Effectiveness of Healthy Habits for Hospitalized Older Adults to Optimize Rehabilitation

Pain Clinical Trial

— HH  

Official title:

Effectiveness of Healthy Habits for Hospitalized Older Adults to Optimize Rehabilitation

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04269239
• Other study ID #: H - 45617 HealthyHab
• Status: Recruiting
• Phase: N/A
• Start date: April 30, 2021
• Est. completion date: November 30, 2024

Study information

• Verified date: January 2024
• Source: Baylor College of Medicine
• Contact: Doris Escobedo
• Phone: 713-487-5540
• Email: doris.escobedo[@]bcm.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study aims to evaluate behavioral interventions in conjunction with medical rehabilitation to promote functional health in patients recovering from orthopedic surgery. Half of the subjects in this study will be assigned to an intervention that meets with a study therapist to discuss implementing healthy habits. The other half of subjects will assigned to an intervention group that meets with a study therapists to discuss implementing healthy sleep habits. Both groups will undergo several physical and cognitive assessments.

Description:

Improving healthy habits such as sleep, nutrition or physical activity is expected to enhance rehabilitation in knee or hip arthroplasty patients, by increasing their ability to attend and adhere to rehabilitation recommendations following surgery. Half of the subjects in this study will be assigned to an intervention that meets with a study therapist to discuss implementing healthy habits (physical activity, nutrition, pain-coping techniques, etc). The other half of subjects will assigned to an intervention group that meets with a study therapists to discuss implementing healthy sleep habits. Both groups will undergo several physical and cognitive assessments at baseline (prior to surgery), post-hospital, post-intervention and at a 6 month follow-up visit.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 124
• Est. completion date: November 30, 2024
• Est. primary completion date: August 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 40 Years and older

Eligibility

Inclusion Criteria:

1. Patients with a minimum age of 40 years, no maximum age limit, planning on having a hip or knee arthroplasty.

2. The ability to communicate during the screening process (e.g., no aphasia or other severe language impairment).

3. Meet DSM-5 criteria for insomnia disorder assessed by Duke Structured Interview for Sleep Disorders.

4. Score =8 on the Insomnia Severity Index (ISI) or =5 on the Pittsburgh Sleep Quality Index (PSQI).

5. Referral and attendance of medical rehabilitation post-discharge.

Exclusion Criteria:

1. Evidence of recent severe mental health disorders (e.g., suicide attempt or psychiatric hospitalization in the past year).

2. Presence of psychotic disorder, substance abuse or dependence, or bipolar disorder assessed by MINI International Neuropsychiatric Inventory (to increase generalizability other psychiatric comorbidities such as depression or anxiety will not be excluded).

3. Untreated comorbid sleep disorders based on structured diagnostic interview including:

narcolepsy, periodic leg movement disorder, and/or obstructive sleep apnea risk.

4. Cognitive impairment defined as <20 on the Mini Mental Status Exam (MMSE) that could potentially limit comprehension of the intervention. Note, while an MMSE of <24 is often used as a cutoff for cognitive impairment, we do not wish to exclude those with mild cognitive problems from this study as there is evidence that individuals with mild cognitive problems still benefit from insomnia treatments.

Related Conditions & MeSH terms

• Insomnia
• Osteoarthritis
• Osteoarthritis, Hip
• Osteoarthritis, Knee
• Pain

Intervention

Behavioral:
• Healthy Habits
Participants in this group will be coached during four hour-long sessions on topics such as physical activity, nutrition, pain coping skills, bladder health, diabetes, heart health, eyes/vision, hearing, and doctor-patient communication.
• Sleep Habits
Participants in this group will be coached during four hour-long sessions on topics such as sleep education, sleep restriction, stimulus control, cognitive restructuring, sleep hygiene education, and relapse prevention.

