Choose to Move (CTM) is a 3-month, choice-based health-promoting program for low active older adults being scaled-up across British Columbia (BC), Canada. Recently, the investigators adapted CTM for the \>14000 people in BC who are on surgical waitlists for total knee replacement or total hip replacement (TKR/THR) for osteoarthritis (OA). The primary goals of this observational study are to describe how the adapted program, Choose to Move Replacement Ready (CTM-RR), is implemented in BC and determine if the adapted program improves health outcomes in people with hip and/or knee osteoarthritis who are on surgical waitlists for TKR/THR. The investigators will also evaluate whether any health benefits achieved by CTM-RR participants are maintained three months after they finish the program and also during the remaining time that they wait for their TKR/THR surgery. The investigators will work with referral partners from hospitals and orthopaedic clinics in BC to recruit participants into CTM-RR. Participants who enrol in CTM-RR will answer online survey questions about the program and about their physical activity, mobility, pain, function, quality of life, willingness to undergo surgery, overall perception of their joint condition, psychosocial health, self-efficacy, social isolation, loneliness, and sedentary time. CTM-RR activity coaches will also answer online survey questions about the program. CTM-RR participants, activity coaches, and referral partners will also participate in interviews about the program.
Choose to Move (CTM) an effective 3-month, choice-based health-promoting program for low active older adults being scaled-up in phases across British Columbia (BC), Canada. Choose to Move Replacement Ready (CTM-RR) is an adapted version of the program tailored to support individuals with hip and/ or knee osteoarthritis on surgical waitlists for TKR/THR, with the overall goal of enhancing key health outcomes. Referral partners from hospitals and orthopaedic clinics in BC will inform patients about CTM-RR when they are booked for a hip or knee replacement surgery. Trained activity coaches hired by the Active Aging Society will deliver the online CTM-RR program to individuals on surgical waitlists for TKR/THR who register for the program. The investigators will then evaluate implementation of CTM-RR, impact of CTM-RR on participants' physical and social health, and maintenance of any health benefits. The primary aim of this trial is to assess implementation and effectiveness of the adapted CTM-RR program. The specific objectives are to: 1. assess implementation of CTM-RR. Specifically, implementation determinants (context, acceptability, feasibility, appropriateness, self-efficacy) and implementation outcomes (1° implementation outcome: fidelity; 2° implementation outcomes: reach, retention, adoption, dose, adaptation, satisfaction). 2. evaluate effectiveness of CTM-RR. Specifically, whether CTM-RR increases participants' pre-operative moderate-to-vigorous physical activity (moderate to vigorous physical activity, 1° effectiveness outcome), mobility, psychosocial health, self-efficacy to manage their condition; improves their pain, function, quality of life, and perception of their joint condition, and decreases social isolation and loneliness (2° effectiveness outcomes). 3. evaluate if participant health benefits (if any) are maintained 3 months after CTM-RR is completed. 4. evaluate if participant health benefits (if any) are maintained up until participant's surgery (i.e. during the remaining surgical waiting period). In partnership with the Active Aging Society, the investigators aim to deliver 20 CTM-RR online programs over two years to approximately 300 participants across BC. There is no cost to participate in the CTM-RR program, and individuals may participate in CTM-RR regardless of whether they choose to be evaluated as part of this trial. The investigators expect approximately 70% of CTM-RR participants to volunteer for the evaluation. The investigators will conduct a pre-post, observational cohort trial using a hybrid implementation effectiveness type 2 trial design. Data will be collected at 0 (baseline), 3 (postintervention), and 6 (long-term follow-up) months and 2-weeks before surgery (pre-operative) to assess implementation and impact of CTM-RR, and maintenance of any program-related benefits.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
210
As described under study arm description.
Active Aging Research Team, Robert H. N. Ho Research Centre
Vancouver, British Columbia, Canada
RECRUITINGImplementation outcome: Fidelity (Proportion of participants who adhered to CTM-RR program components)
Obtained from post-program survey. Measures adherence to prescribed frequency, intensity, duration, and type of exercises performed, and attendance at CTM-RR group meetings.
Time frame: 3 months
Effectiveness outcome: Change in physical activity
Single-item physical activity questionnaire. Output measure is self-reported number of days engaging in ≥30 minutes of moderate-to-vigorous physical activity in the past week (range 0-7). Higher scores reflect a better outcome (i.e. increased physical activity)
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Reach
Number of individuals participating in CTM-RR programs will be obtained from program records
Time frame: 3 months
Retention
Obtained from evaluation records. Proportion of participants who consent to the evaluation who complete each assessment.
Time frame: Baseline, 3 and 6 months, 2 weeks pre-operative
Dose delivered
Obtained from post-program survey. Proportion of required intervention components (group meetings and one-on-one consultations) delivered by activity coaches.
