Generalizability of the Progressive Resistance Training versus Total Hip Arthroplasty (PROHIP) trial: a cross-sectional study of 402 patients in Denmark

• Published in: Acta orthopaedica Vol. 96; p. 698
• Main Authors: Frydendal, Thomas, Christensen, Robin, Mechlenburg, Inger, Mikkelsen, Lone Ramer, Varnum, Claus, Bieder, Manuel Josef, Jakobsen, Stig Storgaard, Overgaard, Søren, Ingwersen, Kim Gordon
• Format: Journal Article
• Language: English
• Published: Sweden Medical Journals Sweden 17.09.2025
• Subjects: Aged; Arthroplasty; Arthroplasty, Replacement, Hip - methods; Cross-Sectional Studies; Denmark; Exercise; Female; Hip; Humans; Male; Middle Aged; Osteoarthritis; Osteoarthritis, Hip - rehabilitation; Osteoarthritis, Hip - surgery; Osteoarthritis, Hip - therapy; Patient Reported Outcome Measures; Resistance Training - methods; Treatment Outcome; Denmark
• ISSN: 1745-3682; 1745-3674; 1745-3682
• DOI: 10.2340/17453674.2025.44756

 There is ongoing debate over whether results from randomized trials assigning patients to surgery or first-line treatment can be generalized to clinical practice. Therefore, we aimed to compare patients with hip osteoarthritis accepting enrollment in the Progressive Resistance Training versus Total Hip Arthroplasty (PROHIP) trial in Denmark with those declining (enrolled in an observational cohort [non-PROHIP]).  We used a cross-sectional study design to compare demographics and patient-reported outcomes among patients eligible for enrollment in the PROHIP trial. We used the standardized difference (StdDiff), the absolute difference with 95% confidence interval (CI), and the propensity (odds ratio [OR]) of accepting participation in the PROHIP trial to assess imbalances between groups. We pre-specified that StdDiff values < 0.2 indicated a negligible difference, whereas values ≥ 0.8 indicated incomparability. 402 patients were included, with 109 in the PROHIP trial and 293 in the non-PROHIP cohort. Patients enrolled in the PROHIP trial had a mean (standard deviation [SD]) Oxford Hip Score at baseline of 25.1 (SD 5.9) compared with 22.6 (SD 6.9) in the non-PROHIP cohort (between-group difference, 2.5 points [CI 1.1-4.0], StdDiff 0.4, OR 1.06 [CI 1.02-1.10]). This pattern was consistent across almost all secondary patient-reported outcomes applied in the PROHIP trial. For most demographic variables, there were negligible between-group differences at baseline.  We found minimal imbalances in some baseline demographic variables and most patient-reported outcomes, with those who accepted enrollment in the PROHIP trial having more favorable outcomes at recruitment than those who declined. However, most differences were not clinically important.