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Trial registered on ANZCTR
Registration number
ACTRN12614000230651
Ethics application status
Approved
Date submitted
19/02/2014
Date registered
4/03/2014
Date last updated
13/07/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Hip Osteoarthritis: effect of combining Pain coping skills training with Exercise and education - HOPE trial
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Scientific title
Effect of exercise, education and pain coping skills training on hip pain and physical function in people with persistent hip pain: HOPE trial
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Secondary ID [1]
283853
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NIL
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Universal Trial Number (UTN)
U1111-1151-8587
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Trial acronym
HOPE
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Chronic hip pain
290830
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Condition category
Condition code
Musculoskeletal
291195
291195
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0
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Osteoarthritis
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Physical Medicine / Rehabilitation
291619
291619
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0
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Physiotherapy
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intervention: Pain coping skills training (PCST) delivered on-line combined with general online education followed by physiotherapist prescribed home exercises.
PCST program will be completed in weeks 1-8. Participants will complete on-line pain coping skills training (PCST) in the form of the PainCOACH program consisting of 8 interactive modules, each taking approximately 45 minutes. Participants will be asked to complete one module per week. At the completion of the 8 week modules participants will be asked to continue applying their pain coping skills. Pain coping skills training will be monitored using a PainCOACH specific logbook.
General Education will be received in weeks 1-8. The on-line education component will consist of short fact sheets. These will be presented once a week and will cover topics such as what is OA, healthy eating, importance of exercise, sleep etc. They will take approximately 5 minutes to read.
Participants will attend 5 x 30 minute physiotherapy guided exercise sessions, between weeks 8-24 (approximately one every 3 weeks). The session will focus on developing a home exercise program focused on hip muscle strength and hip joint range of motion. The home exercise program, developed by the project physiotherapist should consist of 4-6 exercises and take approximately 15 minutes to complete. Home exercises are to be completed three times per week from week 8 to week 52. Home exercise practice will be recorded by participants in a log book.
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Intervention code [1]
288532
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Behaviour
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Intervention code [2]
288850
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Rehabilitation
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Comparator / control treatment
General online education followed by physiotherapy prescribed home exercise therapy.
General online education and physiotherapy guided exercise is the same as in the intervention group as described above.
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Control group
Active
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Outcomes
Primary outcome [1]
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Average walking hip pain - Numeric rating scale
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Assessment method [1]
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Timepoint [1]
291185
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Baseline, 8, 24 and 52 weeks after baseline
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Primary outcome [2]
291186
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Self reported physical function - Physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index
(WOMAC)
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Assessment method [2]
291186
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Timepoint [2]
291186
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Baseline, 8, 24 and 52 weeks after baseline
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Secondary outcome [1]
306199
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Global rating of change. Participant perceived response to treatment - Participants will rate their perceived change in pain, physical function and change overall with treatment (compared to baseline) on a 7-point ordinal scale.
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Assessment method [1]
306199
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Timepoint [1]
306199
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Baseline, 8, 24 and 52 weeks after baseline
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Secondary outcome [2]
306200
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Self reported pain - Pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index
(WOMAC)
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Assessment method [2]
306200
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Timepoint [2]
306200
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Baseline, 8, 24 and 52 weeks after baseline
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Secondary outcome [3]
306201
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Habitual physical activity - Physical activity for the elderly (PASE)
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Assessment method [3]
306201
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Timepoint [3]
306201
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Baseline, 8, 24 and 52 weeks after baseline
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Secondary outcome [4]
306202
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Health related quality of life assessed using the Quality of Life instrument version 2 (AQoLII)
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Assessment method [4]
306202
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Timepoint [4]
306202
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Baseline, 8, 24 and 52 weeks after baseline
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Secondary outcome [5]
306203
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Self reported psychological measures
Arthritis Self Efficacy Scale
Pain Catastrophising Scale
Coping Strategies Questionnaire
Depression, Anxiety and Stress (DASS-21) Questionnaire
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Assessment method [5]
306203
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Timepoint [5]
306203
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Baseline, 8, 24 and 52 weeks after baseline
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Eligibility
Key inclusion criteria
Persistent hip pain for more than 3 months and for most days of the past month
Self-reported average walking pain level over the past week of equal to or greater than 4 out of 10 on a numeric rating scale
Ability to travel to one of the study Physiotherapy clinics
Current email address and access to a computer with broadband internet connection
Able to commit approximately 12 months to 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
Hip joint replacement on the painful side
Knee replacement on either side within the previous 6 months
Planning hip joint or knee surgery within the past/next 12 months
Current or past (within 3 months) oral or intra-articular corticosteroid use
Systemic arthritic conditions
Self-reported high-level depression (score of >21 on the depression subscale of the Depression, Anxiety and Stress Scale (DASS-21)
Other muscular, joint or neurological condition affecting lower limb function
Undertaken a previous behavioural treatment program in the past 12 months
Physiotherapy treatment or exercises specifically for the back, hip and knee in past 6 months
Unable to comply with protocol
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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)
A trained research assistant will conduct telephone screening of volunteers. Eligible consenting participants will complete baseline questionnaires online following which they will be randomised into one of two treatment groups: (i) control: exercise and on-line education; or (ii) intervention: exercise and on-line education plus on-line PCST “PainCOACH”.
To conceal randomization, consecutively numbered, sealed, opaque envelopes will be prepared by a researcher with no other involvement in the study. The envelopes will be stored in a locked location and will be opened in sequence to reveal group allocation by a different researcher not involved in the sequence generation or concealment.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
The randomisation schedule will be prepared by the study biostatistician. Randomisation will be by random permuted blocks of varying size stratified according to therapist (to control for therapist variation).