Locations

Country	Name	City	State
United States	University of Texas Medical Branch	Galveston	Texas
United States	Baylor College of Medicine Medical Center	Houston	Texas
United States	Kelsey Seybold Clinic	Houston	Texas

Sponsors (1)

Lead Sponsor	Collaborator
Baylor College of Medicine

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	PROMIS Pain Intensity	The PROMIS Pain Intensity is a 3 question questionnaire that asks participants to rank intensity of past and current pain over the last seven days on a five point scale from 'had no pain' to 'very severe'.	7-14 days before scheduled surgery
Other	PROMIS Pain Intensity	The PROMIS Pain Intensity is a 3 question questionnaire that asks participants to rank intensity of past and current pain over the last seven days on a five point scale from 'had no pain' to 'very severe'.	7-14 days after hospital discharge
Other	PROMIS Pain Intensity	The PROMIS Pain Intensity is a 3 question questionnaire that asks participants to rank intensity of past and current pain over the last seven days on a five point scale from 'had no pain' to 'very severe'.	7-14 days after completing the 8 week intervention period
Other	PROMIS Pain Intensity	The PROMIS Pain Intensity is a 3 question questionnaire that asks participants to rank intensity of past and current pain over the last seven days on a five point scale from 'had no pain' to 'very severe'.	6 months after completing the intervention
Other	PROMIS Pain Interference	The PROMIS Pain Interference is a 6 question questionnaire that ask participants to rank how pain interfered with aspects of their daily life on a five point scale from 'not at all' to 'very much'.	7-14 days before schedule surgery
Other	PROMIS Pain Interference	The PROMIS Pain Interference is a 6 question questionnaire that ask participants to rank how pain interfered with aspects of their daily life on a five point scale from 'not at all' to 'very much'.	7-14 days after hospital discharge
Other	PROMIS Pain Interference	The PROMIS Pain Interference is a 6 question questionnaire that ask participants to rank how pain interfered with aspects of their daily life on a five point scale from 'not at all' to 'very much'.	7-14 days after completing the 8 week intervention period
Other	PROMIS Pain Interference	The PROMIS Pain Interference is a 6 question questionnaire that ask participants to rank how pain interfered with aspects of their daily life on a five point scale from 'not at all' to 'very much'.	6 months after completing the intervention
Other	PROMIS Fatigue	The PROMIS Fatigue questionnaire has 8 questions that ask participants on a five point scale of either 'not at all' to very much' or 'never' to 'always' different statements about fatigue and how it impacted their activities of daily living.	7-14 days before scheduled surgery
Other	PROMIS Fatigue	The PROMIS Fatigue questionnaire has 8 questions that ask participants on a five point scale of either 'not at all' to very much' or 'never' to 'always' different statements about fatigue and how it impacted their activities of daily living.	7-14 days after hospital discharge
Other	PROMIS Fatigue	The PROMIS Fatigue questionnaire has 8 questions that ask participants on a five point scale of either 'not at all' to very much' or 'never' to 'always' different statements about fatigue and how it impacted their activities of daily living.	7-14 days after completing the 8 week intervention period
Other	PROMIS Fatigue	The PROMIS Fatigue questionnaire has 8 questions that ask participants on a five point scale of either 'not at all' to very much' or 'never' to 'always' different statements about fatigue and how it impacted their activities of daily living.	6 months after completing the intervention
Other	PROMIS Emotional Distress-Depressesion	The PROMIS Emotional Distress-Depression questionnaire has 8 questions that asks participants to rank on a five point scale form 'never' to 'always' the frequency of different negative feelings over the past seven days.	7-14 days before scheduled surgery
Other	PROMIS Emotional Distress-Depressesion	The PROMIS Emotional Distress-Depression questionnaire has 8 questions that asks participants to rank on a five point scale form 'never' to 'always' the frequency of different negative feelings over the past seven days.	7-14 days after hospital discharge
