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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04825483
Registration number
NCT04825483
Ethics application status
Date submitted
28/03/2021
Date registered
1/04/2021
Titles & IDs
Public title
Effects of a Weight Loss Program in People With Hip Osteoarthritis
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Scientific title
Effects of a Weight Loss Program in People With Hip Osteoarthritis: a Randomised Controlled Trial
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Secondary ID [1]
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20516
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Universal Trial Number (UTN)
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Trial acronym
ECHO
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Hip Osteoarthritis
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Overweight and Obesity
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Condition category
Condition code
Musculoskeletal
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Osteoarthritis
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Diet and Nutrition
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Obesity
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other interventions - Weight loss
Other interventions - Exercise
Experimental: Weight loss and exercise - In addition to the physiotherapist-prescribed exercise program, participants in the weight loss and exercise group will also undergo six consultations with a dietitian. They will undergo a ketogenic very low-calorie diet (VLCD) including meal replacements, with an intensive weight loss phase and weight maintenance phase. The exercise component will be the same as that provided for the exercise only comparator. All dietitian and physiotherapy consultations will be delivered online by video-conference platform.
Active comparator: Exercise only - Participants will undergo five consultations (30-45 minutes) with a physiotherapist over 6 months for prescription of a home-based strengthening exercise program and physical activity plan (to be conducted independently at home), as well as OA education. All consultations will be conducted remotely via video-conference.
Other interventions: Weight loss
Participants will receive resources to support the weight loss program including a recipe book, activities book and "how-to guide". The diet program comprises two phases: 1) intensive weight loss through a ketogenic Very Low Calorie Diet (VLCD), including meal replacements for two meals/day, and 2) transition from ketogenic VLCD onto a longer-term eating plan for weight maintenance. Meal replacements will be provided free of charge for up to 6 months. Participants will be encouraged to lose at least 10% body weight.
Other interventions: Exercise
Participants will receive resources to facilitate the physiotherapy management plan, including information about the video-conference platform, osteoarthritis information, an exercise plan/log book and a booklet of possible exercises. The physiotherapist consultations include a structured, progressive exercise and physical activity plan. Participants will be given exercise resistance bands and a ankle weight for home exercises.
Physiotherapists will choose from a list of exercises, aiming to prescribe 5-6 at once. Intensity is determined using a modified Rating of Perceived Exertion (RPE) scale, where it should feel "hard" to "very hard" to perform a full set of each exercises. Participants are encouraged to complete exercises three times per week. Physiotherapists encourage the participant to increase their general and incidental levels of physical/aerobic activity based on their individual needs and goals, as well as their current level of activity.
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Intervention code [1]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Severity of hip pain
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Assessment method [1]
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Scored on an 11-point Numeric Rating Scale for average hip pain in the last week. Ranges from 0 to 10; where 0=no pain and 10=worst pain possible.
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Timepoint [1]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [1]
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Severity of hip pain
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Assessment method [1]
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Scored on an 11-point Numeric Rating Scale for average hip pain in the last week. Ranges from 0 to 10; where 0=no pain and 10=worst pain possible.
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Timepoint [1]
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Change between baseline and 12 months post-randomisation
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Secondary outcome [2]
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Body weight
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Assessment method [2]
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Measured on home scales and self-reported in kilograms. The percentage of body weight change (baseline-follow up/baseline x100%) will be calculated .
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Timepoint [2]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [3]
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Body weight
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Assessment method [3]
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Measured on home scales and self-reported in kilograms. The percentage of body weight change (baseline-follow up/baseline x100%) will be calculated .
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Timepoint [3]
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Change between baseline and 12 months post-randomisation
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Secondary outcome [4]
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Body Mass Index (BMI)
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Assessment method [4]
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Calculated from height and weight, in Kg/m2
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Timepoint [4]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [5]
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Body Mass Index (BMI)
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Assessment method [5]
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Calculated from height and weight, in Kg/m2
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Timepoint [5]
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Change between baseline and 12 months post-randomisation
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Secondary outcome [6]
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Total body fat mass
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Assessment method [6]
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Measured using dual energy x-ray absorptiometry and reported in grams and % of total body mass
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Timepoint [6]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [7]
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Hip pain
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Assessment method [7]
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Proportion of participants who meet or exceed the minimal clinical important difference in Numerical Rating Scale for pain (1.8 units). Expressed as percentage relative to number of participants allocated to each group.
