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Osteoarthritis, KneeQUADX-1NCT02931058

Quadriceps Exercise Before Total Knee Arthroplasty (The QUADX-1 Trial)

A study testing Two knee-extension exercise sessions per week., Four knee-extension exercise sessions per week. and Six knee-extension exercise sessions per week. in people with Osteoarthritis, Knee, run by Hvidovre University Hospital at 1 site in Denmark.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The trial investigates the efficacy of knee-extension exercise prior to total knee replacement. The participants are randomly allocated to one of three exercise dosages. There is no control group. Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
Osteoarthritis, Knee
What is being tested?
Two knee-extension exercise sessions per week., Four knee-extension exercise sessions per week. and Six knee-extension exercise sessions per week.
Could I receive a placebo?
No, everyone receives an active treatment
How many people
140 participants
Where
1 siteDenmark
Study dates
Oct 2016to 25 Feb 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient is a possible candidate for a primary TKA due to knee osteoarthritis
  • Patient is eligible for home-based quadriceps exercise
  • Patient has an age ≥ 50 years
  • Patient is a possible candidate for primary unilateral TKA, based on all the below terms:
  • Knee pain >3 (Numeric Rating Scale) in the last week
  • Kellgren-Lawrence classification grade ≥2
Show all 9Show fewer
  • Oxford Knee Score <30
  • Patient is resident in one of the three municipalities (København, Hvidovre or Brøndby) involved in the trial
  • Patient is able to speak and understand Danish

Who cannot join

  • Exercise is contra-indicated for the patient
  • Patient has a neurological disorder
  • Patient has a diagnosed systemic disease (ASA score ≥ 3)
  • Patients with terminal illness
  • Patient has severe bone deformity demanding use of nonstandard implants
  • Weekly alcohol consumption above national recommendations (>7 units women, >14 units men)

Trial locations and contacts

1 site in 1 country.

Denmark1 site
  • Clinical Research Centre, Amager Hvidovre hospital

    Hvidovre, 2650

Other trials in Denmark

About this study

Official title: Efficacy of Pre-operative Quadriceps Strength Training on Knee-extension Strength Before and Shortly Following Total Knee Arthroplasty: A Randomized Dose-response Trial (The QUADX-1 Trial)

The trial investigates the efficacy of knee-extension exercise prior to total knee replacement. The participants are randomly allocated to one of three exercise dosages. There is no control group.

Read the detailed description

Patients with end-stage knee osteoarthritis (OA) have decreased knee-extension strength and suffer from knee pain. Strengthening of the knee-extensor muscle is a key element in conservative treatment for patients with knee OA. However, the most effective exercise dosage for knee-extension strength exercise is unknown.

In this trial the investigators investigate the efficacy of three different dosages of knee-extension strength exercise. Patients eligible for total knee replacement are offered home-based pre-operative knee-extension exercise and are randomly allocated to one of three exercise dosage groups. There is no control group. The knee-extension exercise is performed with an elastic exercise band mounted with sensor (BandCizer) which registers when the patients exercise, how much they exercise and how they exercise.

The intervention time is 12 weeks and the primary time point of interest is after exercise/just before surgery. Secondary time points of interest are shortly after surgery and three months after surgery.

The patients are given detailed exercise instruction at trial entry and hereafter they exercise unsupervised at home for 12 weeks. At week 4 and 8 they receive follow-up instruction.

Both the patients who choose not to have TKA and those who do after the exercise period will be followed with annual outcome assessments as part of a follow-up cohort.

Embedded in the trial is a qualitative study. Focus group interviews will be performed with the participating patients about their experienced enablers and barriers related to adherence to the home-based intervention, once the post-operative outcome assessment has been completed. Likewise, the orthopedic surgeons and physiotherapists allocated to the trial will undergo focus group interviews, once the trial is completed, to explore their experienced enablers and barriers related to administering the home-based intervention.

Protocol amendments 8/2-2017: Additional protocol approved by The Danish National Committee on Biomedical Research Ethics (protocol no. 55528 and 55529). Approved protocol amendments are the following inclusion and exclusion criteria: inclusion criteria age ≥45, and exclusion criteria ASA-score ≥4.