Other	PROMIS Emotional Distress-Depressesion	The PROMIS Emotional Distress-Depression questionnaire has 8 questions that asks participants to rank on a five point scale form 'never' to 'always' the frequency of different negative feelings over the past seven days.	7-14 days after completing the 8 week intervention period
Other	PROMIS Emotional Distress-Depressesion	The PROMIS Emotional Distress-Depression questionnaire has 8 questions that asks participants to rank on a five point scale form 'never' to 'always' the frequency of different negative feelings over the past seven days.	6 months after completing the intervention
Other	PROMIS Psychosocial Illness Impact - Negative	The PROMIS Psychosocial Illness Impact - Negative questionnaire has 16 questions that query participants about 8 aspects of psychosocial well being over the past seven days ranked on a five point scale from 'not at all' to 'very much'.	7-14 days before scheduled surgery
Other	PROMIS Psychosocial Illness Impact - Negative	The PROMIS Psychosocial Illness Impact - Negative questionnaire has 16 questions that query participants about 8 aspects of psychosocial well being over the past seven days ranked on a five point scale from 'not at all' to 'very much'.	7-14 days after hospital discharge
Other	PROMIS Psychosocial Illness Impact - Negative	The PROMIS Psychosocial Illness Impact - Negative questionnaire has 16 questions that query participants about 8 aspects of psychosocial well being over the past seven days ranked on a five point scale from 'not at all' to 'very much'.	7-14 days after completing the 8 week intervention period
Other	PROMIS Psychosocial Illness Impact - Negative	The PROMIS Psychosocial Illness Impact - Negative questionnaire has 16 questions that query participants about 8 aspects of psychosocial well being over the past seven days ranked on a five point scale from 'not at all' to 'very much'.	6 months after completing the intervention
Other	PROMIS Satisfaction with Social Roles and Activities	The PROMIS Satisfaction with Social Roles and Activities questionnaire has 4 questions that assess participants satisfaction in their social roles ranked on a five point scale from 'not at all' to 'very much'.	7-14 days before scheduled surgery
Other	PROMIS Satisfaction with Social Roles and Activities	The PROMIS Satisfaction with Social Roles and Activities questionnaire has 4 questions that assess participants satisfaction in their social roles ranked on a five point scale from 'not at all' to 'very much'.	7-14 days after hospital discharge
Other	PROMIS Satisfaction with Social Roles and Activities	The PROMIS Satisfaction with Social Roles and Activities questionnaire has 4 questions that assess participants satisfaction in their social roles ranked on a five point scale from 'not at all' to 'very much'.	7-14 days after completing the 8 week intervention period
Other	PROMIS Satisfaction with Social Roles and Activities	The PROMIS Satisfaction with Social Roles and Activities questionnaire has 4 questions that assess participants satisfaction in their social roles ranked on a five point scale from 'not at all' to 'very much'.	6 months after completing the intervention
Other	PROMIS Ability to Participate in Social Roles and Activity	The PROMIS Ability to Participate in Social Roles and Activity questionnaire has four questions that asks participants about their ability to participate socially ranked on a five point scale from 'not at all' to 'very much'.	7-14 days before scheduled surgery
Other	PROMIS Ability to Participate in Social Roles and Activity	The PROMIS Ability to Participate in Social Roles and Activity questionnaire has four questions that asks participants about their ability to participate socially ranked on a five point scale from 'not at all' to 'very much'.	7-14 days after hospital discharge
Other	PROMIS Ability to Participate in Social Roles and Activity	The PROMIS Ability to Participate in Social Roles and Activity questionnaire has four questions that asks participants about their ability to participate socially ranked on a five point scale from 'not at all' to 'very much'.	7-14 days after completing the 8 week intervention period
Other	PROMIS Ability to Participate in Social Roles and Activity	The PROMIS Ability to Participate in Social Roles and Activity questionnaire has four questions that asks participants about their ability to participate socially ranked on a five point scale from 'not at all' to 'very much'.	6 months after completing the intervention