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Timepoint [7]
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6 months post-randomisation
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Secondary outcome [8]
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Hip pain
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Assessment method [8]
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Proportion of participants who meet or exceed the minimal clinical important difference in Numerical Rating Scale for pain (1.8 units). Expressed as percentage relative to number of participants allocated to each group.
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Timepoint [8]
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12 months post-randomisation
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Secondary outcome [9]
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Hip Osteoarthritis Outcome Scale (HOOS) Pain Subscale
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Assessment method [9]
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Scored using 10 questions regarding hip pain in the last week, with Likert response options ranging from no pain to extreme pain. Ranges from 0 to 20 and normalised to 0 - 100 scale. Higher scores indicate less pain.
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Timepoint [9]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [10]
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Hip Osteoarthritis Outcome Scale (HOOS) Pain Subscale
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Assessment method [10]
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Scored using 10 questions regarding hip pain in the last week, with Likert response options ranging from no pain to extreme pain. Ranges from 0 to 20 and normalised to 0 - 100 scale. Higher scores indicate less pain.
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Timepoint [10]
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Change between baseline and 12 months post-randomisation
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Secondary outcome [11]
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Hip Osteoarthritis Outcome Scale (HOOS) Activities of daily living subscale
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Assessment method [11]
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Scored using 17 questions regarding hip function in the last week, with Likert response options ranging from no dysfunction to extreme dysfunction. Ranges from 0 to 68 and normalised to 0 - 100 scale. Higher scores indicate less dysfunction.
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Timepoint [11]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [12]
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Hip Osteoarthritis Outcome Scale (HOOS) Activities of daily living subscale
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Assessment method [12]
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Scored using 17 questions regarding hip function in the last week, with Likert response options ranging from no dysfunction to extreme dysfunction. Ranges from 0 to 68 and normalised to 0 - 100 scale. Higher scores indicate less dysfunction.
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Timepoint [12]
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Change between baseline and 12 months post-randomisation
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Secondary outcome [13]
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Hip Osteoarthritis Outcome Scale (HOOS) Quality of Life Subscale
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Assessment method [13]
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Scored using 4 questions regarding quality of life in the last week, with Likert response options ranging from none to extreme. Ranges from 0 to 16 and normalised to 0 - 100 scale. Higher scores indicate better quality of life.
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Timepoint [13]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [14]
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Hip Osteoarthritis Outcome Scale (HOOS) Quality of Life Subscale
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Assessment method [14]
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Scored using 4 questions regarding quality of life in the last week, with Likert response options ranging from none to extreme. Ranges from 0 to 16 and normalised to 0 - 100 scale. Higher scores indicate better quality of life.
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Timepoint [14]
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Change between baseline and 12 months post-randomisation
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Secondary outcome [15]
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Quality of life (AQoL-8D)
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Assessment method [15]
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Scored from 35 questions regarding health-related quality of life in the last week. Ranges from -0.04 to 1.00; higher scores indicate better quality of life.
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Timepoint [15]
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Change between baseline and 6 months post-randomisation
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Secondary outcome [16]
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Quality of life (AQoL-8D)
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Assessment method [16]
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Scored from 35 questions regarding health-related quality of life in the last week. Ranges from -0.04 to 1.00; higher scores indicate better quality of life.
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Timepoint [16]
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Change between baseline and 12 months post-randomisation
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Secondary outcome [17]
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Global rating of change in physical activity
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Assessment method [17]
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Scored using a 7-point global rating of change Likert scale with response options ranging from "much less" to "much more" when compared to baseline.
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Timepoint [17]
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6 months post-randomisation
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Secondary outcome [18]
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Global rating of change in physical activity
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Assessment method [18]
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Scored using a 7-point global rating of change Likert scale with response options ranging from "much less" to "much more" when compared to baseline.
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Timepoint [18]
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12 months post-randomisation
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Secondary outcome [19]
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Global rating of overall change in hip problem
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Assessment method [19]
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Scored using a 7-point global rating of change Likert scale with response options ranging from "much worse" to "much better" when compared to baseline.
