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Trial registered on ANZCTR
Registration number
ACTRN12624000580572
Ethics application status
Approved
Date submitted
21/03/2024
Date registered
7/05/2024
Date last updated
7/05/2024
Date data sharing statement initially provided
7/05/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Kneed: A pilot randomised trial of an online pain rehabilitation program to treat persistent pain after knee replacement for osteoarthritis
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Scientific title
Kneed: A pilot randomised trial of an online pain rehabilitation program to treat persistent pain after knee replacement for osteoarthritis
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Secondary ID [1]
311789
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Persistent pain after knee replacement for osteoarthritis
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Condition category
Condition code
Physical Medicine / Rehabilitation
329984
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0
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Other physical medicine / rehabilitation
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Anaesthesiology
330302
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0
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Pain management
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Musculoskeletal
330303
330303
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0
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Osteoarthritis
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Kneed group participate in an 8-week self-paced online pain rehabilitation program of education, exercise and strategies to treat pain, reduced function, dysfunctional sleep and stress. The program has been developed by NJ, a Rehabilitation Physician with 20 years + experience in treating pain. Kneed is unsupervised and is entirely online. It consists of written information, downloadable programs, quizzes and videos providing pain neuroscience education and strategies to self-manage pain. There are two introductory modules that take 30 minutes and then Participants can choose which modules they wish to do. Exercise is taught to be self-paced and is low to medium intensity, the time spent doing exercise is encouraged to be 30 minutes a day as a goal (usually walking). There are videos demonstrating balance, strength and range of motion exercises for the knee. It is limited to people living in Australia with internet access. Adherence is not monitored but there is a downloadable goal sheet for exercise and functional activities chosen by the participant. Strategies for pain include pacing, exercise, sleep management, relaxation, progressive muscular relaxation, goal setting and motor imagery. The program is not personalised.
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Intervention code [1]
328238
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Rehabilitation
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Intervention code [2]
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Treatment: Other
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Comparator / control treatment
Usual care - waitlist control. Participants in the usual care group can continue with their current management guided by their GP or clinicians and will be able to participate in the program at the end of 8 weeks.
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Control group
Active
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Outcomes
Primary outcome [1]
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Feasibility
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Assessment method [1]
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Recruitment: %seeing advertisement (page views - Facebook analytics), % clicking through to eligibility survey (Facebook analytics), % eligible (% completing eligibility survey who are eligible/total number completing eligibility survey- recruitment records and survey results), % enrolment (% eligibile and consenting to participate/%eligible - recruitment records ), % starting (% consenting and starting Kneed program/ number consenting - recruitment and program records), % completing 1 hour (% consenting and completing 1 hour/ % consenting - Google analytics)
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Timepoint [1]
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At 8 weeks (intervention group): % completing 1 hour assessed
At the conclusion of the study: recruitment and eligibility
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Primary outcome [2]
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Acceptability
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Assessment method [2]
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a. Page views and time spent on program (google analytics)
b. Qualitative semi-structured interviews - themed qualitative analysis using NVIVO software
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Timepoint [2]
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a. For 8 weeks after starting intervention
b. Following completion of the program
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Primary outcome [3]
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usability
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Assessment method [3]
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MAUQ - mhealth app usability questionnaire
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Timepoint [3]
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At completion - 8 weeks after starting the intervention
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Secondary outcome [1]
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Pain
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Assessment method [1]
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Numerical Rating Scale (NRS)
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Timepoint [1]
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Baseline (at enrolment), 4 weeks and 8 weeks after starting program or waitlist control
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Secondary outcome [2]
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Function
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Assessment method [2]
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Oxford Knee Functional Subscale score
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Timepoint [2]
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Baseline (at enrolment), 4 weeks and 8 weeks after starting program or waitlist control
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Secondary outcome [3]
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Quality of Life
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Assessment method [3]
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Euroqol visual analogue scale
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Timepoint [3]
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Baseline (at enrolment) and 8 weeks after starting program or waitlist control
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Secondary outcome [4]
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Pain
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Assessment method [4]
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Oxford Knee Score Pain Subscale
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Timepoint [4]
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Baseline (at enrolment), 4 weeks and 8 weeks after starting program or waitlist control
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Secondary outcome [5]
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Depression
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Assessment method [5]
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DASS 21
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Timepoint [5]
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Baseline (at enrolment)and 8 weeks after starting program or waitlist control
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Secondary outcome [6]
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Catastrophizing
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Assessment method [6]
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Pain Catastrophizing Scale
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Timepoint [6]
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Baseline (at enrolment) and 8 weeks after starting program or waitlist control
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Secondary outcome [7]
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Pain Self-efficacy
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Assessment method [7]
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Pain Self-Efficacy Questionnaire
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Timepoint [7]
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Baseline (at enrolment)and 8 weeks after starting program or waitlist control
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Secondary outcome [8]
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Patient Global Impression of Change
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Assessment method [8]
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Patient Global Impression of Change Scale
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Timepoint [8]
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8 weeks after starting program or waitlist control
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Secondary outcome [9]
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Anxiety
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Assessment method [9]
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DASS 21
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Timepoint [9]
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Baseline (at enrolment) and 8 weeks after starting program or waitlist control
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Secondary outcome [10]
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Stress
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Assessment method [10]
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DASS21
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Timepoint [10]
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Baseline (at enrolment) and 8 weeks after starting program or waitlist control
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Eligibility
Key inclusion criteria
Persistent pain > 3/10 on Numerical Rating Scale in index knee
>3 months after total knee replacement for osteoarthritis
internet access and email
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Minimum age
18
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
History of rheumatoid or other inflammatory arthritis
Likely to undergo knee or other surgery in the next 3 months
Active illness from any medical condition that makes exercise potentially unsuitable such as unstable angina
Inability to walk within their household
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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)
Sealed, opaque, consecutively numbered envelopes containing the group A or B based on the computer-generated sequence will be used to allocate each participant by a research assistant.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Random permuted blocks of varying length, as recommended by CONSORT, will be employed using Stata Software.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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
For the primary outcome, this program will be considered feasible if the criteria are met for recruitment and the majority of participants find the program usable, completed the introduction modules and spent > 1 hour on the program as above.