Other	Rehabilitation Attendance	Weekly rehabilitation attendance will be measured via patient self-report.	From hospital discharge until subject notifies study staff they have stopped attending, on average around 12 weeks.
Other	Plasma IL-6	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Interleukin-6 (IL-6).	7-14 days before scheduled surgery
Other	Plasma IL-6	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Interleukin-6 (IL-6).	7-14 days after hospital discharge
Other	Plasma IL-6	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Interleukin-6 (IL-6).	7-14 days after completing the 8 week intervention period
Other	Plasma IL-6	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Interleukin-6 (IL-6).	6 months after completing the intervention
Other	Plasma CRP	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine C-reactive protein (CRP)	7-14 days before scheduled surgery
Other	Plasma CRP	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine C-reactive protein (CRP)	7-14 days after hospital discharge
Other	Plasma CRP	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine C-reactive protein (CRP)	7-14 days after completing the 8 week intervention period
Other	Plasma CRP	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine C-reactive protein (CRP)	6 months after completing the intervention
Other	Plasma VWF	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine vonWillebrand factor (VWF)	7-14 days before scheduled surgery
Other	Plasma VWF	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine vonWillebrand factor (VWF)	7-14 days after hospital discharge
Other	Plasma VWF	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine vonWillebrand factor (VWF)	7-14 days after completing the 8 week intervention period
Other	Plasma VWF	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine vonWillebrand factor (VWF)	6 months after completing the intervention
Other	Plasma TNFalpha	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Tumor Necrosis Factor alpha (TNFa)	7-14 days before scheduled surgery
Other	Plasma TNFalpha	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Tumor Necrosis Factor alpha (TNFa)	7-14 days after hospital discharge
Other	Plasma TNFalpha	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Tumor Necrosis Factor alpha (TNFa)	7-14 days after completing the 8 week intervention period
Other	Plasma TNFalpha	Blood samples will be taken by study staff to measure circulating proinflammatory cytokine Tumor Necrosis Factor alpha (TNFa)	6 months after completing the intervention
Other	Medication Monitoring Form	Medication Monitoring Form will be used to track medication use. Medications will be coded by drug class.	7-14 days before schedule surgery
Other	Medication Monitoring Form	Medication Monitoring Form will be used to track medication use. Medications will be coded by drug class.	7-14 days after hospital discharge
Other	Medication Monitoring Form	Medication Monitoring Form will be used to track medication use. Medications will be coded by drug class.	7-14 days after completing the 8 week intervention period
Other	Medication Monitoring Form	Medication Monitoring Form will be used to track medication use. Medications will be coded by drug class.	6 months after completing the intervention
Other	Treatment Expectation Questionnaire	This questionnaire 8-question measure provided before treatment. It will be used to collect information on participants' reasons for treatment as well as their expectations of treatment (e.g., its effectiveness, the amount of effort it will take, confidence in their doctor). Participant will mark answers to each question on a visual analog scale (e.g., from Not Confident at all to Very Confident).	Immediately prior to beginning the intervention
Other	Treatment Satisfaction Questionnaire	Treatment Satisfaction Scale is a 10-question measure provided after treatment. It measures participants' perceptions on the treatment's effectiveness, benefits, and influence on quality of life (e.g., improvements in work productivity, mood, etc.). Questions are measured on a 5-point Likert scale from Not at all to Very Much.	Immediately following the completion of the intervention
Primary	Insomnia Severity Index (ISI)	ISI is a questionnaire that provides a clinically meaningful index of insomnia. It is a 7-item validated self-report scale that assesses subjective symptoms of insomnia. Items are scored on a 0-4 scale to yield a score of 0-28. Higher scores indicate greater insomnia severity. A cutoff score of = 8 is optimal to detect clinical levels of insomnia.	7-14 days before scheduled surgery
