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| Name | Class |
|---|---|
| Maastricht University | OTHER |
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The objectives of this study are to investigate the feasibility primarily and furthermore the effects of a four to eight-weeks program of a combined clinic- and home-based preoperative physical therapy (exercise training and education) versus usual care in patients awaiting unilateral primary TKA up to 3 months after surgery.
The patients randomized into the intervention group are going to pass through a three-week therapy program. This program is based on MD's prescription and provides 9 sessions of physical therapy per prescription. All patients carry out their therapy at University Center for Prevention and Sports Medicine (UCePS) Balgrist. Before the evaluation phase starts, each patient is introduced by a member of the research team and gets a written information sheet about the goal of the study and the following procedure. The patients have to signature an informed consent to their participation in our investigation. Both groups are to be tested four times: The first assessment is appointed at a minimum of four weeks before surgery. Their baseline characteristics are noted, knee ROM, SCT, TUG, 5STS, 2MWT, handgrip strength and pain score are assessed and they need to fill in the KOOS, the Short Form 12 (SF-12) and the Tegner Activity Scale. After the first assessment, the Intervention Group (IG) is allowed to start the physical therapy exercise and education intervention. Each Physical Therapist treating a participant was previously introduced to the study protocol and the intended intervention. They conduct a total of 9 sessions over a 4 to 8-weeks period before surgery with one to two appointments per week. The Control Group (CG) is asked to keep its activity level as it is before the baseline measure. It is not desired, that anyone in this group starts a new type of therapy or training in preoperative stage. Patients in both groups keep their diary about changes concerning pain, medicament intake, training and therapies during the full length of intervention and follow-up phase.
One monitoring visit at the investigator's site prior to the start, one visit within one year after inclusion of the first participant and approximately once visit per annum during the course of the study will be organised by the Sponsor. Furthermore, there will be a monitoring visit at the study end. During the monitoring, all documents including source data/documents will be accessible for the monitor and all questions will be answered. Data will be entered in REDCap and retrieved from the clinic's information system.
If a subject is withdrawn, all previous collected data will be used for the final evaluation. All collected data will be used. An intention to treat analysis will be performed.
Data Handling and Record Keeping / Archiving:
Data management:
Reporting of Serious Adverse Events (SAE):
Clinical investigators and ultimately the Principal Investigator (PI) have the primary responsibility for SAE identification, documentation, grading, and assignment of attribution to the intervention under study. Clinical study participants will be routinely questioned about Adverse Events (AE) at study visits. The well-being of the participants will be ascertained by neutral questioning ("How are you?"). Observed or volunteered SAE, regardless of treatment group or suspected causal relationship to the study treatment(s) will be recorded in the patient file and subsequently in the electronic CRF (eCRF) if a relationship to the study intervention cannot be excluded. All SAEs in which a relation to the study intervention cannot be excluded, will be fully documented in the appropriate eCRF. For each such SAE, the investigator will provide the onset, duration, intensity, treatment required, outcome and action taken with the investigational device or study related procedure.The investigator shall report these events: a.) to the sponsor within 24 hours after they become known; and b.) to the responsible ethics committee via Business Administration System for Ethic Committees (BASEC) within 15 days.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Prehab Group / Intervention Group | Experimental | 4 to 8 weeks of preoperative physical therapy training and education intervention before total knee replacement surgery. |
|
| Control Group | No Intervention | Usual care / no treatment before total knee replacement surgery. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prehab intervention | Other | Individual training program containing strengthening, sensori-motor, joint mobilisation and endurance exercises as well as educational inputs concerning perioperative procedure and instructions on e.g. how to walk with crutches. |
| Measure | Description | Time Frame |
|---|---|---|
| Preoperative functional performance compared to baseline | To compare functional performance immediately pre-surgery after preoperative physical therapy in patients awaiting a TKA to baseline. Assessment: Knee Osteoarthritis Outcome Score (KOOS). The minium score = 0 , the maximum score = 100, where a higher score indicates a better outcome. | 2-10 days before sugery |
| Measure | Description | Time Frame |
|---|---|---|
| Preoperative functional performance compared to usual care | To compare functional performance immediately pre-surgery after preoperative physical therapy to patients with usual care. Assessment: Knee Osteoarthritis Outcome Score (KOOS). The minium score = 0 , the maximum score = 100, where a higher score indicates a better outcome. | 2-10 days before sugery |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Johannes Scherr, Prof. | Balgrist University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital Balgrist | Zurich | 8008 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41131492 | Derived | Granicher P, Kocher M, de Bie R, Swanenburg J, Scherr J. Exploring feasibility of health-related quality of life assessments and pain diaries in patients undergoing prehabilitation before total knee arthroplasty: a pilot study. BMC Musculoskelet Disord. 2025 Oct 23;26(1):988. doi: 10.1186/s12891-025-09184-9. |
| Label | URL |
|---|---|
| Information on the prehabilitation program at University Hospital Balgrist. | View source |
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There is not a plan to make Individual Participant Data (IPD) available.
