In a systematic review published in Disability and Rehabilitation, PhD candidate Lyndon Hawke examined what we know about the effectiveness of behavioural interventions that aim to increase levels of physical activity after hip or knee joint replacement.
Replacing an osteoarthritic hip or knee is often thought to remove a significant barrier to engaging in many forms of exercise. However, after undergoing joint replacement surgery many people fail to meet daily physical activity guidelines. One explanation of this is that people’s physical activity levels are aligned more closely with behavioral factors than levels of pain or physical function.
This leaves us with the question: What do we currently know about the effectiveness of interventions that aim to modify these behavioral factors? The review aimed to answer this question by drawing together information from five randomized controlled trials. Some of the interventions evaluated in these trials included motivational exercise counselling, physical activity feedback using wearable activity sensors, and telephone health coaching. The review found that our best available evidence leaves us uncertain about the effectiveness of such programs. We simply don’t yet know whether behavioral interventions work in this context. High quality trials with larger sample sizes would be needed to resolve this uncertainty.
So why were the results of these studies not more positive? In the review, a few possibilities were discussed. As none of the studies reported on processes that ensured intervention fidelity, it is possible that the programs were not appropriately implemented. Some of the studies also allocated less time to these interventions than is generally thought to be necessary when trying to cause meaningful behavioral changes to physical activity levels. One of the important takeaways from the review was that behavioral interventions may be more effective if greater attention was paid to the timing, duration and fidelity of these programs.
To find out more, you can find the complete publication here.