Prehabilitation Using Aquatic Exercise

NCT02773745 | Completed DMC

• 1 other identifier: IRB00032580
• Study Type: interventional
• Target: 44
• Locations: 1 country
• Sites: 1

Brief Summary

With aging population, total knee arthroplasty is performed with increasing frequency. Although the surgery is successful in general, significant number of patients suffers persistent pain and disability. Traditional risk assessment tool have been focused on single organ systems. Our investigators have found that mobility, assessed by the Mobility Assessment Tool short form (MAT-sf), is a simple and accurate method to predict postoperative outcome, including length of stay, postoperative complications, and nursing home placement for older patients. Prehabilitation is the process of enhancing a person's functional capacity to withstand an incoming stressor. Although multiple studies have tested prehabilitation before joint replacement surgery, results have been mixed. The investigators hypothesize that patients with limited mobility are most likely to benefit from prehabilitation. The investigators plan to use individualized aquatic exercise as a prehabilitation tool to enhance compliance; the resistance of water strengthen muscle and increasing energy expenditure; the buoyancy of water provides environment where the joints are not weight bearing. The aims of the study are: 1) To evaluate the feasibility of prehabilitation using 6-8 weeks of aquatic exercise in 40 geriatric patients who are scheduled for total knee arthroplasty for osteoarthritis; 2) To examine the effects of 6-8 weeks of aquatic exercise on mobility, pain, stiffness, physical function, cognitive function and depression; inflammatory markers and 3) To estimate the effect of prehabilitation on postoperative outcomes. The investigators plan to enroll 40 patients age \>50, who are scheduled for elective primary total knee replacement. Investigators will screen patients in the Preoperative Assessment Clinic and enroll patients who have decreased mobility, measured by MAT-sf. Patients will be randomized into either a prehabilitation group or a usual care group. All the participants will undergo extensive assessment on their pain, stiffness, and physical function, depression, balance and cognitive function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the expanded Short Physical Performance Battery (eSPPB), and Montreal Cognitive Assessment (MoCA). Serum inflammatory markers will be assessed at the baseline. The prehabilitation group will undergo 6-8 weeks of individualized aquatic exercise in a heated pool (60 min/session, 3 times per week). Aquatic equipment maybe used to challenge balance and trunk stabilization. All participants will be reassessed immediately before surgery and 4 weeks after the surgery using WOMAC, eSPPB, MoCA and MAT-sf. Serum inflammatory markers and body composition will be reassessed at the same time points. The primary outcome of interest is will be postoperative complications, length of stay, Intensive Care Unit length of stay, and institutionalization. If successful, investigators will have sound pilot data for several critical health outcomes with which to support an external proposal for a larger-scale study.

Conditions

Osteoarthritis, Knee

Outcome Measures

Primary Outcomes (3)

• Change in physical function using the MAT-sf

  Change in MAT-sf score from baseline (prior to surgery) to follow up (4-6 weeks after surgery)

  4-6 weeks after surgery

• Change in physical function using the eSPPB

  Change in eSPPB score from baseline (prior to surgery) to follow up (4-6 weeks after surgery)

  4-6 weeks after surgery

• Change in physical function using the Postural Sway Force Plate

  Change in postural sway score from baseline (prior to surgery) to follow up (4-6 weeks after surgery)

  4-6 weeks after surgery

Study Arms (2)

Standard of Care

NO INTERVENTION

Participant will receive standard of care and a brochure on healthy eating.

Aquatic Prehabilitation Group

ACTIVE COMPARATOR

The prehabilitation group will undergo 6-8 weeks of individualized aquatic exercise in a heated pool (60 min/session, 3 times per week). Aquatic equipment maybe used to challenge balance and trunk stabilization.

Behavioral: Aquatic Prehab

Interventions

Aquatic Prehab BEHAVIORAL

Pool therapy

Aquatic Prehabilitation Group

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Signed Informed Consent
• Age \> 50
• Willingness to exercise in a pool 3 times a week
• MAT-Sf score ≤ 58 for men and ≤ 50 for women
• Participant is scheduled for primary total knee replacement surgery due to OA \>4 weeks from expected BV visit
• Not involved in any other behavioral, exercise or investigational drug intervention study

You may not qualify if:

• Impaired cognitive function (MoCA \<21)
• Undergoing knee replacement surgery for indications other than OA
• Undergoing bilateral knee replacements
• Major deficits in hearing or vision
• Currently exercising more than 3 times per week
• Severe depression (GDS-sf ≥ 12)
• Contraindications to the pool: open wounds/ incontinence/history of seizures in last year

Sponsors & Collaborators

• Wake Forest University Health Sciences: lead

Study Sites (1)

Clinical Research Unit

Winston-Salem, North Carolina, 27157, United States

Location

MeSH Terms

Conditions

Osteoarthritis, Knee

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Study Officials

• Sunghye Kim, MD

  Wake Forest University Health Sciences

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 9, 2016
• First Posted: May 16, 2016
• Study Start: April 1, 2016
• Primary Completion: January 19, 2018
• Study Completion: January 19, 2018
• Last Updated: June 13, 2019

Record last verified: 2019-06

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)