicate better health-related quality of life.
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Equipment Checklist
The Equipment Checklist included recommended equipment and mobility aids for total hip replacement. This checklist was developed in accordance with current guidelines and clinical recommendations. Participants indicated which items they had obtained. The reported value is the number of items obtained per participant. Higher scores indicate more recommended equipment obtained.
Time frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
30-second Chair-Stand Test
The 30-Second Chair-Stand Test measures lower-body strength and endurance. Participants stand fully from a seated position and sit back down as many times as possible within 30 seconds. The score is the number of completed sit-to-stand repetitions. Higher scores indicate better lower-body strength and function.
Time frame: T1 (Baseline); T2 (7-10 days before surgery).
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