Does Rehabilitation After Total Knee Arthroplasty Work? - Feasibility Trial

NCT ID: NCT05935020

Last Updated: 2025-07-09

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

COMPLETED

Clinical Phase

NA

Total Enrollment

25 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-08-22

Study Completion Date

2024-09-10

Brief Summary

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The aim of this feasibility trial is to investigate the feasibility of a trial intervention for a population of patients after total knee replacement for osteoarthritis. This study follows a hybrid type 1 design where the primary focus is on the feasibility of the intervention, and the secondary focus is on gaining a better understanding of context and acceptability.

The main questions it aims to answer are:

* Recruitment (Process/Resources): Are patients willing to engage, and stay, in the trial (estimated by inclusion-rate, participant retention, etc.) and what reasons do patients give for not wishing to enroll or later dropping out of the trial? (inquired face-to-face, during enrolment).
* Harms (Scientific): Does the non-exercise intervention appear "safe" (i.e. not harmful) for the patients? (estimated by for instance: adverse events, reasons for dropouts and sense of security).
* Trial procedure feasibility (Management/Scientific): How well does recruitment and trial procedures work at trial sites? (estimated through feedback from site personnel).
* Participant (patient) experienced acceptability of their assigned intervention: An interview-based follow-up using the Theoretical Framework of Acceptability.

Participants will be randomized to one of two interventions, at discharge from the hospital, following knee replacement, which are being tested for feasibility:

1. "Usual-care" - referral to municipal (free-of-charge) physiotherapy (commonly 6-8 weeks of therapeutic exercise).
2. "Return to everyday life" - no referral to municipal physiotherapy.

Participants in both groups are encouraged to follow WHO guidelines of physical activity, to the degree that their post-surgical symptoms allow (within their orthopedic surgeon's recommendations/limitations). All participants are given a "symptom guide", meaning a folder containing information on what to expect, and when and what to react to, during their recovery after the knee-replacement.

For clarity it should be mentioned, that the quantitative and qualitative data-outputs will be reported separately for improved clarity (the study is not a mixed methods design).

Detailed Description

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Feasibility-criteria (Handling of feasibility outcomes: primary and secondary):

As the feasibility-trial investigates a combination of randomization acceptance, trial procedures, and intervention organization, a primary outcome measure is not specified. The outcome measures planned in the large scale effectiveness trial will be applied, but the outcomes will not be used to assess efficacy, as the trial is not powered for these outcomes. They will be used to indicate efficiency of trial procedures and safety, and to gain information on patients' willingness to enroll and remain in the trial.

Feasibility outcomes will be assessed when all 24 feasibility participants have completed their 12-week follow-up outcome-assessment. An overall assessment of large-scale trial feasibility will be made in the main investigator group, by comparing feasibility research questions with feasibility criteria/outcomes. As there are many components within the feasibility criteria, a summary of findings will be produced. This is used to inform a discussion (main investigator group) to find consensus regarding a final decision on whether a large-scale trial is considered feasible (see Criterion interpretation below).

The feasibility components are organized as related to process, resources, management and scientific, as proposed by Thabane (Thabane et al., 2010). The recruitment (process and resources) is considered the primary feasibility outcome and thusly has specified feasibility criteria.

Criterion interpretation:

It should be noted that feasibility criteria are set to inform a basis for discussion of the trial feasibility in the main investigator group, and the final interpretation is based on the discussion (mentioned above) of which criteria succeeded, which failed, and to which degree. Thusly, a single criterion exactly exceeding or staying just below the criteria set is still subject to discussion and may not singularly mean that the large-scale trial is not feasible (i.e., having only 84% of participants complete the primary outcome does not automatically cancel the large-scale trial, nor does a 85% primary outcome completion rate make the criteria exempt from a discussion regarding feasibility). The trial group discussion aims to result in one of the following interpretations (with elaboration where needed):

1\) main study not feasible - stop main study, 2) feasible with modification - continue main study with modifications, 3) feasible without modification - no modifications but close monitoring, 4) feasible as is - continue without modifications.

Conditions

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Osteoarthritis, Knee

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Two group, parallel, randomized, controlled feasibility trial
Primary Study Purpose

OTHER

Blinding Strategy

TRIPLE

Caregivers Investigators Outcome Assessors
Investigator and Outcomes Assessor are blinded to participant group allocation. Further, the personnel administering the intervention after discharge from the surgical ward (Care Provider) is masked.

Study Groups

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Usual Care

Referral to municipal rehabilitation after TKA

Group Type ACTIVE_COMPARATOR

Usual care - Municipal exercise-based rehabilitation

Intervention Type OTHER

The patients in this group follow prescribed (by the orthopedic surgeon) "usual care" municipal exercise-based rehabilitation. The content of the rehabilitation is planned in collaboration between the patient and the physical therapist, based on the offered municipal treatment options (which varies between municipalities) and patient preferences (i.e., home-based exercise, outpatient exercise, group-based exercise, or a combination thereof). The contents of the municipal services offered will be described in detail in the trial report.

A prescribed therapeutic rehabilitation exercise plan could for instance be a 6-week combined home-exercise (1-2 times/week) and group-exercise (1 time/week) intervention, followed by encouragement to continue self-administered home exercise after the 6 weeks.

