Interprofessional Preoperative Geriatric Assessment for Older Arthroplasty Patients With Multimorbidity (IPPGA-RCT)

University of Eastern Finland

Status: Not yet enrolling

Conditions: Multimorbidity; Hip Arthrosis; Knee Arthrosis

Treatments: Other: Preoperative geriatric assessment

Study type: Interventional

Funder types: Other

Identifiers

NCT04001699

HERIT

Details and patient eligibility

About

The objective of this randomized control trial is to investigate effects and cost effectiveness of interprofessional preoperative assessment among older knee or hip arthroplasty patients. The main hypothesis is that preoperative assessment and optimization have a positive impact on the patents' quality of life and expenditure of social and health care services.

Full description

Knee and hip arthrosis are common conditions among older adults. Progression of arthrosis often leads to worsening of symptoms and decreased mobility, daily functioning and quality of life. Total joint arthroplasty improves pain in end-stage arthrosis but accustomed postoperative care and rehabilitation alone may not guarantee optimal regain of functioning for frail and vulnerable older arthroplasty patients. Preoperative optimization of older patients with multimorbidity and functional limitations may improve benefits of the arthroplasty even at lower costs. Patients randomized into intervention arm of the present study receive preoperative assessment with treatment and prehabilitation plan. The focuses of the intervention are patient's chronic conditions, nutritional status, medication and physical activity. The intervention is delivered by multiprofessional team (geriatrician, registered nurse, physiotherapist and pharmacist).

Older adults undergoing surgery are a rapidly growing but vulnerable patient group. Knowledge on effects of preoperative evaluation and optimization is sparse, especially on the effects of multi-domain interventions.

Enrollment: 140 estimated patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Place of residence: Kuopio or Vesanto municipality
• Age ≥ 65 years
• Clinical decision for knee or hip arthroplasty, elective operation with more than one month waiting time, primary arthroplasty of the index joint.
• Multimorbidity: the patient has at least two chronic diseases with potential to affect functioning, diseases are defined according to the Function Comorbidity Index (FCI)

Additional inclusion criteria, at least two of the following:

• 5 or more medicines taken regularly (polypharmacy)
• continuous walking distance less than 500 m
• needs help in dressing and/or washing oneself
• needs help when visiting or taking care of businesses outside home
• body mass index ≤ 23 or ≥ 34

Exclusion criteria

• does not meet the above inclusion criteria

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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140 participants in 2 patient groups

Intervention

Experimental group

Description:

Preoperative assessment conducted by an interprofessional team

Treatment:

Other: Preoperative geriatric assessment

Usual care

Active Comparator group

Description:

Usual care

Treatment:

Other: Preoperative geriatric assessment