Implementation Science, Mobility Limitation, Older Adults, Osteoarthritis (OA), Osteoarthritis (OA) of the Hip, Osteoarthritis (OA) of the Knee, Pain, Physical Activity, Sedentary Behaviors, Social Isolation or Loneliness, Total Hip Arthroplasty (THA), Total Knee Anthroplasty
Conditions
Keywords
Osteoarthritis, Implementation science, Physical activity, Social isolation, Older adults, Mobility, Joint replacement, Loneliness, Pain
Brief summary
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.
Detailed description
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.
Interventions
BEHAVIORALChoose to Move Replacement Ready
As described under study arm description.
Sponsors
University of British Columbia
Active Aging Society
Specialist Services Committee (Doctors of BC)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Activity coach hired by the Active Aging Society (activity coaches must speak English to participate in the evaluation); 2. English-speaking older adults (aged \>=50 years) who participate in CTM-RR will be invited to participate in the evaluation; 3. Referral partner (People who work in a healthcare setting who refer patients into the program)
Exclusion criteria
1. non-English speaking activity coach 2. non-English speaking referral partner
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effectiveness outcome: Change in physical activity | baseline, 3 and 6 months, 2 weeks pre-operative | 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) |
| Implementation outcome: Fidelity (Proportion of participants who adhered to CTM-RR program components) | 3 months | Obtained from post-program survey. Measures adherence to prescribed frequency, intensity, duration, and type of exercises performed, and attendance at CTM-RR group meetings. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in patient global assessment of target joint | baseline, 3 and 6 months, 2 weeks pre-operative | 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). |
| Change in arthritis-specific self-efficacy | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in pain intensity | baseline, 3 and 6 months, 2 weeks pre-operative | Pain Numerical Rating Scale (NRS): score (0-10) assesses pain intensity on average during the past week. Higher scores indicate worse pain intensity. |
| Change in willingness to undergo surgery | baseline, 3 and 6 months, 2 weeks pre-operative | 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). |
| Change in anxiety | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in kinesiophobia | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Reach | 3 months | Number of individuals participating in CTM-RR programs will be obtained from program records |
| Retention | Baseline, 3 and 6 months, 2 weeks pre-operative | Obtained from evaluation records. Proportion of participants who consent to the evaluation who complete each assessment. |
| Dose delivered | 3 months | Obtained from post-program survey. Proportion of required intervention components (group meetings and one-on-one consultations) delivered by activity coaches. |
| Adoption | 3 months | Obtained from program records. Number of referral partners who refer participants to the program. |
| Adaptation (survey) | 3 months | 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. |
| Satisfaction with CTM-RR (survey) | 3 months | 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. |
| Change in walking time | baseline, 3 and 6 months, 2 weeks pre-operative | International Physical Activity Questionnaire (IPAQ-SF): assesses self-reported weekly minutes of walking |
| Change in sedentary time | baseline, 3 and 6 months, 2 weeks pre-operative | International Physical Activity Questionnaire (IPAQ-SF): assesses self-reported weekly minutes of sedentary time |
| Change in bone and muscle strengthening activity | baseline, 3 and 6 months, 2 weeks pre-operative | Single-item muscle strengthening activity survey. Number of days in past week doing activities that increase bone and muscle strength |
| Change in balance activity | baseline, 3 and 6 months, 2 weeks pre-operative | Single-item activity survey. Number of days in past week doing activities that improve balance. |
| Change in capacity for mobility | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in social isolation | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in loneliness | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in ability to participate in daily activities | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in exercise self-efficacy | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in Hip disability and Osteoarthritis Outcome 12-item Score | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
| Change in Knee disability and Osteoarthritis Outcome 12-item Score | baseline, 3 and 6 months, 2 weeks pre-operative | 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. |
Countries
Canada
Contacts
CONTACTDouglas L Race, MSc
CONTACTGiulia Coletta, PhD
PRINCIPAL_INVESTIGATORHeather A McKay, PhD
University of British Columbia
PRINCIPAL_INVESTIGATORLaura Churchill, PT, PhD
University of British Columbia
PRINCIPAL_INVESTIGATORJoanie Sims Gould, MSW, PhD
University of British Columbia
Outcome results
None listed