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core research:

Hip and knee replacements are two highly successful orthopaedic operations which reduce pain for people with osteoarthritis. Over 206,000 hip and knee replacements were performed in the UK each year. Historically, it has been assumed that people are more active following hip or knee replacement through the amelioration of their joint pain. However previous research undertaken by this team has identified that physical activity, at best, remains the same from pre- to post-operatively, and in some instances reduces. The reasons for this may differ between the groups with knee replacements more often associated with increased pain in the initial 12 post-operative months compared to hip replacements, whereas those who have a hip replacement may have greater fear avoidance through the risks of joint implant dislocation.

Given that physical activity can significantly reduce the symptoms associated with common diseases such as high blood pressure, heart disease and diabetes, this population’s physical inactivity has a detrimental effect on their health. Participating in regular physical activity can decrease the risk of cardiovascular disease by 52%, diabetes by 65%, some cancers by 40%, reduces all-cause mortality by 33% and cardiovascular mortality by 35%. Accordingly, supporting people to be more physically active can improve both patient’s health and decrease the economic burden these diseases place on the NHS.

The purpose of this study is to test a physiotherapy approach to increase physical activity after hip and knee replacement. PEP-TALK is a pragmatic multi-centre, randomised controlled trial which will test a group exercise and behaviour change treatment which targets barriers people have which can stop them being physically active, to maximise their 'whole-body' health and the effect of this on their NHS needs.

The PEP-TALK trial is being conducted across three cities in the UK (Oxford, London, Norwich). In total 250 people will be randomised to have treatment consisting of either (a) six sessions (once weekly) behaviour change treatment and physiotherapy group exercise with other people after their hip or knee replacement, and three follow-on telephone calls, or (b) six sessions (once weekly) physiotherapy group exercise alone (no behaviour change treatment nor follow-up phone calls). Patients will be asked to complete questionnaires to measure the benefits of each treatment six and 12 months after their operation.

 

BACKGROUND:

Over 206,000 hip and knee replacements were performed in the United Kingdom (UK) last year. As well as joint pain, half of these people have other diseases such as high blood pressure, heart disease, diabetes and depression.

Physical activity is known to improve these conditions. Before a hip or knee replacement, it can be difficult to be physically active because of pain and fatigue. It is hoped that after joint replacement, this improves so people can be more active. However, people after hip or knee replacement are often no more active than before and, importantly, do not know how to be. They miss out on some of the health benefits which joint replacement can offer.

 

Aims and objectives:

The aim of this trial is to answer the research question: Does a group exercise and behaviour-change intervention targeted to increase physical activity participation increase health related quality of life (HRQoL) and clinical outcomes following a total hip or total knee replacement?

 

STUDY DESIGN:

PEP-TALK is a pragmatic multi-centre, randomised controlled trial which will test a group exercise and behaviour change treatment which targets barriers people have which can stop them being physically active, to maximise their 'whole-body' health and the effect of this on their NHS needs.

The PEP-TALK trial is being conducted across three cities in the UK (Oxford, London, Norwich). In total 250 people will be randomised to have treatment consisting of either (a) six sessions (once weekly) behaviour change treatment and physiotherapy group exercise with other people after their hip or knee replacement, and three follow-on telephone calls, or (b) six sessions (once weekly) physiotherapy group exercise alone (no behaviour change treatment nor follow-up phone calls). Patients will be asked to complete questionnaires to measure the benefits of each treatment six and 12 months after their operation.

If shown to be effective, this group-based treatment for people who have difficulty in being more active, could improve these individual's health and well-being, and could save the NHS money by reducing visits to GP practices because of other medical problems which physical activity can reduce.

 

PEP-TALK is led by Dr Toby Smith (NDORMS, University of Oxford). If you would like to know more about the study, please contact the research team on pep-talk@ndorms.ox.ac.uk

 

 

 

 

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