None listed
Conditions
Brief summary
Persistent hip pain in individuals over 50 years of age is most often due to underlying hip osteoarthritis (OA). Hip osteoarthritis (OA) is a chronic musculoskeletal condition causing pain, physical dysfunction, psychological impairments and reduced quality-of-life. There is currently no cure, thus hip OA is a major public health problem contributing to substantial patient morbidity, health care costs and lengthy surgical waiting lists. Although exercise is recommended by all clinical guidelines for managing hip OA, clinical trials have shown that exercise is either not effective or has only modest benefits. Exercise, typically aimed at addressing muscle strength deficits and restricted joint range of motion, does not directly address psychological factors that are significantly increased in people with hip OA and are associated with higher pain levels and poorer function. Pain coping skills training (PCST), a form of cognitive behavioural therapy, is effective but its clinical application is limited because of poor access to appropriately-trained health professionals and high treatment costs. There is an urgent need to evaluate alternate delivery methods of PCST as an adjunctive treatment to exercise in OA. There are no studies in hip OA that have evaluated the efficacy of PCST (or any other behavioural intervention) either alone, or combined with biomedical treatments such as exercise. This study has two main aims comparing two interventions; Intervention A = Online general education and online PCST, followed by exercise, compared to Intervention B = online education, followed by exercise. In both interventions exercise commences in week 8, on completion of the online educational component. Both interventions are assessed at two separate time points, week 24 and week 8. The first aim is to assess and compare at 24 weeks the effect of the two interventions on pain and physical function. The second aim is to assess and compare the effect of Intervention A and B on pain and physical function prior to the commencement of exercise which is introduced in week 8 in both groups.
Interventions
Intervention: Pain coping skills training (PCST) delivered on-line combined with general online education followed by physiotherapist prescribed home exercises.
PCST program will be completed in weeks 1-8. Participants will complete on-line pain coping skills training (PCST) in the form of the PainCOACH program consisting of 8 interactive modules, each taking approximately 45 minutes. Participants will be asked to complete one module per week. At the completion of the 8 week modules participant
Intervention: Pain coping skills training (PCST) delivered on-line combined with general online education followed by physiotherapist prescribed home exercises. PCST program will be completed in weeks 1-8. Participants will complete on-line pain coping skills training (PCST) in the form of the PainCOACH program consisting of 8 interactive modules, each taking approximately 45 minutes. Participants will be asked to complete one module per week. At the completion of the 8 week modules participants will be asked to continue applying their pain coping skills. Pain coping skills training will be monitored using a PainCOACH specific logbook. General Education will be received in weeks 1-8. The on-line education component will consist of short fact sheets. These will be presented once a week and will cover topics such as what is OA, healthy eating, importance of exercise, sleep etc. They will take approximately 5 minutes to read. Participants will attend 5 x 30 minute physiotherapy guided exercise sessions, between weeks 8-24 (approximately one every 3 weeks). The session will focus on developing a home exercise program focused on hip muscle strength and hip joint range of motion. The home exercise program, developed by the project physiotherapist should consist of 4-6 exercises and take approximately 15 minutes to complete. Home exercises are to be completed three times per week from week 8 to week 52. Home exercise practice will be recorded by participants in a log book.
Sponsors
The University of Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Persistent hip pain for more than 3 months and for most days of the past month Self-reported average walking pain level over the past week of equal to or greater than 4 out of 10 on a numeric rating scale Ability to travel to one of the study Physiotherapy clinics Current email address and access to a computer with broadband internet connection Able to commit approximately 12 months to the study
Exclusion criteria
Hip joint replacement on the painful side Knee replacement on either side within the previous 6 months Planning hip joint or knee surgery within the past/next 12 months Current or past (within 3 months) oral or intra-articular corticosteroid use Systemic arthritic conditions Self-reported high-level depression (score of >21 on the depression subscale of the Depression, Anxiety and Stress Scale (DASS-21) Other muscular, joint or neurological condition affecting lower limb function Undertaken a previous behavioural treatment program in the past 12 months Physiotherapy treatment or exercises specifically for the back, hip and knee in past 6 months Unable to comply with protocol
Outcome results
None listed