Active Wait: Feasibility of health coaching targeting patients with low activation waiting for total hip or total knee replacement

Objectives

To explore the feasibility and acceptability of health coaching compared to an online self-management programme (Active Wait) for patients with low activation awaiting total hip or knee replacement.

Design

Mixed-methods feasibility study using an exploratory randomised controlled trial with a nested qualitative component.

Setting

Single-centre study conducted in (sites anonymised).

Participants

Fifty adults (mean 65 (SD 2) years old) awaiting a total hip or knee replacement with low activation (patient activation measure 1 or 2) were randomly assigned to health coaching (n=25) or Active Wait (n=25).

Interventions

The health coaching group received up to 8 sessions over 12-weeks, delivered in-person or remotely and tailored to individual needs. The Active Wait group had access to a 12-week self-management programme with prehabilitation guidance.

Main outcome measures

Primary outcomes were feasibility (recruitment, retention and adherence) and acceptability (participant satisfaction and perceived benefit). Secondary outcomes included patient activation and quality of life.

Results

Recruitment (50/89, 56%) and adherence to health coaching (78/88, 89%) were successful, but follow-up retention for both groups was below target (33/55, 66%). Health coaching reported higher benefit (6%), enjoyment (14%), and satisfaction (7%) compared to Active Wait. Health coaching improved patient activation (19%) and perceived overall health (15%) compared to baseline, whereas Active Wait saw negligible effects (5% and -2% respectively). Semi-structured interviews highlighted the personalised and supportive nature of health coaching, reducing anxiety and enhancing self-management.

Conclusion

Health coaching is feasible and acceptable for patients with low activation. The findings from this preliminary study are important to inform the design of a larger trial.

Contribution of paper

• Reports on the feasibility and acceptability of a health coaching intervention for people waiting for lower limb joint arthroplasty.

• Examines the impact of health coaching compared with a digital prehabilitation resource on self-reported quality of life, mobility, pain and activation amongst a sample of people waiting for lower limb joint arthroplasty.

• Explores the experience of arthroplasty prehabilitation amongst a team of health coaches and research participants.