For the secondary outcomes, descriptive statistics will be provided to measure the differences between baseline and final outcomes although there will be no tests of significance performed due to the nature of a feasibility trial. Any adverse events occurring will be recorded.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
17/06/2024
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Actual
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Date of last participant enrolment
Anticipated
30/09/2024
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Actual
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Date of last data collection
Anticipated
30/11/2024
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Actual
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Sample size
Target
50
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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Monash University, School of Clinical Sciences
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Address [1]
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Country [1]
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Australia
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Funding source category [2]
316125
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Other Collaborative groups
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Name [2]
316125
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Epworth Monash Rehabilitation Medicine Unit
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Address [2]
316125
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Country [2]
316125
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Australia
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Primary sponsor type
Other Collaborative groups
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Name
Epworth Monash Rehabilitation Medicine Unit
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Address
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
318299
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
314952
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Monash University Human Research Ethics Committee
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Ethics committee address [1]
314952
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https://www.monash.edu/researchoffice/ethics
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Ethics committee country [1]
314952
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Australia
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Date submitted for ethics approval [1]
314952
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11/12/2023
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Approval date [1]
314952
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13/03/2024
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Ethics approval number [1]
314952
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41207
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Summary
Brief summary
Whilst most patients are satisfied with their outcomes after a total knee replacement, moderate to severe persistent knee pain, defined as pain persisting beyond 3 post-operative months following surgery, can affect 25% of people at 6-months. NJ’s PhD studies have found associations of persistent high pain with reduced function, and reduced health related quality of life. Other studies have found that pain persisting after a knee replacement can interfere with walking, general activity and mood and reduced quality of life. A literature review conducted as part of NJ’s PhD (unpublished) found no rehabilitation programs addressing persistent pain after knee replacement. NJ, during his PhD studies, has designed a web-based, self-paced, pain rehabilitation program called Kneed to treat pain, reduced function and reduced quality of life for those with persistent pain after total knee replacement for osteoarthritis. The program consists of pain neuroscience education, exercise, motor imagery, desensitization techniques, relaxation, sleep and cognitive strategies such as goal setting. Educational and other strategies aim to normalize movement patterns (by reducing protective movements) and engage participants in functional activities by empowering behavior change. Kneed is being evaluated for the first time in a research study but has been used by patients under clinical supervision from Dr NJ (a Rehabilitation Physician) in a clinical practice. The potential benefit of Kneed as a digital health solution is to provide low-cost treatment to a broad audience, not limited by location (for example, rural areas and cities without pain management services). There are currently no evidence-based treatments available for this persistent pain condition, Kneed aims to provide one.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof John Olver
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Address
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Epworth Healthcare, Suite 2.4, 32 Erin Street, Richmond, Victoria, Australia 3121
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Country
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Australia
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Phone
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+613 94268771
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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John Olver
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Address
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Epworth healthcare Suite 2.4, 32 Erin Street, Richmond, Victoria Australia, 3121
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Country
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Australia
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Phone
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+613 94268771
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Dr Nathan Johns
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Address
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Epworth Healthcare, Suite 2.4, 32 Erin Street, Richmond, Victoria, Australia, 3121
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Country
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Australia
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Phone
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+613 94268771
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Fax
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Email
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[email protected]
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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?
de-identified PROMS
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When will data be available (start and end dates)?
Data will be available at completion of the study (December 2024) and held for 5 years.
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Available to whom?
Researchers with justification
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Available for what types of analyses?
Meta-analysis, peer review
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How or where can data be obtained?
[email protected]
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
21922
Ethical approval
[email protected]
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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