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
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
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The minimum clinically important difference in OA trials is a change in pain of 1.8 units and a change of six physical function WOMAC units (out of 68). Based on our previous data from a RCT of a physiotherapy intervention for hip OA, we assumed a between-participant standard deviation of 1.2 for pain and 8.8 units for physical function, and a baseline to week 24 follow-up correlation of 0.45 for pain and 0.35 for physical function. The required sample size for analysis of covariance of change controlling for the baseline value with power set at 90%, and type I error at .05 is 59 participants per group for physical function and 11 per group for pain. To be adequately powered for both primary outcomes and allowing for an approximate 20% drop-out rate, we will recruit 71 participants per group.
Our biostatistician will analyse the data in a blinded manner. Main comparative analyses between groups will be performed using an intention-to-treat analysis. For continuous outcomes (eg pain, physical function), differences in mean change (follow-up minus baseline) will be compared between groups using linear regression modelling adjusted for baseline values of the outcome. The proportion of 'improved' participants in each group will be compared using the relative risk (RR) from a generalised linear binomial model with a log link. We will also perform a per protocol analysis as appropriate. Linear regression modelling will assess relationships between psychological factors and treatment outcomes.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/04/2014
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Actual
27/03/2014
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Date of last participant enrolment
Anticipated
31/12/2015
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Actual
14/04/2015
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Date of last data collection
Anticipated
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Actual
9/05/2016
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Sample size
Target
142
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Accrual to date
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Final
144
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Recruitment in Australia
Recruitment state(s)
QLD,VIC
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Funding & Sponsors
Funding source category [1]
288503
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Government body
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Name [1]
288503
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National Health and Medical Research Council
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Address [1]
288503
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National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
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Country [1]
288503
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Australia
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Primary sponsor type
University
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Name
The University of Melbourne
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Address
The University of Melbourne
Victoria 3010
Australia
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Country
Australia
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Secondary sponsor category [1]
287208
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None
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Name [1]
287208
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Address [1]
287208
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Country [1]
287208
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
290361
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University of Melbourne Human Research Ethics Committee
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Ethics committee address [1]
290361
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Melbourne Research The University of Melbourne Level 5, Alan Gilbert Building VIC 3010
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Ethics committee country [1]
290361
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Australia
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Date submitted for ethics approval [1]
290361
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28/10/2013
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Approval date [1]
290361
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20/12/2013
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Ethics approval number [1]
290361
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1341124.1
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Summary
Brief summary
Persistent hip pain in individuals over 50 years of age is most often due to underlying hip osteoarthritis (OA). Hip osteoarthritis (OA) is a chronic musculoskeletal condition causing pain, physical dysfunction, psychological impairments and reduced quality-of-life. There is currently no cure, thus hip OA is a major public health problem contributing to substantial patient morbidity, health care costs and lengthy surgical waiting lists. Although exercise is recommended by all clinical guidelines for managing hip OA, clinical trials have shown that exercise is either not effective or has only modest benefits. Exercise, typically aimed at addressing muscle strength deficits and restricted joint range of motion, does not directly address psychological factors that are significantly increased in people with hip OA and are associated with higher pain levels and poorer function. Pain coping skills training (PCST), a form of cognitive behavioural therapy, is effective but its clinical application is limited because of poor access to appropriately-trained health professionals and high treatment costs. There is an urgent need to evaluate alternate delivery methods of PCST as an adjunctive treatment to exercise in OA. There are no studies in hip OA that have evaluated the efficacy of PCST (or any other behavioural intervention) either alone, or combined with biomedical treatments such as exercise. This study has two main aims comparing two interventions; Intervention A = Online general education and online PCST, followed by exercise, compared to Intervention B = online education, followed by exercise. In both interventions exercise commences in week 8, on completion of the online educational component. Both interventions are assessed at two separate time points, week 24 and week 8. The first aim is to assess and compare at 24 weeks the effect of the two interventions on pain and physical function. The second aim is to assess and compare the effect of Intervention A and B on pain and physical function prior to the commencement of exercise which is introduced in week 8 in both groups.
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Trial website
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Trial related presentations / publications
Trial is currently under consideration for publication.
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Public notes
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Contacts
Principal investigator
Name
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Prof Kim Bennell
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Address
45330
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Centre for Health, Exercise and Sports Medicine
Department of Physiotherapy
University of Melbourne
Alan Gilbert Building
Victoria 3010
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Country
45330
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Australia
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Phone
45330
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+ 61 3 83444135
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Fax
45330
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Email
45330
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[email protected]
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Contact person for public queries
Name
45331
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Rachel Nelligan
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Address
45331
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Centre for Health, Exercise and Sports Medicine
Department of Physiotherapy
University of Melbourne
Alan Gilbert Building
Victoria 3010
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Country
45331
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Australia
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Phone
45331
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+61 3 8344 9411
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Fax
45331
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Email
45331
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[email protected]
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Contact person for scientific queries
Name
45332
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Kim Bennell
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Address
45332
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Centre for Health, Exercise and Sports Medicine
Department of Physiotherapy
University of Melbourne
Alan Gilbert Building
Victoria 3010
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Country
45332
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Australia
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Phone
45332
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+ 61 3 83444135
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Fax
45332
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Email
45332
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol.
2015
https://dx.doi.org/10.2522/ptj.20150119
N.B. These documents automatically identified may not have been verified by the study sponsor.
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