Feasibility of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER) (HIPPER)

June 28, 2026 updated by: William C. Miller, University of British Columbia

Feasibility of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER) Intervention Protocol: An eHealth Approach for Pre-surgical Hip Replacement Education

Osteoarthritis (OA), leading to hip replacement, is a leading contributor to global mobility impairment. Given the boom in the older demographic it is not surprising that there is an 11% increased demand for replacement every 5 years in Canada. Health promotion interventions, such as prehabilitation, defined as pre-surgical education, are vital to optimizing surgical outcomes, reducing hospitalization costs, accelerating rehabilitation, and reducing patient discomfort and pre-operative anxiety. HIPPER is a 2-year randomized controlled trial (RCT) that will assess feasibility indicators and clinical outcomes of online prehab education modules compared to online educational webinars. The feasibility indicators (process, resource, management, and treatment issues) and clinical outcomes (physical function, anxiety, depression, pain, daily activities, self-efficacy, and health related quality of life) will be assessed among Vancouver-dwelling older adults aged > 50 years, with advanced hip osteoarthritis. The findings will lead to the refinement of the design protocol in order to evaluate a contemporary, standardized, and geographically accessible prehab education program in a large multi-site RCT.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This feasibility study will use a single-site, parallel group evaluator blind RCT. Subjects (N=40) will be randomly assigned to the experimental (HIPPER n=20) or control (n=20) groups.The experimental group will receive the interactive online HIPPER intervention consisting of 12 modules (~20 mins/module). The control group is usual practice consisting of a 2 hr online large group educational webinar. Feasibility indicators (i.e. recruitment and retention; subject burden; safety; intervention administration/adherence; perceived benefit) will be evaluated as binary outcomes against pre-set parameters reflecting viability for a multi-site large-scale RCT. The primary clinical outcome of interest when assessing effect size for the eventual RCT is the Hospital Anxiety and Depression Scale-Anxiety. Secondary clinical outcomes include measures of pain, function, daily activities, self-efficacy, equipment checklist, system usability scale, environmental setup, physical activity, and health related quality of life.

Upon successful screening/enrollment and baseline data collection (T1) the Study Coordinator will contact the statistician by telephone or email and obtain group assignment within 48 hours. Subjects will be randomized using a 1:1 allocation ratio between groups. A central computerized randomization process will be designed by the statistician, with an undisclosed block size. To address bias, subjects will be instructed not to discuss their program and Testers will reinforce this point at each session. T1 data will be collected at our clinic while the follow up data collected 7-10 days prior to surgery (T2), and 30 days post-surgery (T3).

The findings from the study will be summarized and mailed to each participant upon study completion. HIPPER and control group assessments will be held at GF Strong Rehabilitation Centre and at subject's homes.

The outcome will lead to the refinement of the design protocol in order to robustly evaluate a contemporary, standardized, and geographically accessible prehabilitation education program. Ultimately, HIPPER may be found to have significant individual and social (health system level) benefits.

Study Type

Interventional

Enrollment (Actual)

51

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • British Columbia
      • Vancouver, British Columbia, Canada, V5Z 2G9
        • GF Strong Rehabilitation Centre

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

50 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

Community-dwelling participants with advanced hip OA will be included if they:

  • are living in the greater Vancouver region;
  • are aged 50 years or older;
  • are scheduled to have a single THR in 12 weeks or later;
  • have access to the internet

Exclusion Criteria:

  • cannot communicate and complete questionnaires in English;
  • anticipate a health condition or procedure that contraindicates their THR surgery;
  • are actively receiving physical therapy for their hip symptoms;
  • have had a previous THR.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: HIPPER
The HIPPER group will receive 12 interactive online modules (~20 minutes each). HIPPER participants will receive email or phone contact (participant preference) to provide them with website portal access consisting of the web address, and simple instructions to access the website using personalized encrypted login information to the site.
Other: HIPPER
Participants can complete the online educational modules at home or another location with internet access. The total time to complete all of the modules is about 2 hours and 30 minutes.
Other Names:
  • Behavioral: Online prehab education
Active Comparator: OASIS Online Educational Webinars
To provide a comparable level of education, participants in the Online Education group will receive 2 hours of OASIS online educational webinars as per current practice.
Other: OASIS Online Educational Webinars
2-hour online educational large group sessions
Other Names:
  • Behavioral: large group education sessions

