The PEP-TALK Trial
Research type
Research Study
Full title
A behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: a pragmatic phase III randomised controlled trial
IRAS ID
245306
Contact name
Toby Smith
Contact email
Sponsor organisation
University of Oxford, Clinical Trials and Research Governance
Duration of Study in the UK
2 years, 11 months, 31 days
Research summary
Summary of Research
Over 206,000 hip and knee replacements were performed in the United Kingdom (UK) last year. As well as joint pain, half of these people have other diseases such as high blood pressure, heart disease, diabetes and depression.Physical activity is known to improve these conditions. Before a hip or knee replacement, it can be difficult to be physically active because of pain and fatigue. It is hoped that after joint replacement, this improves so people can be more active. However, people after hip or knee replacement are often no more active than before and, importantly, do not know how to be. They miss out on some of the health benefits which joint replacement can offer. This study will test a group exercise and behaviour change treatment which targets barriers people have which can stop them being physically active, to maximise their ‘whole-body’ health and the effect of this on their NHS needs.
People will be randomly allocated by chance (like tossing a coin) to have treatment consisting of either (a) six sessions (once weekly) behaviour change treatment and physiotherapy group exercise with other people after their hip or knee replacement, and three follow-on telephone calls, or (b) six sessions (once weekly) physiotherapy group exercise alone (no behaviour change treatment nor follow-up phone calls). Patients will be asked to complete questionnaires to measure the benefits of each treatment six and 12 months after their operation.
Patients have been involved in designing this study and the research question. One of our researchers has first-hand experience of trying to increase their levels of physical activity following joint replacement. If shown to be effective, this group-based treatment for people who have difficulty in being more active, could improve these individual’s health and well-being, and could save the NHS money by reducing visits to GP practices because of other medical problems which physical activity can reduce.
Summary of Results
Half of all people who undergo hip or knee replacement have diseases such as high blood pressure, heart disease, diabetes and depression. Physical activity is known to improve these. However, people after hip or knee replacement have difficulties in being active even though their pain may have improved. They miss out on some of the health benefits which joint replacement can offer. This research aimed to test a group exercise and behaviour change treatment which targets barriers people have which can stop them being physically active, to maximise their ‘whole-body’ health and the effect of this on their NHS needs.People were randomly allocated by chance to have treatment consisting of either (a) six sessions (once weekly) behaviour change treatment and physiotherapy group exercise with other people after their hip or knee replacement, and three follow-on telephone calls, or (b) six sessions (once weekly) physiotherapy group exercise alone (no behaviour change treatment nor follow-up phone calls). Patients completed questionnaires to measure the effect of each treatment six and 12 months after their operation.
85 patients were randomised to the exercise-class physiotherapy; 139 were randomised to the PEP-TALK plus exercise class physiotherapy. Patients who received the PEP-TALK group-discussion reported the same outcome in levels of physical activity performed, symptoms and general results from their operation compared to those who received the exercise-class physiotherapy alone. However the impact of COVID-19 with the early stopping of recruitment and the cancellation of physiotherapy and surgery means we are unsure how typical these results are.
Patients were involved in designing, running and sharing the results of the research. They have been particularly helpful in providing guidance during the COVID-19 pandemic.
The findings from this research are being shared with the public through social media posts and presentations and health professionals with reports, presentations and posters.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
18/SC/0423
Date of REC Opinion
23 Oct 2018
REC opinion
Further Information Favourable Opinion