Prehabilitation + Education for Shoulder Replacement Surgery

(PREPS Trial)

Overseen By Katrina Munro

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Disqualifiers: Hemi-arthroplasty, Contraindications to exercise, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores new ways to prepare patients for shoulder replacement surgery by comparing three methods: an online pre-rehabilitation program (Preoperative Rehabilitation and Education Program), the same online program with therapist support, and the current in-class education standard. The researchers aim to determine which method best helps patients manage pain, reduce anxiety, and avoid re-injury after surgery. Patients scheduled for a total or reverse shoulder replacement who can commit to a year of follow-up are ideal candidates. The trial seeks to make surgery preparation more accessible, especially for patients in Southern Ontario. As an unphased trial, it offers patients the chance to contribute to innovative approaches that could enhance surgical preparation and recovery.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this online educational program is safe for patients undergoing shoulder replacement surgery?

Research has shown that programs designed to prepare patients for surgery are generally safe and manageable. In past studies, participants in these programs before surgery experienced improved mobility and overall well-being. The goal is to enhance patient preparation and recovery.

These programs typically offer exercises and information accessible online. No direct evidence indicates harmful effects from participation. Instead, they aim to reduce anxiety, boost confidence, and improve recovery after shoulder surgery. Overall, these programs are considered low-risk and beneficial for patients preparing for surgery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how a prehabilitation and education approach might enhance recovery in shoulder replacement surgery. Unlike the standard care, which involves a WebEx pre-op class, this trial investigates whether an online pre-rehabilitation program, with or without additional therapist guidance, could better prepare patients. By starting rehab six weeks before surgery, this method could improve outcomes by boosting physical readiness and understanding of the procedure. This proactive approach could lead to quicker recovery times and better overall results for patients undergoing shoulder replacement.

What evidence suggests that this trial's treatments could be effective for shoulder replacement surgery?

Research has shown that a good rehabilitation program can greatly improve recovery after shoulder replacement surgery. In this trial, participants will join different groups to evaluate the effectiveness of prehabilitation and education. One group will receive the standard of care, including a WebEx pre-operative education class led by a physiotherapist and occupational therapist. Another group will participate in an online pre-rehabilitation program six weeks before surgery. A third group will receive both the online program and additional therapy sessions. Studies have found that performing rehab exercises before surgery can enhance mobility, improve quality of life, and strengthen muscles. Starting rehab early also aids in pain relief and reduces anxiety, which are common after surgery. Additionally, online educational programs better prepare patients, increase understanding, and empower them during recovery. These findings suggest that a well-planned rehab program before surgery can be very helpful for those undergoing shoulder replacement surgery. ^{1 3 5 6 7}

Who Is on the Research Team?

Joy MacDermid, PhD

Principal Investigator

Western University, Canada

Are You a Good Fit for This Trial?

This trial is for English-speaking adults over 18 who are scheduled for total shoulder replacement surgery at HULC in no less than 9 weeks and can commit to the study for a year post-surgery. It's not suitable for those with exercise contraindications or those having hemi-arthroplasty.

Inclusion Criteria

Able to provide informed consent

Speaks and reads in English unless can provide a translator

I am over 18 years old.

Exclusion Criteria

Any contraindications to exercise

I have agreed to undergo partial joint replacement surgery.

I agreed to join the study less than 8 weeks before my surgery.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Education and Rehabilitation

Participants undergo a 6-week online pre-rehabilitation and education program before surgery

6 weeks

Online modules

Surgery

Participants undergo total shoulder arthroplasty surgery

Follow-up

Participants are monitored for recovery and outcomes post-surgery

12 months

Assessments at 6 weeks, 3 months, 6 months, and 12 months

What Are the Treatments Tested in This Trial?

Interventions

• Preoperative Rehabilitation and Education Program

Trial Overview The study tests an online pre-rehabilitation program (PREPS) against the standard WebEx class led by therapists before shoulder replacement surgery. One group gets PREPS, another PREPS plus therapy, and a third follows current standard care.