Symptom guide and encouragement to follow DHA/WHO recommendations for physical activity

Intervention Type BEHAVIORAL

Participants in both groups receive a recovery-guide pamphlet at discharge, containing the following information: 1) Recommendations to follow DHA/WHO guidelines for physical activity, 2) Figures and tables describing common post-operative symptoms (symptom guide), and when to react (when the symptoms may require attention from a health-professional), 3) What to expect from the post-surgical period in relation to activities of daily living, 4) Common short- and long-term complications to total knee arthroplasty and 5) Trial-participant and ethics-committee information documents. Parts 2-4 are usual clinical practice, with slight variations in descriptions between sites.

After surgery, participants in both groups are encouraged to resume their desired pre-surgical activities when they feel they are able (within the limits given from the orthopedic wards).

Return to Everyday Life

No referral to municipal rehabilitation after TKA

Group Type OTHER

Return to Everyday life

Intervention Type OTHER

The patients in this group return to their desired pre-surgical activities, at their own speed, when they feel that they are ready for it. They are not prescribed any exercise-based rehabilitation (usual care) by their orthopedic surgeon.

This effectively means they will not receive a therapeutic progressive exercise plan; designed and prescribed to restore previous function or reducing pain or disability caused by injury, disease, or surgery - typically referred to as "exercise therapy" or "therapeutic exercise".

Symptom guide and encouragement to follow DHA/WHO recommendations for physical activity

Intervention Type BEHAVIORAL

Participants in both groups receive a recovery-guide pamphlet at discharge, containing the following information: 1) Recommendations to follow DHA/WHO guidelines for physical activity, 2) Figures and tables describing common post-operative symptoms (symptom guide), and when to react (when the symptoms may require attention from a health-professional), 3) What to expect from the post-surgical period in relation to activities of daily living, 4) Common short- and long-term complications to total knee arthroplasty and 5) Trial-participant and ethics-committee information documents. Parts 2-4 are usual clinical practice, with slight variations in descriptions between sites.

After surgery, participants in both groups are encouraged to resume their desired pre-surgical activities when they feel they are able (within the limits given from the orthopedic wards).

Interventions

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Usual care - Municipal exercise-based rehabilitation

The patients in this group follow prescribed (by the orthopedic surgeon) "usual care" municipal exercise-based rehabilitation. The content of the rehabilitation is planned in collaboration between the patient and the physical therapist, based on the offered municipal treatment options (which varies between municipalities) and patient preferences (i.e., home-based exercise, outpatient exercise, group-based exercise, or a combination thereof). The contents of the municipal services offered will be described in detail in the trial report.

A prescribed therapeutic rehabilitation exercise plan could for instance be a 6-week combined home-exercise (1-2 times/week) and group-exercise (1 time/week) intervention, followed by encouragement to continue self-administered home exercise after the 6 weeks.

Intervention Type OTHER

Return to Everyday life

The patients in this group return to their desired pre-surgical activities, at their own speed, when they feel that they are ready for it. They are not prescribed any exercise-based rehabilitation (usual care) by their orthopedic surgeon.

This effectively means they will not receive a therapeutic progressive exercise plan; designed and prescribed to restore previous function or reducing pain or disability caused by injury, disease, or surgery - typically referred to as "exercise therapy" or "therapeutic exercise".

Intervention Type OTHER

Symptom guide and encouragement to follow DHA/WHO recommendations for physical activity

Participants in both groups receive a recovery-guide pamphlet at discharge, containing the following information: 1) Recommendations to follow DHA/WHO guidelines for physical activity, 2) Figures and tables describing common post-operative symptoms (symptom guide), and when to react (when the symptoms may require attention from a health-professional), 3) What to expect from the post-surgical period in relation to activities of daily living, 4) Common short- and long-term complications to total knee arthroplasty and 5) Trial-participant and ethics-committee information documents. Parts 2-4 are usual clinical practice, with slight variations in descriptions between sites.

After surgery, participants in both groups are encouraged to resume their desired pre-surgical activities when they feel they are able (within the limits given from the orthopedic wards).

Intervention Type BEHAVIORAL

Other Intervention Names

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Referral to Municipal Rehabilitation after Surgery No referral to municipal rehabilitation after surgery Symptom self-management and encouraged physical activity

Eligibility Criteria

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Inclusion Criteria

* Over 18 years of age
* Residing in one of fourteen collaboration municipalities
* Referral to primary total knee arthroplasty for osteoarthritis

Exclusion Criteria

* Insufficient danish skills (read/write/speak) to understand questionnaires and outcomes
* Inability to provide informed consent
* Severe surgical sequelae (i.e. requiring revision surgery, joint mobilization under anaestesia, or joint infection)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Danske Fysioterapeuter

OTHER

Sponsor Role collaborator

Sygekassernes Helsefond

OTHER

Sponsor Role collaborator

University of Copenhagen

OTHER

Sponsor Role collaborator

The Danish Rheumatism Association

OTHER

Sponsor Role collaborator

Tværspuljen

UNKNOWN

Sponsor Role collaborator

Copenhagen University Hospital, Hvidovre

OTHER

Sponsor Role lead

Responsible Party

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Birk Mygind Grønfeldt

PhD Fellow

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Copenhagen University Hospital Hvidovre

Hvidovre, , Denmark

Site Status

Næstved Sygehus

Næstved, , Denmark

Site Status

Countries

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Denmark

Other Identifiers

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DRAW-TKA-Feasibility

Identifier Type: -

Identifier Source: org_study_id

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