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Hospital Anxiety and Depression Scale - Anxiety Subscale (HADS-A)
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The Hospital Anxiety and Depression Scale (HADS-A) measures anxiety symptoms. The anxiety subscale (HADS-A) has 7 items, each rated 0-3 and summed to a total of 0-21. Higher scores indicate worse outcomes (greater anxiety).
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Hospital Anxiety and Depression Scale - Depression Subscale (HADS-D)
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The Hospital Anxiety and Depression Scale (HADS-D) measures depression symptoms. The depression subscale (HADS-D) has 7 items, each rated 0-3 and summed to a total of 0-21. Higher scores indicate higher levels of depression.
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Oxford Hip Score (OHS)
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The Oxford Hip Score (OHS) measures pain and function in patients with hip osteoarthritis. It has 12 items, each rated 0-4, summed to a total of 0-48. Higher scores indicate lower levels of disability.
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Change in Self-Efficacy for Rehabilitation Outcome Scale (SER)
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The Self-Efficacy for Rehabilitation Outcome Scale (SER) measures confidence in performing rehabilitation activities. It has 12 items, each rated 0-10, summed to a total of 0-120. Higher scores indicate greater self-efficacy.
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
System Usability Scale (SUS)
Time Frame: T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery); Completed only by participants in the HIPPER group.
The System Usability Scale (SUS) measures perceived usability of a system. It has 10 items rated on a 5-point scale; item scores are converted, summed, and multiplied by 2.5 to give a total of 0-100. Higher scores indicate better perceived usability.
T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery); Completed only by participants in the HIPPER group.
Hip Disability and Osteoarthritis Outcome Score - Activities of Daily Living Subscale (HOOS-ADL)
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The Hip Disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living (ADL) subscale measures difficulty with daily activities in patients with hip osteoarthritis. It has 17 items, each rated on a five-point Likert scale (0 = none to 4 = extreme difficulty), summed to a total ranging from 0 to 68. Higher scores indicate greater difficulty with daily activities.
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Physical Activity Scale for the Elderly (PASE)
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The Physical Activity Scale for the Elderly (PASE) measures self-reported physical activity over the past 7 days in older adults. Scores are a weighted sum of time spent across activity types, ranging from 0 to 400 or more. Higher scores indicate greater physical activity.
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index Score
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The EuroQol 5-Dimension 5-Level (EQ-5D-5L) measures health-related quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Responses were converted to a single utility index ranging from -0.285 to 1 (extreme problems on all dimensions) to 1 (full health). Higher scores indicate better health-related quality of life.
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
Equipment Checklist
Time Frame: T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
The Equipment Checklist included recommended equipment and mobility aids for total hip replacement. This checklist was developed in accordance with current guidelines and clinical recommendations. Participants indicated which items they had obtained. The reported value is the number of items obtained per participant. Higher scores indicate more recommended equipment obtained.
T1 (Baseline); T2 (7-10 days before surgery); T3 (Post-Intervention, 30 days after surgery)
30-second Chair-Stand Test
Time Frame: T1 (Baseline); T2 (7-10 days before surgery).
The 30-Second Chair-Stand Test measures lower-body strength and endurance. Participants stand fully from a seated position and sit back down as many times as possible within 30 seconds. The score is the number of completed sit-to-stand repetitions. Higher scores indicate better lower-body strength and function.
T1 (Baseline); T2 (7-10 days before surgery).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of British Columbia

Collaborators

Canadian Institutes of Health Research (CIHR)

Investigators

  • Principal Investigator: William C Miller, PhD, University of British Columbia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 10, 2021

Primary Completion (Actual)

April 25, 2023

Study Completion (Actual)

April 25, 2023

Study Registration Dates

First Submitted

November 9, 2016

First Submitted That Met QC Criteria

November 16, 2016

First Posted (Estimated)

November 21, 2016

Study Record Updates

Last Update Posted (Actual)

August 17, 2026

Last Update Submitted That Met QC Criteria

June 28, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • H16-02553

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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