AzTrials
AzTrials

Knee Replacement, TotalPAS-TKANCT04090125

Improving Physical Activity and Gait Symmetry After Total Knee Arthroplasty

A study testing PAS Intervention in people with Knee Replacement, Total and Knee Arthroplasty, Total, run by University of North Carolina, Chapel Hill at 1 site in United States.

Completed

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

Official record
Search all trials

Trial summary

The purpose of this pilot study is to examine the effectiveness of the Physical Activity and Symmetry (PAS) program, compared to an attention (ATT)control group, for patients with post-total knee arthroplasty (TKA). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
PAS Intervention
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
60 participants
Where
1 siteUnited States
Study dates
8 Nov 2019to 26 Jul 2023
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

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

Who may be able to join

  • Patients receiving post-total knee arthroplasty (TKA) physical therapy (PT) at a University of North Carolina (UNC) Healthcare System clinic

Who cannot join

  • significant cognitive impairment
  • neurological disorders affecting gait
  • systemic rheumatic disease
  • hospitalization for a cardiovascular condition the past six months
  • psychosis
  • substance abuse disorder
  • lower extremity surgery in the past year
  • any other health conditions determined to be contraindications to a home exercise program

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UNC Thurston Arthritis Research Center

    Chapel Hill, North Carolina, 27599

Other trials in United States

About this study

The purpose of this pilot study is to examine the effectiveness of the Physical Activity and Symmetry (PAS) program, compared to an attention (ATT)control group, for patients with post-total knee arthroplasty (TKA). The investigators hypothesize that the PAS treatment will result in meaningful improvements in physical activity (PA) and joint loading symmetry compared to the ATT group.

Read the detailed description

Background and Significance: Total knee arthroplasty (TKA) has been shown to decrease pain and to improve range of motion and some aspects of physical function. However, accumulating evidence shows that patients have persistent deficits in other critical outcomes following TKA. First, the majority of patients do not substantially increase physical activity beyond levels prior to TKA, remaining well below Department of Health and Human Services recommendations and levels of healthy individuals. This has serious negative implications for both joint health and overall health. Second, studies show that gait asymmetries are common following TKA, such that patients continue to load the non-surgical leg more heavily during walking, even when the post-surgical leg is pain free. This places the contralateral limb at risk for developing or worsening osteoarthritis. Other research shows there is large variability in post-TKA rehabilitation, along with sub-optimal exercise content. Collectively, these findings emphasize the critical need to improve the post-TKA rehabilitation process. However, there are currently no evidence-based approaches to improve overall physical activity and deficits in joint loading symmetry that have been identified following TKA.

Study Aims: This research project will provide important preliminary information on the novel post-TKA PAS program through achieving the following specific aims: 1) Obtain preliminary data on the efficacy of the PAS program with respect to the change in objectively assessed physical activity, measured via accelerometers; 2) Obtain preliminary data on the efficacy of the PAS program with respect to change in peak load symmetry during walking, measured by a novel 3-sensor insole device; 3) Assess the feasibility and acceptability of the PAS program following TKA.

Study Description: Investigators will conduct an exploratory randomized controlled study, with n=60 patients >=18 years receiving post-TKA physical therapy (PT) at a UNC Healthcare System clinic. Patients will be equally allocated to the PAS intervention or an attention (ATT) control group.

Being tested
PAS Intervention, Attention Control
Keywords
knee, total knee replacement, physical therapy

What participants receive

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

  • PAS InterventionBehavioural

    The PAS program will be initiated during the final usual care PT visits. The PAS content will be included within the last two routine PT visits (Sessions 1 and 2). Session 1 will emphasize the importance of PA in TKA recovery, work with participants to establish SMART goals regarding overall PA and provide community-based and other resources to support overall PA. Session 2 will include balance exercise content to improve joint loading symmetry and home exercises will be assigned. Then, PAS participants will receive a follow-up phone call after 4 weeks (to assist with activity progression and problem-solving) and an additional in-person visit after 8 weeks (to visually monitor exercise performance and re-assess proportional weight-bearing ability).

