A Multidisciplinary Intervention in Total Knee Arthroplasty

NCT ID: NCT03771430

Last Updated: 2023-01-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

282 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-08-28

Study Completion Date

2024-12-31

Brief Summary

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The purpose of this study is to investigate the effectiveness of cognitive behavioral therapy delivered as an e-therapy program, combined with physical exercise delivered by physiotherapists, for patients on waiting list for total knee arthroplasty. The patients will be randomized to either 1) a non-surgical program consisting of web-based cognitive behavioral therapy combined with physiotherapy, 2) total knee arthroplasty (TKA) surgery followed by web-based cognitive behavioral therapy combined with physiotherapy, or 3) a control group who undergo TKA followed by standard physiotherapy.

Detailed Description

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The study is a multidisciplinary trial testing an intervention delivered by physiotherapists. Up to 20% of total knee arthroplasty (TKA) patients continue to experience moderate/severe pain 12 months after TKA. While physical therapy (PT) and cognitive-behavior therapy (CBT) have shown promise for improving outcomes, they have not been evaluated in combination or in patients at risk for chronic pain after TKA. This trial will evaluate PT+CBT combined, either as a substitute for or as a supplement to TKA for patients at risk for chronic pain after TKA.

Pilot/Feasibility study:

The study will include a feasibility/pilot study with 15 patients to be performed from November 2018. The intervention and study procedures may be modified based on results from the feasibility/pilot study.

Full scale Randomized Controlled Trial (RCT):

The full-scale RCT will include 282 patients scheduled for TKA. Patients will be randomly assigned to one of three groups: 1) non-surgical intervention (i.e., PT+CBT), 2) a combination of TKA with pre- and postoperative PT+CBT, or 3) A control group receiving TKA and usual care follow-up. Primary outcome: The Pain subscale from the KOOS. The intervention has the potential to improve outcomes for patients who currently obtain little benefit from standard TKA.

Cross-sectional observational study: Patients declining to participate in the RCT will be offered the option to participate in a separate cross-sectional study. The inclusion and exclusion criteria will be identical to the RCT. Patients who agree to participate in the cross-sectional study will complete the same baseline questionnaires as in the RCT and are asked about the reasons they did not want to participate in the RCT.

Conditions

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Osteoarthritis; Primary Degenerative Joint Disease of Knee

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Non-surgical group

Osteoarthritis education, exercise and eCBT

Group Type EXPERIMENTAL

Osteoarthritis education, exercise and CBT

Intervention Type BEHAVIORAL

Osteoarthritis Education

1. 60-min session by AktivA trained PT)

* Signs/symptoms, risk factors, weight control, treatment
* Importance of physical activity
* Appropriate activity \& training modalities

Exercise and CBT Support
2. 60-min sessions/week for 12 weeks (a total of 24 sessions) led by AktivA and CBT trained PT)

* Warm-up session
* Strengthening exercises
* Functional exercises
* Stretching
* Monitoring of CBT progress
* Review of CBT lessons learned
* Integration of CBT skills
* Enhance motivation to continue

Online CBT (iCBT) (10 modules completed at home)

* Pain causes \& prevention
* Pain management
* Health promotion \& stress reduction at home \& work
* Adapting for leisure \& work
* Controlling flare-ups
* Maintaining \& improving results

Combined group

Total knee arthroplasty + osteoarthritis education, exercise and eCBT

Group Type EXPERIMENTAL

Osteoarthritis education, exercise and CBT

Intervention Type BEHAVIORAL

Osteoarthritis Education

1. 60-min session by AktivA trained PT)

* Signs/symptoms, risk factors, weight control, treatment
* Importance of physical activity
* Appropriate activity \& training modalities

Exercise and CBT Support
2. 60-min sessions/week for 12 weeks (a total of 24 sessions) led by AktivA and CBT trained PT)

* Warm-up session
* Strengthening exercises
* Functional exercises
* Stretching
* Monitoring of CBT progress
* Review of CBT lessons learned
* Integration of CBT skills
* Enhance motivation to continue

Online CBT (iCBT) (10 modules completed at home)

* Pain causes \& prevention
* Pain management
* Health promotion \& stress reduction at home \& work
* Adapting for leisure \& work
* Controlling flare-ups
* Maintaining \& improving results

Total Knee Arthroplasty

Intervention Type PROCEDURE

Standard total knee arthroplasty will be performed.

Surgery only (standard care)

Total knee arthroplasty + standard physiotherapy

Group Type ACTIVE_COMPARATOR

Total Knee Arthroplasty

Intervention Type PROCEDURE

Standard total knee arthroplasty will be performed.