Protocol amendments 30/3-2017: Additional protocol approved by The Danish National Committee on Biomedical Research Ethics (protocol no. 57312). Approved protocol amendments are the following inclusion criteria: knee pain during the last week (NRS) ≥3, and the OKS questionnaire score has been omitted as an inclusion criteria.

Protocol amendments 6/9-2017: At the third outcome assessment (at hospital discharge, 3-8 days after surgery) only the outcomes isometric knee-extensor strength, 6MWT, SCT and current knee pain are assessed. The KOOS and OKS questionnaires as well as knee pain during the last week are omitted at this end-point as they are not validated to assess acute post-operative conditions, and use a too long recall period.

Being tested
Two knee-extension exercise sessions per week., Four knee-extension exercise sessions per week., Six knee-extension exercise sessions per week.
Keywords
Knee-extension exercise, Quadriceps exercise, Knee osteoarthritis, Exercise adherence, Dose-response relationship, Prehabilitation
Medical subject headings
Osteoarthritis, Knee

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Two knee-extension exercise sessions per week.Other

    Each exercise session comprises a single strength training exercise; knee-extension, which is performed in 3 sets with 12 RM repetitions in each set.

    The knee-extension resistance training exercise is performed with an elastic exercise band.

  • Four knee-extension exercise sessions per week.Other

    Each exercise session comprises a single strength training exercise; knee-extension, which is performed in 3 sets with 12 RM repetitions in each set.

    The knee-extension resistance training exercise is performed with an elastic exercise band.

  • Six knee-extension exercise sessions per week.Other

    Each exercise session comprises a single strength training exercise; knee-extension, which is performed in 3 sets with 12 RM repetitions in each set.

    The knee-extension resistance training exercise is performed with an elastic exercise band.

Study groups in NCT02931058
Study groupRoleWhat they receive
Group 2Active comparatorTwo knee-extension exercise sessions per week. Each exercise session comprises a single strength training exercise; knee-extension, which is performed in 3 sets with 12 RM repetitions in each set. The knee-extension resistance training exercise is performed with an elastic exercise band.
Receives: Other: Two knee-extension exercise sessions per week.
Group 4Active comparatorFour knee-extension exercise sessions per week. Each exercise session comprises a single strength training exercise; knee-extension, which is performed in 3 sets with 12 RM repetitions in each set. The knee-extension resistance training exercise is performed with an elastic exercise band.
Receives: Other: Four knee-extension exercise sessions per week.
Group 6Active comparatorSix knee-extension exercise sessions per week. Each exercise session comprises a single strength training exercise; knee-extension, which is performed in 3 sets with 12 RM repetitions in each set. The knee-extension resistance training exercise is performed with an elastic exercise band.
Receives: Other: Six knee-extension exercise sessions per week.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Isometric knee-extension strength at 60 degrees knee flexion measured as Nm/kg body mass

    The measurement will be assessed using a computerized strength chair (Good Strength Chair, Metitur Oy, Jyvaskyla, Finland).

    Measured: Change from 1) baseline to 2) after 12 weeks of exercise/just before surgery

Secondary outcomes (8)
  1. Isometric knee-extension strength at 60 degrees knee flexion measured as Nm/kg body mass

    The measurement will be assessed using a computerized strength chair (Good Strength Chair, Metitur Oy, Jyvaskyla, Finland).

    Measured: Change from 1) baseline to 3) at hospital discharge (3-8 days after surgery), and change from 1) baseline to 4) three months after surgery

  2. 6 min walk test for distance (6MWT)

    The test measures the maximal distance a participant is able to walk in six minutes between two cones placed 29 meters apart from each other.

    Measured: Change from 1) baseline to 2) after 12 weeks of exercise/just before surgery, and change from 1) baseline to 3) at hospital discharge (3-8 days after surgery), and change from 1) baseline to 4) three months after surgery

  3. Stair climb test (SCT)

    The test measure the time (seconds) it takes to ascend and descend an 11-step flight of stairs with 16 cm step height.

    Measured: Change from 1) baseline to 2) after 12 weeks of exercise/just before surgery, and change from 1) baseline to 3) at hospital discharge (3-8 days after surgery), and change from 1) baseline to 4) three months after surgery

  4. Knee Osteoarthritis Outcome Score (KOOS)

    The KOOS is a questionnaire with 42 questions regarding knee function.