  • Attention ControlBehavioural

    This will include usual in-person post TKA PT followed by 2 additional contacts (Session 1 and 2) with the physical therapist. Session 1 (phone) will review recovery benchmarks, assessment of participants' daily activities and reminders about symptoms that should trigger contacting a medical professional. Session 2 (in-person) will involve physical performance tests and comparison to appropriate normative values.

Study groups in NCT04090125
Study groupRoleWhat they receive
Physical Activity and Symmetry (PAS) InterventionExperimentalParticipants assigned to the PAS intervention will receive 4 sessions on balance training and physical activity coaching delivered by a physical therapist, in addition to their usual post-TKA physical therapy (PT) care.
Receives: Behavioral: PAS Intervention
Attention ControlPlacebo comparatorParticipants assigned to the ATT group will receive usual post-TKA physical therapy (PT) care, followed by two additional sessions with their physical therapist.
Receives: Behavioral: Attention Control

What is being measured

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

  1. Change From Baseline to Month 3 in Objectively Assessed Physical Activity (Accelerometer)

    Minutes of moderate to vigorous intensity PA (MVPA) per week measured via accelerometer.

    A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 3

  2. Change From Baseline to Month 6 in Objectively Assessed Physical Activity (Accelerometer)

    Minutes of moderate to vigorous intensity PA (MVPA) per week measured via accelerometer.

    A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 6

  3. Change From Baseline to Month 3 in Peak Joint Load Symmetry During Walking

    Participants will complete a 10 meter walking test while load beneath each foot is recorded using an instrumented insole. Loading symmetry (peak ground reaction force) will be assessed using the limb symmetry index (LSI (|Surgical/Non-Surgical|*100), values lower than 100% indicate less loading of the surgical limb.

    A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 3

  4. Change From Baseline to Month 6 in Peak Joint Load Symmetry During Walking

    Participants will complete a 10 meter walking test while load beneath each foot is recorded using an instrumented insole. Loading symmetry (peak ground reaction force) will be assessed using the limb symmetry index (LSI (|Surgical/Non-Surgical|*100), values lower than 100% indicate less loading of the surgical limb.

    A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 6

Secondary outcomes (16)
  1. Change From Baseline to Month 3 in Self-Reported Physical Activity.

    Self-Reported Physical Activity will be assessed using the Modified version of the CHAMPS (Community Health Activities Model Program for Seniors) Physical Activity Measure. Data from the questionnaire is used to determine variety, frequency, and minutes per week from physical activity. This outcome pertains to minutes of physical activity of moderate or greater intensity (metabolic equivalents ≥ 3.0). A square root transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 3

  2. Change From Baseline Month 6 in Self-Reported Physical Activity.

    Self-Reported Physical Activity will be assessed using the Modified version of the CHAMPS (Community Health Activities Model Program for Seniors) Physical Activity Measure. Data from the questionnaire is used to determine variety, frequency, and minutes per week from physical activity. This outcome pertains to minutes of physical activity of moderate or greater intensity (metabolic equivalents ≥ 3.0). A square root transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline to Month 6

  3. Change From Baseline to Month 3 in Steps Per Day

    Step counts measured via accelerometer. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 3

  4. Change From Baseline to Month 6 in Steps Per Day

    Step counts measured via accelerometer. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 6

  5. Change From Baseline to Month 3 in Minutes of Any Physical Activity (PA)

    Minutes of any PA measured via accelerometer. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 3

  6. Change From Baseline to Month 6 in Minutes of Any Physical Activity (PA)

    Minutes of any PA measured via accelerometer. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.

    Measured: Baseline, Month 6

  7. Change From Baseline to Month 3 in Sedentary Minutes

    Minutes of sedentary activity per day, measured via accelerometer

    Measured: Baseline, Month 3

  8. Change From Baseline to Month 6 in Sedentary Minutes

    Minutes of sedentary activity per day, measured via accelerometer

    Measured: Baseline, Month 6

  9. Change From Baseline to Month 3 in Berg Balance Scale

    Berg Balance Scale includes 14 tests of static and dynamic balance. Each item is scored along a 5-point scale, ranging from 0 to 4. Zero indicates the lowest level of function and 4 the highest level of function. The total score ranges from 0 to 56. Lower scores indicate reduced functional mobility.