How Is the Trial Designed?

Group I: Online only Experimental Treatment 1 Intervention

a group consisting of an online pre-rehabilitation program 6 weeks before surgery

Group II: Online and PT Experimental Treatment 1 Intervention

a group consisting of an online pre-rehabilitation program 6 weeks before surgery + therapist

Group III: Standard of Care Group Active Control 1 Intervention

A group consisting of the current standard of care at HULC, which is a WebEx pre-operative education class lead by a physiotherapist and occupational therapist.

Who Is Running the Clinical Trial?

London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

686

Recruited

427,000+

London Health Sciences Centre OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

668

Recruited

424,000+

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

678

Recruited

421,000+

Lawson Health Research Institute

Lead Sponsor

Trials

684

Recruited

432,000+

Western University, Canada

Collaborator

Trials

270

Recruited

62,500+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Published Research Related to This Trial

A systematic review of 33 studies involving 3167 citations found that prehabilitation did not significantly improve postoperative function, quality of life, or pain in patients undergoing knee or hip arthroplasty for osteoarthritis.

However, prehabilitation programs lasting over 500 minutes may reduce the need for postoperative rehabilitation, indicating a potential benefit in healthcare utilization, even though no significant reductions in readmissions or nursing home placements were observed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. Cabilan, CJ., Hines, S., Munday, J.[2022]

Preoperative scapular rehabilitation significantly reduced pain and improved shoulder function in patients undergoing arthroscopic repair for rotator cuff injuries, with notable benefits observed after one year.

Patients who received scapular rehabilitation showed greater improvements in shoulder abduction and overall quality of life compared to those who did not, indicating that targeted preoperative exercises can enhance recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pre-Operative Scapular Rehabilitation for Arthroscopic Repair of Traumatic Rotator Cuff Tear: Results of a Randomized Clinical Trial. de Almeida, LL., Mendes Júnior, AF., Neto, JDM., et al.[2022]

Anatomic total shoulder arthroplasty patients using a neutral rotation sling position experienced less night pain and improved range of motion, supported by moderate evidence from the review of 14 studies.

The review highlighted that many factors influencing treatment outcomes, such as telemedicine and immediate range of motion exercises, had only preliminary or conflicting evidence, indicating a need for more standardized and high-quality research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factors associated with better treatment outcome of physical therapy interventions after shoulder arthroplasty: A systematic review. Claes, A., Mertens, MG., Verborgt, O., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12181192/

A pilot randomized control trial protocol This pilot randomized controlled trial will evaluate feasibility and satisfaction with our program for individuals undergoing a shoulder replacement.

2. withpower.com withpower.com/trial/phase-arthritis-8-2023-4c2c2

Prehabilitation + Education for Shoulder Replacement ... Research suggests that a well-designed rehabilitation program is crucial for successful outcomes after shoulder replacement surgery. Early rehabilitation and ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0011384025001893

Impact of Preoperative Rehabilitation Training on Clinical ... Some studies suggest that preoperative rehabilitation training may improve surgical outcomes through multiple mechanisms: first, pain management ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2803788

Prehabilitation for Patients Undergoing Orthopedic Surgery The prehabilitation intervention significantly improved function, health-related quality of life, muscle strength, and back pain prior to surgery.

5. jhandtherapy.org jhandtherapy.org/article/S0894-1130(25)00059-6/fulltext

Codesigning the web-based “Preoperative Rehab ... PREPS is designed to improve patient preparedness for surgery, increase rehab adherence/awareness and empower patients during their replacement ...

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40547196/

A pilot randomized control trial protocol This pilot randomized controlled trial will evaluate feasibility and satisfaction with our program for individuals undergoing a shoulder replacement.

7. sciencedirect.com sciencedirect.com/science/article/pii/S0894113025000596

Codesigning the web-based “Preoperative Rehab ... PREPS is an integrative co-designed virtual preoperative program that supports patients' preparation for a shoulder replacement.