Abstract
This research project sought to understand how osteoarthritis patients awaiting hip or knee joint replacement surgery can be encouraged and supported to participate in pre-operative physical activity behaviour (‘prehab’). The Capability, Opportunity, Motivation Model of Behaviour Change (COM-B model) provided the theoretical framework.
Using qualitative methods, studies one and two were conducted with patients (n=27) to understand 1) factors underlying the decision to participate, or not, in prehab, and 2) the ‘teachable moment’ in the pre-op period. Study one themes showed patients’ need to feel physically and psychologically capable to perform physical activity through knowledge of what physical activity to do, that such activity is appropriate and manageable for their pain and current physical state. They would be motivated by knowing how participation may help maintain their pre-op function and improve their post-op recovery and ‘return to normal’. Facility-based prehab would be acceptable for social aspects, but home-based can overcome significant logistical challenges. Furthermore, the current hospital resource provided to motivate participation in pre-op physical activity was not viewed as useful. Study two showed three teachable moment occurrences: the orthopaedic consultation when the surgeon approves/waitlists patients for surgery, the final anaesthetic consultation once a surgery date is known, and during an interaction between the patient and their personal GP. Identifying these timepoints elucidated when patients’ enhanced receptiveness to support can be capitalised upon for behaviour change efforts to be optimally employed. In study three, clinicians (n=19) were interviewed to understand their abilities to engage in discussions with patients about pre-op physical activity behaviour and experiences of doing so. Clinicians believed patients should participate in physical activity in the pre-op period, but the success of their discussions was challenged because they were unclear on what their role was, and were worried about patient receptiveness to physical activity advice and information. They felt their knowledge on OA-appropriate advice/information, and skills to have effective motivational conversations was limited and compounded by limited clinical time available and other healthcare system operational difficulties. Based on these findings, in study four, a prehab resource booklet designed to support patients to increased their physical activity behaviour through supporting their capability, opportunity, and motivation was evaluated in a four-week pilot randomised controlled trial (n=62). Physical activity, capability, opportunity, and motivation were measured one week before patients’ orthopaedic or anaesthetic consultation appointment (baseline), and three days, two weeks, and four weeks post-appointment. Participants were randomised to receive the existing (control) or intervention resource at their appointment. Results showed the intervention group had greater physical activity participation; physical, psychological, and knowledge capability; physical opportunity; and reflective motivation at week four versus controls. Capability (all), opportunity (physical), and motivation (reflective) each mediated physical activity at week four. Overall, results explain how osteoarthritis patients’ pre-op physical activity participation can be encouraged, and the challenges experienced by clinicians trying to promote prehab. The research provides evidence for the efficacy of a brief prehab intervention that is easily administered in clinic and supports physical activity behaviour change using behaviour change techniques to improve patients’ capability, opportunity, and motivation. Further research should investigate the longer-term effects of the resource or explore how it could support clinicians’ discussions with patients about prehab.