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| ID | Term |
|---|---|
| D020370 | Osteoarthritis, Knee |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| Preoperative stair climbing before TKA compared to baseline | To compare stair climbing after preoperative physical therapy immediately pre-surgery to baseline in patients awaiting a TKA. Assessment is an indicator for stair climbing: - Stair Climbing Test (SCT) | 2-10 days before sugery |
| Preoperative stair climbing before TKA compared to usual care | To compare stair climbing after preoperative physical therapy immediately before TKA to usual care. Assessment is an indicator for stair climbing: - Stair Climbing Test (SCT) | 2-10 days before sugery |
| Preoperative walking performance before TKA compared to baseline | To compare walking performance after preoperative physical therapy immediately pre-surgery to baseline in patients awaiting a TKA. Assessment are indicators for walking performance:
| 2-10 days before sugery |
| Preoperative walking performance before TKA compared to usual care | To compare walking performance after preoperative physical therapy immediately pre-surgery to usual care in patients awaiting a TKA. Assessment are indicators for walking performance:
| 2-10 days before sugery |
| Preoperative strength before TKA compared to baseline | To compare strength after preoperative physical therapy immediately pre-surgery to baseline in patients awaiting a TKA. Assessments are indicators for strength:
| 2-10 days before sugery |
| Preoperative strength before TKA compared to usual care | To compare strength after preoperative physical therapy immediately pre-surgery to usual care in patients awaiting a TKA. Assessments are indicators for strength:
| 2-10 days before sugery |
| Preoperative activity level before TKA compared to baseline | To compare activity level before TKA to baseline. Assessments: - Tegner Activity Scale (TAS): The minimum score = 0, the maximum score = 10, where a higher score indicates a better outcome. | 2-10 days before surgery |
| Preoperative activity level beforeTKA compared to usual care | To compare activity level before TKA to patients with usual care. Assessments: - Tegner Activity Scale (TAS): The minimum score = 0, the maximum score = 10, where a higher score indicates a better outcome. | 2-10 days before surgery |
| Preoperative level of pain compared to baseline | To compare the level of pain after preoperative physical therapy immediately pre-surgery to baseline in patients awaiting a TKA. Assessment: - Numeric rating scale (NRS): The minimum score = 0, the maximum score = 10, where a lower score indicates a better outcome. | 2-10 days before sugery |
| Preoperative level of pain compared to usual care | To compare the level of pain after preoperative physical therapy immediately pre-surgery to patients with usual care. Assessment: - Numeric rating scale (NRS): The minimum score = 0, the maximum score = 10, where a lower score indicates a better outcome. | 2-10 days before sugery |
| Preoperative quality of life compared to baseline | To compare the quality of life after preoperative physical therapy immediately pre-surgery to baseline in patients awaiting a TKA. Assessment: - Short Form 12 (SF-12): The minimum score = 0, the maximum score = 100, where a higher score indicates a better outcome. | 2-10 days before sugery |
| Preoperative quality of life compared to usual care | To compare the quality of life after preoperative physical therapy immediately pre-surgery to patients with usual care. Assessment: - Short Form 12 (SF-12): The minimum score = 0, the maximum score = 100, where a higher score indicates a better outcome. | 2-10 days before sugery |
| Preoperative knee joint mobility compared to baseline | To assess preoperative range of motion (ROM) compared to baseline. Active knee joint mobility is assessed with a long-legged goniometer in supine position, where the patient pulls his/her heel towards his/her buttocks and extends his/her knee as far as possible. Assessment: Degrees [°] Notation: Neutral-zero-method | 2-10 days before surgery |
