Comparing two resources on pre-surgical physical activity and motivation for patients with hip/knee osteoarthritis

This is a behavioural intervention to assess the impact of PreHAB: Pre-arthroplasty Home-based physical Activity Booklet on pre-surgical physical activity and motivation (based on constructs within the Capability-Opportunity-Motivation-Behaviour (COM-B) Model of Behaviour). PreHAB has been designed specifically for this study and has been informed by findings from previous studies over the past 2 years by the doctoral researcher and with support from the co-investigators with expertise in psychology of physical activity and behaviour change and (clinical) exercise physiology. PreHAB is a patient- and clinician-informed, osteoarthritis-specific home-based pre-surgical physical activity resource for those awaiting arthroplasty. PreHAB is a resource booklet containing a home-based exercise programme, with information about the programme that reinforces the importance of pre-surgical physical activity and the appropriateness of the exercise for lower osteoarthritis, the importance of keeping active before surgery and what previous research has shown regarding this, how patients can have a role in their pre-surgical health, past-patient quotes and modelling/images and descriptions of how to perform each exercise, encouragement and ideas for exercise progress (e.g., sets, reps, number of days, duration) throughout the 6wk study, and worksheets for patients to consider their own motivations, action planning (with examples), barrier planning (with examples), and logsheets to record each week's action plan and exercise participation. PreHAB contains several behaviour change techniques (BCTs), such as goal setting, problem solving, action planning, review of goals, self-monitoring of behaviour, skills training/instruction, information about health consequences, information about antecedents, prompts/cues, restructuring the social environment, adding objects to the environment, framing/reframing, verbal persuasion about capability, and focus on past success. The BCTs listed above are non-exhaustive regarding those which have been incorporated in PreHAB, and further information can be requested if required. The physical activity programme in the booklet provides the participant with 9 exercises (descriptions + pictures of how to perform the exercise), and encouragement to incorporate some walking if they feel up to it. The exercises are a combination of upper and lower body strength exercises, such as side and front raises and knee pull-aparts, performed with an elastic resistance band (provided with the booklet). Participants are asked to aim to perform the exercises at least three times a week for 10 minutes or more, initially doing as many reps of each exercise as they can manage in Week 1, and are provided with suggested ways to progress each week if they think they can manage it. Participants can decide for themselves when and how often they do the exercises, and write this on their action plan worksheets for each week; they record each session and number of reps on their logbook sheets for each week. Patients will be randomised by the doctoral researcher to receive PreHAB and a theraband or the control (usual care leaflet) at their hospital-scheduled anaesthetic appointment OR surgeon appointment. As such, there are two intervention arms: PreHAB @ Anaesthetic Appointment and PreHAB @ Surgeon Appointment. These appointments generally occur at least 4 months before surgery. The appointment clinician will hand participants the allocated intervention or control resource; the clinician will not discuss either resource beyond the usual verbal information they provide patients about being active before surgery. Patients can direct their questions to members of the research team, whose contact details are provided to them on the Participant Information Sheet. Patients who consent to participate will be asked questionnaires over the phone two weeks before their scheduled appointment and across the four weeks following their scheduled appointment.