Primary	Insomnia Severity Index (ISI)	ISI is a questionnaire that provides a clinically meaningful index of insomnia. It is a 7-item validated self-report scale that assesses subjective symptoms of insomnia. Items are scored on a 0-4 scale to yield a score of 0-28. Higher scores indicate greater insomnia severity. A cutoff score of = 8 is optimal to detect clinical levels of insomnia.	7-14 days after hospital discharge
Primary	Insomnia Severity Index (ISI)	ISI is a questionnaire that provides a clinically meaningful index of insomnia. It is a 7-item validated self-report scale that assesses subjective symptoms of insomnia. Items are scored on a 0-4 scale to yield a score of 0-28. Higher scores indicate greater insomnia severity. A cutoff score of = 8 is optimal to detect clinical levels of insomnia.	7-14 days after completing the 8 week intervention period
Primary	Insomnia Severity Index (ISI)	ISI is a questionnaire that provides a clinically meaningful index of insomnia. It is a 7-item validated self-report scale that assesses subjective symptoms of insomnia. Items are scored on a 0-4 scale to yield a score of 0-28. Higher scores indicate greater insomnia severity. A cutoff score of = 8 is optimal to detect clinical levels of insomnia.	6 months after completing the intervention
Primary	Wrist actigraphy	A wearable device will be used to measure participant sleep over seven days.	7-14 days before scheduled surgery
Primary	Wrist actigraphy	A wearable device will be used to measure participant sleep over seven days.	7-14 days after hospital discharge
Primary	Wrist actigraphy	A wearable device will be used to measure participant sleep over seven days.	7-14 days after completing the 8 week intervention period
Primary	Wrist actigraphy	A wearable device will be used to measure participant sleep over seven days.	6 months after completing the intervention
Secondary	PROMIS Physical Function (short form)	The PROMIS physical function short form is a 10 item questionnaire used to assess patient perceived motor abilities. Participants are asked five questions to rank 'from not at all' to 'cannot do' how their health limits their involvement in different activities. Five additional questions ask participants if they are able to complete activities of daily living ranked from 'without any difficulty' to 'unable to do'	7-14 days before scheduled surgery
Secondary	PROMIS Physical Function (short form)	The PROMIS physical function short form is a 10 item questionnaire used to assess patient perceived motor abilities. Participants are asked five questions to rank 'from not at all' to 'cannot do' how their health limits their involvement in different activities. Five additional questions ask participants if they are able to complete activities of daily living ranked from 'without any difficulty' to 'unable to do'	7-14 days after hospital discharge
Secondary	PROMIS Physical Function (short form)	The PROMIS physical function short form is a 10 item questionnaire used to assess patient perceived motor abilities. Participants are asked five questions to rank 'from not at all' to 'cannot do' how their health limits their involvement in different activities. Five additional questions ask participants if they are able to complete activities of daily living ranked from 'without any difficulty' to 'unable to do'	7-14 days after completing the 8 week intervention period
Secondary	PROMIS Physical Function (short form)	The PROMIS physical function short form is a 10 item questionnaire used to assess patient perceived motor abilities. Participants are asked five questions to rank 'from not at all' to 'cannot do' how their health limits their involvement in different activities. Five additional questions ask participants if they are able to complete activities of daily living ranked from 'without any difficulty' to 'unable to do'	6 months after completing the intervention
Secondary	PROMIS Mobility	The PROMIS Mobility questionnaire has 14 questions also used to used to assess patient perceived motor abilities. Participants are asked to respond on a five-point scale from 'without any difficulty' to 'unable to do' about their ability to perform various physical activities.	7-14 days before scheduled surgery
Secondary	PROMIS Mobility	The PROMIS Mobility questionnaire has 14 questions also used to used to assess patient perceived motor abilities. Participants are asked to respond on a five-point scale from 'without any difficulty' to 'unable to do' about their ability to perform various physical activities.	7-14 days after hospital discharge