| Preoperative knee joint mobility compared to usual care | To assess preoperative range of motion (ROM) compared to patients awaiting TKA with usual care. Active knee joint mobility is assessed with a long-legged goniometer in supine position, where the patient pulls his/her heel towards his/her buttocks and extends his/her knee as far as possible. Assessment: Degrees [°] Notation: Neutral-zero-method | 2-10 days before surgery |
| Postoperative functional performance 6 weeks after TKA compared to baseline | To compare functional performance 6 weeks after TKA compared to baseline. Assessment: Knee Osteoarthritis Outcome Score (KOOS). The minium score = 0 , the maximum score = 100, where a higher score indicates a better outcome. | 6 weeks postoperative |
| Postoperative functional performance 6 weeks after TKA compared to usual care | To compare functional performance 6 weeks after TKA to patients with usual care. Assessment: Knee Osteoarthritis Outcome Score (KOOS). The minium score = 0 , the maximum score = 100, where a higher score indicates a better outcome. | 6 weeks postoperative |
| Postoperative activity level 6 weeks after TKA compared to baseline | To compare activity level 6 weeks after TKA to baseline. Assessments: - Tegner Activity Scale (TAS): The minimum score = 0, the maximum score = 10, where a higher score indicates a better outcome. | 6 weeks postoperative |
| Postoperative activity level 6 weeks after TKA compared to usual care | To compare activity level 6 weeks after TKA to patients with usual care. Assessments: - Tegner Activity Scale (TAS): The minimum score = 0, the maximum score = 10, where a higher score indicates a better outcome. | 6 weeks postoperative |
| Postoperative level of pain 6 weeks after TKA compared to usual care | To compare the level of pain 6 weeks after TKA to patients with usual care. Assessment: - Numeric rating scale (NRS): The minimum score = 0, the maximum score = 10, where a lower score indicates a better outcome. | 6 weeks postoperative |
| Postoperative level of pain 6 weeks after TKA compared to baseline | To compare the level of pain 6 weeks after TKA to baseline. Assessment: - Numeric rating scale (NRS): The minimum score = 0, the maximum score = 10, where a lower score indicates a better outcome. | 6 weeks postoperative |
| Feasibility of prehabilitation program: Number of participants with adherence to the therapy sessions of at least 80% | To assess feasibility of preoperative physical therapy intervention in patients awaiting a TKA (defined as adherence to the therapy sessions of at least 80%). | 6 weeks postoperative |
| Dischargeability: Length of Stay in hospital (LoS) | To compare readiness for discharge from the hospital after surgery after preoperative physical therapy in patients awaiting a TKA to patients treated with usual care. | 6 weeks postoperative |
| Postoperative functional performance 3 months after TKA compared to baseline | To compare functional performance 3 months after TKA to baseline. Assessment: Knee Osteoarthritis Outcome Score (KOOS). The minium score = 0 , the maximum score = 100, where a higher score indicates a better outcome. | 3 months postoperative |
| Postoperative functional performance 3 months after TKA compared to usual care | To compare functional performance 3 months after TKA to patients with usual care. Assessment: Knee Osteoarthritis Outcome Score (KOOS). The minium score = 0 , the maximum score = 100, where a higher score indicates a better outcome. | 3 months postoperative |
| Postoperative stair climbing 3 months after TKA compared to baseline | To compare stair climbing 3 months after TKA to baseline. Assessment is an indicator for stair climbing: - Stair Climbing Test (SCT) | 3 months after sugery |
| Postoperative stair climbing 3 months after TKA compared to usual care | To compare stair climbing 3 months after TKA to usual care. Assessment is an indicator for stair climbing: - Stair Climbing Test (SCT) | 3 months after sugery |