Interventions

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Osteoarthritis education, exercise and CBT

Osteoarthritis Education

1. 60-min session by AktivA trained PT)

* Signs/symptoms, risk factors, weight control, treatment
* Importance of physical activity
* Appropriate activity \& training modalities

Exercise and CBT Support
2. 60-min sessions/week for 12 weeks (a total of 24 sessions) led by AktivA and CBT trained PT)

* Warm-up session
* Strengthening exercises
* Functional exercises
* Stretching
* Monitoring of CBT progress
* Review of CBT lessons learned
* Integration of CBT skills
* Enhance motivation to continue

Online CBT (iCBT) (10 modules completed at home)

* Pain causes \& prevention
* Pain management
* Health promotion \& stress reduction at home \& work
* Adapting for leisure \& work
* Controlling flare-ups
* Maintaining \& improving results

Intervention Type BEHAVIORAL

Total Knee Arthroplasty

Standard total knee arthroplasty will be performed.

Intervention Type PROCEDURE

Other Intervention Names

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AktivA knee replacement

Eligibility Criteria

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Inclusion Criteria

1. Scheduled for TKA for OA at Lovisenberg, Oslo; Martina Hansen, Bærum, or Coastal Hospital Hagevik, Bergen
2. Age 18 - 79 years
3. ASA grade 1-3
4. KL grade 3 or 4
5. BMI\<40
6. Able to read and write in Norwegian

Exclusion Criteria

* Diagnosis of dementia or sero-positive rheumatic disease
* Previously undergone uni or patellofemoral prosthesis in the index knee
* Large axis deviation or instability requiring use of hinged implants
* Scheduled for unicompartmental arthroplasty or revision surgery
Minimum Eligible Age

18 Years

Maximum Eligible Age

79 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Haukeland University Hospital

OTHER

Sponsor Role collaborator

Martina Hansen's Hospital

OTHER

Sponsor Role collaborator

Lovisenberg Diakonale Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Anners Lerdal, PhD

Role: PRINCIPAL_INVESTIGATOR

Lovisenberg Diaconal Hospital, University of Oslo

Arild Aamodt, PhD

Role: PRINCIPAL_INVESTIGATOR

Lovisenberg Diakonale Hospital

Maren F Lindberg, PhD

Role: STUDY_DIRECTOR

Lovisenberg Diakonale Hospital/University of Oslo

Kari Indrekvam, PhD

Role: STUDY_CHAIR

Haukeland University Hospital - Kysthospitalet Hagevik/University of Bergen

Stig Heir, PhD

Role: STUDY_CHAIR

Martina Hansens Hospital

Locations

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Haukeland University Hospital - Kysthospitalet Hagevik

Bergen, , Norway

Site Status RECRUITING

Lovisenberg Diaconal Hospital

Oslo, , Norway

Site Status RECRUITING

Martina Hansens Hospital

Oslo, , Norway

Site Status RECRUITING

Countries

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Norway

Central Contacts

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Maren Falch Lindberg, PhD

Role: CONTACT

+4794815762

Anners Lerdal, PhD

Role: CONTACT

+4795033144

Facility Contacts

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Kari Indrekvam, PhD

Role: primary

+47913 32 899

Mona Badawy, PhD

Role: backup

+4756565927

Maren F Lindberg, PhD

Role: primary

+4794815762

Anners Lerdal, PhD

Role: backup

Stig Heir, PhD

Role: primary

References

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Rognsvag T, Bergvad IB, Furnes O, Indrekvam K, Lerdal A, Lindberg MF, Skou ST, Stubberud J, Badawy M. Exercise therapy, education, and cognitive behavioral therapy alone, or in combination with total knee arthroplasty, in patients with knee osteoarthritis: a randomized feasibility study. Pilot Feasibility Stud. 2024 Feb 28;10(1):43. doi: 10.1186/s40814-024-01470-y.

Reference Type DERIVED
PMID: 38419024 (View on PubMed)

Lindberg MF, Aamodt A, Badawy M, Bergvad IB, Borchgrevink P, Furnes O, Gay C, Heir S, Holm I, Indrekvam K, Kise N, Lau B, Magnussen J, Nerhus TK, Rognsvag T, Rudsengen DE, Rustoen T, Skou ST, Stubberud J, Smastuen MS, Lerdal A. The effectiveness of exercise therapy and education plus cognitive behavioral therapy, alone or in combination with total knee arthroplasty in patients with knee osteoarthritis - study protocol for the MultiKnee trial. BMC Musculoskelet Disord. 2021 Dec 20;22(1):1054. doi: 10.1186/s12891-021-04924-z.

Reference Type DERIVED
PMID: 34930194 (View on PubMed)

Rognsvag T, Lindberg MF, Lerdal A, Stubberud J, Furnes O, Holm I, Indrekvam K, Lau B, Rudsengen D, Skou ST, Badawy M. Development of an internet-delivered cognitive behavioral therapy program for use in combination with exercise therapy and education by patients at increased risk of chronic pain following total knee arthroplasty. BMC Health Serv Res. 2021 Oct 25;21(1):1151. doi: 10.1186/s12913-021-07177-7.

Reference Type DERIVED
PMID: 34696785 (View on PubMed)

Other Identifiers

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MultiKnee Trial

Identifier Type: -

Identifier Source: org_study_id

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