None listed
Conditions
Brief summary
This study is the first to test a new physiotherapy approach to preparing for knee replacement surgery. This new approach is called PACT- Physiotherapy informed by Acceptance and Commitment Therapy. This is a method often used by psychologists to help people experiencing a range of issues that affect their mental health. This study is a pilot study, testing the new approach in 51 people and assessing results from a patient, therapist and hospital perspective before we use this approach in a larger study or in clinical practice.
Interventions
PACT group: Participants will attend 3 additional one-to-one sessions at their local physiotherapy outpatient department pre-operatively of 60 mins, 30 mins and 30 mins duration respectively over a 3 month period, with appointments 6 weeks apart.
The fourth session of 20 mins duration will occur during their inpatient stay when the physiotherapist will attend to them in the ward setting. All physiotherapists conducting the intervention will have more than 3 years experience in musculoskeletal p
PACT group: Participants will attend 3 additional one-to-one sessions at their local physiotherapy outpatient department pre-operatively of 60 mins, 30 mins and 30 mins duration respectively over a 3 month period, with appointments 6 weeks apart. The fourth session of 20 mins duration will occur during their inpatient stay when the physiotherapist will attend to them in the ward setting. All physiotherapists conducting the intervention will have more than 3 years experience in musculoskeletal physiotherapy. They will also receive 16 hours training in the ACT method generally through an accredited ACT training provider. In addition, they will engage in 1 day of trial specific training in PACT, which will be provided by psychologists and physiotherapists experienced in developing and using the PACT method, and will be supported with a therapist training manual. All participants will be supplied with a patient manual, which supports the approach taken during the individual sessions. 'The initial session will include a thorough clinical assessment, and ongoing discussion between the therapist and participant to identify key values of the participant, linking these to behaviour goals around physical activity, action planning, identification of barriers and facilitators and prescription of one specific strength exercise. The strength exercise will target knee extensor and hip abductor strength, and the exact exercise and resistance will be personalised by the therapist based on an 8-10RM prescription. Review sessions will explore progress made with regards to behavioural goals, exploring barriers/facilitators, goal review, and progression of exercises. All sessions will be conducted with a therapeutic stance aligned with Acceptance and Commitment Therapy principles as equal, respectful, empathetic and positive. Participants in this group will also receive the usual care treatment. All sessions will be recorded and assessed by the supervising clinical psychologist for intervention fidelity, including adherence and competence, using a standardised checklist developed a priori. Participating therapists will undergo monthly supervision sessions with the supervising psychologists in person or via videoconferencing.
Sponsors
Western Sydney Local Health District- Blacktown Mt Druitt Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Subjects will be considered eligible for inclusion in this study if they are: • Over 18 years old. • Accepted on to the surgical waiting list for an elective primary unilateral total knee arthroplasty for osteoarthritis at Blacktown Mt Druitt hospital during the period of recruitment. • Attending pre-admission appointments at the same site as their surgery.
Exclusion criteria
Patients will be excluded from the study if they • Have moderate or severe cognitive impairment pre-operatively on testing. • Reside outside of the local government areas covered by WSLHD. • Are having a revision TKA. • Are having a bilateral TKA. • Do not attend pre-admission assessment and education appointments. • Have plans to reside outside the WSLHD local government area on discharge from hospital. • Have further orthopaedic surgery planned in the next six months. • Report symptoms indicative of acute psychological risk, suicidal ideation or psychosis. • Report any current use of illicit substances, or alcohol intake greater than 14 units per week.
Outcome results
None listed