| Postoperative walking performance 3 months after TKA compared to baseline | To compare walking performance 6 weeks after TKA to baseline. Assessment are indicators for walking performance:
| 3 months after surgery |
| Postoperative walking performance 3 months after TKA compared to usual care | To compare walking performance 6 weeks after TKA to usual care. Assessment are indicators for walking performance:
| 3 months after surgery |
| Postoperative strength 3 months after TKA compared to baseline | To compare strength 3 months after TKA to baseline. Assessments are indicators for strength:
| 3 months after sugery |
| Postoperative strength 3 months after TKA compared to usual care | To compare strength 3 months after TKA to ususal care. Assessments are indicators for strength:
| 3 months after sugery |
| Postoperative activity level 3 months after TKA compared to baseline | To compare activity level 3 months after TKA to baseline. Assessments: - Tegner Activity Scale (TAS): The minimum score = 0, the maximum score = 10, where a higher score indicates a better outcome. | 3 months postoperative |
| Postoperative activity level 3 months after TKA compared to usual care | To compare activity level 3 months after TKA to usual care. Assessments: - Tegner Activity Scale (TAS): The minimum score = 0, the maximum score = 10, where a higher score indicates a better outcome. | 3 months postoperative |
| Postoperative level of pain 3 months after TKA compared to baseline | To compare the level of pain 3 months after TKA to baseline. Assessment: - Numeric rating scale (NRS): The minimum score = 0, the maximum score = 10, where a lower score indicates a better outcome. | 3 months postoperative |
| Postoperative level of pain 3 months after TKA compared to usual care | To compare the level of pain 3 months after TKA to patients with usual care. Assessment: - Numeric rating scale (NRS): The minimum score = 0, the maximum score = 10, where a lower score indicates a better outcome. | 3 months postoperative |
| Postoperative quality of life 3 months after TKA compared to baseline | To compare the quality of life 3 months after TKA compared to baseline. Assessment: - Short Form 12 (SF-12): The minimum score = 0, the maximum score = 100, where a higher score indicates a better outcome. | 3 months postoperative |
| Postoperative quality of life 3 months after TKA compared to usual care | To compare the quality of life 3 months after TKA to patients with usual care. Assessment: - Short Form 12 (SF-12): The minimum score = 0, the maximum score = 100, where a higher score indicates a better outcome. | 3 months postoperative |
| Postoperative knee joint mobility 3 months after TKA compared to baseline | To assess postoperative range of motion (ROM) 3months after TKA compared to baseline. Active knee joint mobility is assessed with a long-legged goniometer in supine position, where the patient pulls his/her heel towards his/her buttocks and extends his/her knee as far as possible. Assessment: Degrees [°] Notation: Neutral-zero-method | 3 months after surgery |
| Postoperative knee joint mobility 3 months after TKA compared to usual care | To assess postoperative range of motion (ROM) 3 months after TKA compared to baseline. Active knee joint mobility is assessed with a long-legged goniometer in supine position, where the patient pulls his/her heel towards his/her buttocks and extends his/her knee as far as possible. Assessment: Degrees [°] Notation: Neutral-zero-method | 3 months after surgery |
| Postoperative Global Impression of Change compared to usual care | To assess postoperative Global Impression of Change 3 months after TKA compared to usual care. Assessment: Patient Global Impression of Change (PGIC)-Score: The minimum score = 0, the maximum score = 7, where a lower score indicates a better outcome | 3 months after surgery |
| D012216 |
| Rheumatic Diseases |