    Measured: Baseline, Month 3

  10. Change From Baseline to Month 6 in Berg Balance Scale

    Berg Balance Scale includes 14 tests of static and dynamic balance. Each item is scored along a 5-point scale, ranging from 0 to 4. Zero indicates the lowest level of function and 4 the highest level of function. The total score ranges from 0 to 56. Lower scores indicate reduced functional mobility.

    Measured: Baseline, Month 6

  11. Change From Baseline to Month 3 in Brief Balance Evaluation Systems Test

    Brief Balance Evaluation Systems includes 8 tasks across 6 domains. Each item is scored: 0-3 points (0 representing severe impairment and 3 representing no balance impairment), score range is 0-24). Lower scores indicate higher levels of balance impairment.

    Measured: Baseline, Month 3

  12. Change From Baseline to Month 6 in Brief Balance Evaluation Systems Test

    Brief Balance Evaluation Systems includes 8 tasks across 6 domains. Each item is scored: 0-3 points (0 representing severe impairment and 3 representing no balance impairment), score range is 0-24. Lower scores indicate higher levels of balance impairment.

    Measured: Baseline, Month 6

  13. Change From Baseline to Month 3 in Knee Injury and Osteoarthritis Outcome Score (KOOS)

    The KOOS is a patient-reported outcome measurement instrument, developed to assess the patient's opinion about their knee and associated problems. Five KOOS subscale scores were administered: Pain (9 items), Symptoms (7 items), Function in daily living (17 items), Function in Sport and Recreation (5 items), and knee-related Quality of Life (4 items). All items are scored on 5-point Likert scales. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

    Measured: Baseline, Month 3

  14. Change From Baseline to Month 6 in Knee Injury and Osteoarthritis Outcome Score (KOOS)

    The KOOS is a patient-reported outcome measurement instrument, developed to assess the patient's opinion about their knee and associated problems. Five KOOS subscale scores were administered: Pain (9 items), Symptoms (7 it4ems) Function in daily living (17 items), Function in Sport and Recreation (5 items), and knee-related Quality of Life (4 items). All items are scored on 5-point Likert scales. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

    Measured: Baseline, Month 6

  15. Change From Baseline to Month 3 in Tampa Scale for Kinesiophobia

    The Tampa Scale of Kinesiophobia is a 17 item scale for assessing fear of movement. The scale specifically assesses activity avoidance due to pain-related fear of movement. All items are measured on a 4-point scale from "strongly agree" to "strongly disagree." A score of 17 is the lowest possible score, and indicates no kinesiophobia or negligible. A score of 68 is the highest possible score and indicates extreme fear of pain with movement.

    Measured: Baseline, Month 3

  16. Change From Baseline to Month 6 in Tampa Scale for Kinesiophobia

    The Tampa Scale of Kinesiophobia is a 17 item scale for assessing fear of movement. The scale specifically assesses activity avoidance due to pain-related fear of movement. All items are measured on a 4-point scale from "strongly agree" to "strongly disagree." A score of 17 is the lowest possible score, and indicates no kinesiophobia or negligible. A score of 68 is the highest possible score and indicates extreme fear of pain with movement.

    Measured: Baseline, Month 6

Timeline

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

  1. First posted16 Sep 2019
  2. Study start8 Nov 2019
  3. Primary completion26 Jul 2023
  4. Study completion26 Jul 2023

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
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04090125
Sponsor's protocol ID
19-0568
Other IDs
R21AR074149-01A1
Acronym
PAS-TKA
Status last verified
Dec 2022
First submitted
12 Sep 2019
Last updated
5 Mar 2024
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Deidentified individual data that supports the results will be shared following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.

Questions about this trial

What is this clinical trial studying?

A study testing PAS Intervention in people with Knee Replacement, Total and Knee Arthroplasty, Total, run by University of North Carolina, Chapel Hill at 1 site in United States.

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 1 inclusion and 8 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 5 Mar 2024. 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 United States. 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. Some participants in this study may receive a placebo. 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?

Yes. Results are posted in the registry (first posted 5 Mar 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Change From Baseline to Month 3 in Objectively Assessed Physical Activity (Accelerometer) (time frame: Baseline, Month 3). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 5 Mar 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in