Secondary	PROMIS Mobility	The PROMIS Mobility questionnaire has 14 questions also used to used to assess patient perceived motor abilities. Participants are asked to respond on a five-point scale from 'without any difficulty' to 'unable to do' about their ability to perform various physical activities.	7-14 days after completing the 8 week intervention period
Secondary	PROMIS Mobility	The PROMIS Mobility questionnaire has 14 questions also used to used to assess patient perceived motor abilities. Participants are asked to respond on a five-point scale from 'without any difficulty' to 'unable to do' about their ability to perform various physical activities.	6 months after completing the intervention
Secondary	Short Physical Performance Battery (SPPB ) motor	The Short Physical Performance Battery (SPPB ) is an objective assessment tool for evaluating lower extremity functioning, developed by the NIA. Motor tests include: a chair stand test, standing balance test (side by side stand, semi-tandem stand, tandem stand.),and gait speed test. The three motor tests are scored and a global score is obtained.	7-14 days before scheduled surgery
Secondary	Short Physical Performance Battery (SPPB ) motor	The Short Physical Performance Battery (SPPB ) is an objective assessment tool for evaluating lower extremity functioning, developed by the NIA. Motor tests include: a chair stand test, standing balance test (side by side stand, semi-tandem stand, tandem stand.),and gait speed test. The three motor tests are scored and a global score is obtained.	7-14 days after hospital discharge
Secondary	Short Physical Performance Battery (SPPB ) motor	The Short Physical Performance Battery (SPPB ) is an objective assessment tool for evaluating lower extremity functioning, developed by the NIA. Motor tests include: a chair stand test, standing balance test (side by side stand, semi-tandem stand, tandem stand.),and gait speed test. The three motor tests are scored and a global score is obtained.	7-14 days after completing the 8 week intervention period
Secondary	Short Physical Performance Battery (SPPB ) motor	The Short Physical Performance Battery (SPPB ) is an objective assessment tool for evaluating lower extremity functioning, developed by the NIA. Motor tests include: a chair stand test, standing balance test (side by side stand, semi-tandem stand, tandem stand.),and gait speed test. The three motor tests are scored and a global score is obtained.	6 months after completing the intervention
Secondary	PROMIS Applied Cognitive Abilities	The PROMIS Applied Cognitive Abilities is a 8 item questionnaire used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a 5 point scale from 'not at all' to 'very much' their perceived cognitive performance over the past seven days.	7-14 days before scheduled surgery
Secondary	PROMIS Applied Cognitive Abilities	The PROMIS Applied Cognitive Abilities is a 8 item questionnaire used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a 5 point scale from 'not at all' to 'very much' their perceived cognitive performance over the past seven days.	7-14 days after hospital discharge
Secondary	PROMIS Applied Cognitive Abilities	The PROMIS Applied Cognitive Abilities is a 8 item questionnaire used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a 5 point scale from 'not at all' to 'very much' their perceived cognitive performance over the past seven days.	7-14 days after completing the 8 week intervention period
Secondary	PROMIS Applied Cognitive Abilities	The PROMIS Applied Cognitive Abilities is a 8 item questionnaire used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a 5 point scale from 'not at all' to 'very much' their perceived cognitive performance over the past seven days.	6 months after completing the intervention
Secondary	PROMIS Applied Cognitive Abilities- General Concerns	The PROMIS Applied Cognitive Abilities is a 6 item questionnaire also used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a five point scale from 'never' to 'very often' the incidence of perceived cognitive impairment over the past seven days.	7-14 days before scheduled surgery
Secondary	PROMIS Applied Cognitive Abilities- General Concerns	The PROMIS Applied Cognitive Abilities is a 6 item questionnaire also used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a five point scale from 'never' to 'very often' the incidence of perceived cognitive impairment over the past seven days.	7-14 days after hospital discharge
