Joint PREP: Joint PRehabilitation with Exercise and Protein
Research type
Research Study
Full title
A randomised controlled feasibility trial of a prehabilitation intervention in frail older people undergoing total hip or knee replacement
IRAS ID
312883
Contact name
Vikki Wylde
Contact email
Sponsor organisation
North Bristol NHS Trust
ISRCTN Number
ISRCTN11121506
Duration of Study in the UK
1 years, 3 months, 31 days
Research summary
Research Summary
We want to see if we can improve recovery from surgery in older people having hip or knee replacement by giving them protein and asking them to exercise daily in the weeks before their operation. First, we want to see if people are willing to do this by running a small study, called a ‘feasibility study’. If they are, we will design a larger study to test whether it improves recovery.
One-third to one-half of people waiting for hip or knee replacements are frail and may experience more complications and longer hospital stay. Evidence suggests that an improved diet with extra protein and pre-operative exercise may lead to fewer post-operative complications and faster recovery. However, no studies have looked at pre-operative protein and exercise in frail individuals undergoing hip or knee replacement in the NHS.
We will ask 60 frail individuals over 65 years old and waiting for hip or knee replacement to take part. A computer will randomly assign participants to one of two groups: one will follow usual care and will not be asked to make any changes to their diet or exercise; the other will be asked to add protein (provided for them) to their diet each day and to follow a tailored exercise programme for up to 12-weeks before their operation. All participants will complete questionnaires about their health and quality of life, and information about post-operative recovery and time spent in hospital will be collected from medical records. We will invite some participants to be interviewed about their experiences of taking part. The information we gather will tell us if we can run a larger study in the future. This feasibility study is funded through a two-year grant from the National Institute for Health Research.Summary of Results
Background
Hip and knee replacements are common operations. Some people having joint replacement are physical vulnerable e.g. lower strength and less mobile. This is known as frail. These people may have a slower recovery after surgery. We wanted to see if we could help frail people recover after joint replacement through extra protein and exercise before surgery. Before doing a big study to answer the question, we needed to run a small study to see if people would take part.
Methods
We invited patients who were frail, over 65 years old, and waiting for a hip or knee replacement to take part. Patients were randomly assigned to one of two groups. One group had the usual care at their hospital. The other group were offered the Joint PREP treatment. This treatment involved an appointment with a physiotherapist to design a home exercise plan and 6 follow-up telephone calls over 12 weeks. People were asked to follow this home exercise plan every day for 12 weeks before their operation. To help build muscle strength, people were given a daily protein supplement. Everyone was sent a questionnaire after 12 weeks. Some people talked to a researcher about their experiences of the study.
Results
We contacted 411 patients at three hospitals and 64 patients took part. Most patients who were offered the Joint PREP treatment attended a physiotherapy appointment, did their exercises and had their protein. People who had the protein and exercise programme generally found it to be acceptable, and the follow-up calls from the physiotherapist were helpful to keep people motivated. Most people completed the questionnaires, suggesting that they were acceptable.
Conclusions
This study has shown that a larger study is possible and has helped us to better understand how to design a larger study that it is acceptable to patients.
REC name
East of Scotland Research Ethics Service REC 2
REC reference
22/ES/0033
Date of REC Opinion
30 Aug 2022
REC opinion
Further Information Favourable Opinion