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Timepoint [19]
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6 months post-randomisation
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Secondary outcome [20]
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Global rating of overall change in hip problem
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Assessment method [20]
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Scored using a 7-point global rating of change Likert scale with response options ranging from "much worse" to "much better" when compared to baseline.
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Timepoint [20]
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12 months post-randomisation
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Secondary outcome [21]
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Visceral fat mass
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Assessment method [21]
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Measured using dual energy x-ray absorptiometry and reported in grams and % of total body mass
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Timepoint [21]
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Change between baseline and 6 months post-randomisation
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Eligibility
Key inclusion criteria
* American College of Rheumatology classification criteria with pain in the groin or hip region on most days of the past month and femoral or acetabular osteophytes and joint space narrowing (superior, axial and/ or medial) on x-ray;
* aged 50 years or older;
* report history of hip pain = 3months;
* report an average pain score of at least 4 on an 11-point numeric rating scale (anchored at 0=no pain, 10=worst pain imaginable) over the previous week;
* access to a device with internet connection;
* have a BMI >27 kg/m2;
* willing and able give informed consent and participate fully in the interventions and assessment procedures;
* have ability to weigh themselves (e.g. access to scales);
* pass the Exercise and Sports Science Australia stage 1 adult pre-exercise screening system or obtain general practitioner clearance for participation in the study.
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Minimum age
50
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* weight >150 kgs (due to the added complexities of additional nutritional requirements for individuals above this weight);
* inability to speak and read English;
* on waiting list for/planning back/lower limb surgery or bariatric surgery in next 12 months;
* previous arthroplasty on affected hip;
* recent hip surgery on affected hip (past 6 months);
* self-reported inflammatory arthritis (e.g. rheumatoid arthritis);
* weight loss of > 2 kg over the previous 3 months;
* already actively trying to lose weight by any of the following mechanisms:
1. using meal replacements for weight loss
2. being a member of a commercial weight loss program (e.g. weight watchers)
3. receiving support from another health care professional for weight loss
4. using any drugs prescribed to aid in weight loss
5. using structured meal programs for weight loss such as 'Lite n' Easy'
* unable to undertake ketogenic VLCD without closer medical supervision including self-reported:
1. diagnosis of Type 1 diabetes
2. Type 2 diabetes requiring insulin or other medication apart from metformin
3. warfarin use
4. stroke or cardiac event in previous 6 months
5. unstable cardiovascular condition
6. fluid intake restriction
7. renal (kidney) problems (unless clearance is obtained from GP, including GP confirmation that estimated glomerular filtration rate >30 mL/min/1.73m2)
* any neurological condition affecting lower limbs;
* pregnancy or planned pregnancy
* vegan dietary requirements due to complexity of delivering a nutritionally complete diet within the ketogenic diet regime.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
16/06/2021
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
27/01/2024
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Sample size
Target
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Accrual to date
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Final
101
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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University of Melbourne - Carlton
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Recruitment postcode(s) [1]
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3010 - Carlton
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of Melbourne
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
This randomised controlled trial will compare the effects of a weight loss and exercise program to exercise only on clinical outcomes in 100 people with hip osteoarthritis (OA) and overweight or obesity. The primary aim is to find out whether a weight loss and exercise program will improve hip pain more than an exercise program alone at 6 months follow-up
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Trial website
https://clinicaltrials.gov/study/NCT04825483
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Trial related presentations / publications
Hall M, Hinman RS, Knox G, Spiers L, Sumithran P, Murphy NJ, McManus F, Lamb KE, Cicuittini F, Hunter DJ, Messier SP, Bennell KL. Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial. BMC Musculoskelet Disord. 2022 Mar 5;23(1):215. doi: 10.1186/s12891-022-05128-9.
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Public notes
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Contacts
Principal investigator
Name
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Kim Bennell, PhD
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Address
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University of Melbourne
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
PD can be shared
Supporting document/s available: Study protocol, Statistical analysis plan (SAP), Informed consent form (ICF), Analytic code
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When will data be available (start and end dates)?
Available upon publication of results
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Available to whom?
Upon reasonable request
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04825483