Secondary	PROMIS Applied Cognitive Abilities- General Concerns	The PROMIS Applied Cognitive Abilities is a 6 item questionnaire also used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a five point scale from 'never' to 'very often' the incidence of perceived cognitive impairment over the past seven days.	7-14 days after completing the 8 week intervention period
Secondary	PROMIS Applied Cognitive Abilities - General Concerns	The PROMIS Applied Cognitive Abilities is a 6 item questionnaire also used to assess patient perceived cognitive abilities based on self-report. Participants are asked to rank on a five point scale from 'never' to 'very often' the incidence of perceived cognitive impairment over the past seven days.	6 months after completing the intervention
Secondary	Tele-neuropsychology (T-NP) Battery	The T-NP Battery consists of cognitive tests which measure verbal memory, verbal and phonemic fluency, working memory (list sorting, list learning, delayed recall) Cognition tests will be scored.	7-14 days before scheduled surgery
Secondary	Tele-neuropsychology (T-NP) Battery	The T-NP Battery consists of cognitive tests which measure verbal memory, verbal and phonemic fluency, working memory (list sorting, list learning, delayed recall). Cognition tests will be scored.	7-14 days after hospital discharge
Secondary	Tele-neuropsychology (T-NP) Battery	The T-NP Battery consists of cognitive tests which measure verbal memory, verbal and phonemic fluency, working memory (list sorting, list learning, delayed recall). Cognition tests will be scored.	7-14 days after completing the 8 week intervention period
Secondary	Tele-neuropsychology (T-NP) Battery	The TNP Battery consists of cognitive tests which measure verbal memory, verbal and phonemic fluency, working memory (list sorting, list learning, delayed recall). Cognition tests will be scored.	6 months after completing the intervention
Secondary	Activities of Daily Living (ADLs)	The ADL questionnaire measure self-reported activities of daily living (ADLs). The questionnaire assesses need for assistance in 7 activities of daily living (i.e., eating, dressing, grooming, mobility, transferring, bathing, and continence) - questions are answered as "need help" or "don't need help"	7-14 days before scheduled surgery
Secondary	Activities of Daily Living (ADLs)	The ADL questionnaire measure self-reported activities of daily living (ADLs). The questionnaire assesses need for assistance in 7 activities of daily living (i.e., eating, dressing, grooming, mobility, transferring, bathing, and continence) - questions are answered as "need help" or "don't need help"	7-14 days after hospital discharge
Secondary	Activities of Daily Living (ADLs)	The ADL questionnaire measure self-reported activities of daily living (ADLs). The questionnaire assesses need for assistance in 7 activities of daily living (i.e., eating, dressing, grooming, mobility, transferring, bathing, and continence) - questions are answered as "need help" or "don't need help"	7-14 days after completing the 8 week intervention period
Secondary	Activities of Daily Living (ADLs)	The ADL questionnaire measure self-reported activities of daily living (ADLs). The questionnaire assesses need for assistance in 7 activities of daily living (i.e., eating, dressing, grooming, mobility, transferring, bathing, and continence) - questions are answered as "need help" or "don't need help"	6 months after completing the intervention
Secondary	Instrumental ADLs (IADL) scale	The IADL questionnaire is an 8-item scale designed to assesses the need for assistance in telephone use, shopping, food preparation, housekeeping, laundry, transportation, taking medicines and finances. Higher scores indicate greater independence. The questions are answered in a "yes" or "no" format.	7-14 days before scheduled surgery
Secondary	Instrumental ADLs (IADL) scale	The IADL questionnaire is an 8-item scale designed to assesses the need for assistance in telephone use, shopping, food preparation, housekeeping, laundry, transportation, taking medicines and finances. Higher scores indicate greater independence. The questions are answered in a "yes" or "no" format.	7-14 days after hospital discharge