    Measured: Change from 1) baseline to 2) after 12 weeks of exercise/just before surgery, and change from 1) baseline to 3) at hospital discharge (3-8 days after surgery), and change from 1) baseline to 4) three months after surgery

  5. Oxford Knee Score (OKS)

    The OKS is a 12-item questionnaire regarding knee related function and pain in patients with knee OA.

    Measured: Change from 1) baseline to 2) after 12 weeks of exercise/just before surgery, and change from 1) baseline to 3) at hospital discharge (3-8 days after surgery), and change from 1) baseline to 4) three months after surgery

  6. Knee pain

    Individual knee pain is assessed with the Numeric Rating Scale (NRS). This is an 11-point subjective pain scale ranging from 0-10 (0 indicating no pain).

    Measured: Change from 1) baseline to 2) after 12 weeks of exercise/just before surgery, and change from 1) baseline to 3) at hospital discharge (3-8 days after surgery), and change from 1) baseline to 4) three months after surgery

  7. Surgical status

    At the 2nd outcome assessment (after the 12 weeks exercise period) the patients are asked by the outcome assessor "based on your knee symptoms in the last week would you say that you need knee surgery now?" The answer will be categorized into one of three options; 1) 'yes' I believe I need surgery now, 2) I do not know or, 3) 'no' I do not believe I need surgery now.

    Measured: Assessment at 2) after 12 weeks of exercise/just before surgery

  8. Exercise adherence

    Adherence to the home-based single knee-extension strength exercise will be assessed with elastics exercise bands with build-in BandCizer (sensor) technology.The sensor stores data on date, time, number of sets, repetitions, tonnage (kg x repetitions), and time-under-tension (TUT). In the present trial, a patient is defined as adherent to the exercise intervention if >75% of the prescribed exercise sessions are completed.

    Measured: Assessment at 2) after 12 weeks of exercise/just before surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Oct 2016 (estimated)
  2. Study startOct 2016
  3. Primary completionFeb 2020
  4. Study completion25 Feb 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
140 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02931058
Sponsor's protocol ID
HvidovreUH - QUADX-1 Trial
Acronym
QUADX-1
Status last verified
Apr 2022
First submitted
3 Oct 2016
Last updated
26 Apr 2022
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Yes

Publications

  • Husted RS, Troelsen A, Husted H, Gronfeldt BM, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. Knee-extensor strength, symptoms, and need for surgery after two, four, or six exercise sessions/week using a home-based one-exercise program: a randomized dose-response trial of knee-extensor resistance exercise in patients eligible for knee replacement (the QUADX-1 trial). Osteoarthritis Cartilage. 2022 Jul;30(7):973-986. doi: 10.1016/j.joca.2022.04.001. Epub 2022 Apr 9.

    PubMed 35413476
  • Husted RS, Bandholm T, Rathleff MS, Troelsen A, Kirk J. Perceived facilitators and barriers among physical therapists and orthopedic surgeons to pre-operative home-based exercise with one exercise-only in patients eligible for knee replacement: A qualitative interview study nested in the QUADX-1 trial. PLoS One. 2020 Oct 23;15(10):e0241175. doi: 10.1371/journal.pone.0241175. eCollection 2020.

    PubMed 33095777
  • Husted RS, Troelsen A, Thorborg K, Rathleff MS, Husted H, Bandholm T. Efficacy of pre-operative quadriceps strength training on knee-extensor strength before and shortly following total knee arthroplasty: protocol for a randomized, dose-response trial (The QUADX-1 trial). Trials. 2018 Jan 18;19(1):47. doi: 10.1186/s13063-017-2366-9.

    PubMed 29347947

Questions about this trial

What is this clinical trial studying?

A study testing Two knee-extension exercise sessions per week., Four knee-extension exercise sessions per week. and Six knee-extension exercise sessions per week. in people with Osteoarthritis, Knee, run by Hvidovre University Hospital at 1 site in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Isometric knee-extension strength at 60 degrees knee flexion measured as Nm/kg body mass (time frame: Change from 1) baseline to 2) after 12 weeks of exercise/just before surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02931058, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Apr 2022.

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