Time frame: 3 months
Adoption
Obtained from program records. Number of referral partners who refer participants to the program.
Time frame: 3 months
Adaptation (survey)
Planned or purposeful changes to the delivery of CTM-RR by activity coaches will be assessed by survey (short answer responses; developed in house). Coaches will indicate if they made any adaptations to the program (yes/no) and to provide details of any adaptations such as why it needed to occur.
Time frame: 3 months
Satisfaction with CTM-RR (survey)
Satisfaction with CTM-RR will be assessed via participant (older adults) survey (designed in house). Higher scores (1-5 Likert scale) indicate higher participant satisfaction with the intervention.
Time frame: 3 months
Change in walking time
International Physical Activity Questionnaire (IPAQ-SF): assesses self-reported weekly minutes of walking
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in sedentary time
International Physical Activity Questionnaire (IPAQ-SF): assesses self-reported weekly minutes of sedentary time
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in bone and muscle strengthening activity
Single-item muscle strengthening activity survey. Number of days in past week doing activities that increase bone and muscle strength
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in balance activity
Single-item activity survey. Number of days in past week doing activities that improve balance.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in capacity for mobility
Short-Form-36 health survey (SF-36) Physical Functioning Scale: two items assess self-reported ability to walk ¼ mile and 1 flight of stairs.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in social isolation
Social Isolation Questionnaire: score (0-15) reflects the degree of social interaction and support. Higher scores indicate a greater level of social interaction and support.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in loneliness
The 3-item U.S. Health and Retirement Study Participant Lifestyle Questionnaire reflects experiences of loneliness. Each item is scored on a scale of 1-3. The output variable is the summed score of the 3 items (range 3-9); Higher scores indicate greater perceived loneliness.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in ability to participate in daily activities
The four-item PROMIS- Ability to Participate in Social Roles and Activities Scale- short form 4a will be used to assess perceived ability to perform one's usual social roles and activities. Each item is scored on a scale of 1-5. The output variable is the summed raw score of all 4-items (range 4-20) converted into a T-score (27.5-64.2) ; higher scores indicate greater ability to engage in social roles and activities.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in Hip disability and Osteoarthritis Outcome 12-item Score
The 12-item Hip Disability and Osteoarthritis Outcome Score (HOOS-12) assesses patients' hip condition (pain, function, quality of life). Each item is scored on a scale of 0-10. The output variable is the average score of the 12-items (range 0-100); higher scores indicate worse hip problems.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in Knee disability and Osteoarthritis Outcome 12-item Score
The 12-item Knee Disability and Osteoarthritis Outcome Score (KOOS-12) assesses patients' knee condition (pain, function, quality of life). Each item is scored on a scale of 0-10. The output variable is the average score of the 12- items (range 0-100); higher scores indicate worse knee problems.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in patient global assessment of target joint
Single-item measure using a numerical rating scale: score (0-10) assesses the overall condition of the affected hip or knee joint. Higher scores indicate worse condition (severe symptoms).
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in arthritis-specific self-efficacy
The 8-item questionnaire assesses how certain an individual is that they can manage various aspects of their arthritis. Each item is scored on a scale of 1-10. The output variable is the average score of all 8-items (range 8-80); higher scores indicate more self-efficacy.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in pain intensity
Pain Numerical Rating Scale (NRS): score (0-10) assesses pain intensity on average during the past week. Higher scores indicate worse pain intensity.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in willingness to undergo surgery
One item will assess participants' willingness to undergo hip or knee replacement surgery. The question asks: "What is your current willingness to undergo a \[total hip replacement surgery or total knee replacement surgery\]?" The response options are: definitely unwilling, probably unwilling, unsure, probably willing or definitely willing. Definitely unwilling, probably unwilling, unsure= No, and probably willing or definitely willing=Yes. The output variable is self-reported willingness to undergo surgery (yes/no).
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in anxiety
The Generalized Anxiety Disorder 7-item scale (GAD-7) will be used to assess the presence of anxiety. Each item is scored on a scale of 0-3. The output variable is the summed total of all scores (range 0-21); higher scores indicate greater levels of anxiety.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in kinesiophobia
The 11-item Tampa Scale for Kinesiophobia (TSK-11) assesses fear of movement in individuals with chronic pain. Each item is scored on a scale of 1-4. The output variable is the total summed score of all 11-items (range 11-44); higher scores indicate greater fear of movement.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
Change in exercise self-efficacy
The 10-item Exercise Self-Efficacy Scale (ESES) assesses how confident participants are with regard to carrying out regular physical activities and exercise. Each item is scored on a scale of 1-4. The output variable is the total summed score of all 10 items (range 10-40); higher scores indicate greater self-efficacy for exercise.
Time frame: baseline, 3 and 6 months, 2 weeks pre-operative
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