Secondary	Instrumental ADLs (IADL) scale	The IADL questionnaire is an 8-item scale designed to assesses the need for assistance in telephone use, shopping, food preparation, housekeeping, laundry, transportation, taking medicines and finances. Higher scores indicate greater independence. The questions are answered in a "yes" or "no" format.	7-14 days after completing the 8 week intervention period and
Secondary	Instrumental ADLs (IADL) scale	The IADL questionnaire is an 8-item scale designed to assesses the need for assistance in telephone use, shopping, food preparation, housekeeping, laundry, transportation, taking medicines and finances. Higher scores indicate greater independence. The questions are answered in a "yes" or "no" format.	6 months after completing the intervention
Secondary	Sleep Diary	The sleep diary has 9 core items that query: 1) napping, 2) bedtime, 3) time of first attempt to sleep, 4) time to fall asleep, 5) number of awakenings, 6) duration of awakenings, 7) final wake-up time, 8) rise time, 9) a rating of sleep quality, and an optional space for writing comments.	7-14 days before scheduled surgery
Secondary	Sleep Diary	The sleep diary has 9 core items that query: 1) napping, 2) bedtime, 3) time of first attempt to sleep, 4) time to fall asleep, 5) number of awakenings, 6) duration of awakenings, 7) final wake-up time, 8) rise time, 9) a rating of sleep quality, and an optional space for writing comments.	7-14 days after hospital discharge
Secondary	Sleep Diary	The sleep diary has 9 core items that query: 1) napping, 2) bedtime, 3) time of first attempt to sleep, 4) time to fall asleep, 5) number of awakenings, 6) duration of awakenings, 7) final wake-up time, 8) rise time, 9) a rating of sleep quality, and an optional space for writing comments.	During the 8 week intervention
Secondary	Sleep Diary	The sleep diary has 9 core items that query: 1) napping, 2) bedtime, 3) time of first attempt to sleep, 4) time to fall asleep, 5) number of awakenings, 6) duration of awakenings, 7) final wake-up time, 8) rise time, 9) a rating of sleep quality, and an optional space for writing comments.	7-14 days after completing the 8 week intervention period
Secondary	Sleep Diary	The sleep diary has 9 core items that query: 1) napping, 2) bedtime, 3) time of first attempt to sleep, 4) time to fall asleep, 5) number of awakenings, 6) duration of awakenings, 7) final wake-up time, 8) rise time, 9) a rating of sleep quality, and an optional space for writing comments.	6 months after completing the intervention
Secondary	Knee injury and osteoarthritis outcome score (KOOS)	This questionnaire is divided into subscales of pain, symptoms, activities of daily living, sports/recreation and quality of life. Questions about how knee pain affects participant in each of these categories answered on a scale of None, Mild, Moderate, Severe or Extremely.	7-14 days before scheduled surgery
Secondary	Knee injury and osteoarthritis outcome score (KOOS)	This questionnaire is divided into subscales of pain, symptoms, activities of daily living, sports/recreation and quality of life. Questions about how knee pain affects participant in each of these categories answered on a scale of None, Mild, Moderate, Severe or Extremely.	6 months after completing intervention
Secondary	Hip disability and osteoarthritis outcome score (HOOS)	This questionnaire is divided into subscales of pain, symptoms, activities of daily living, sports/recreation and quality of life. Questions about how hip pain affects participant in each of these categories answered on a scale of None, Mild, Moderate, Severe or Extremely.	7-14 days before scheduled surgery
Secondary	Hip disability and osteoarthritis outcome score (HOOS)	This questionnaire is divided into subscales of pain, symptoms, activities of daily living, sports/recreation and quality of life. Questions about how hip pain affects participant in each of these categories answered on a scale of None, Mild, Moderate, Severe or Extremely.	6 months after completing intervention
Secondary	StepWatch	A wearable device will measure physical activity over a seven day period.	7-14 days before scheduled surgery
Secondary	StepWatch	A wearable device will measure physical activity over a seven day period.	7-14 days after hospital discharge
Secondary	StepWatch	A wearable device will measure physical activity over a seven day period.	7-14 days after completing the 8 week intervention period
Secondary	StepWatch	A wearable device will measure physical activity over a seven day period.	6 months after completing the intervention