Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study

Abstract

Background Over 90,000 total knee replacement (TKR) procedures are performed annually in the United Kingdom (UK). Patients awaiting TKR face long delays whilst enduring severe pain and functional limitations. Almost 20% of patients who undergo TKR are not satisfied post-operatively. Optimising pre-operative TKR education and prehabilitation could help improve patient outcomes pre- and post-operatively; however, current pre-operative TKR care varies widely. Definitive evidence on the optimal content and delivery of pre-operative TKR care is lacking. This study aimed to develop evidence- and consensus-based recommendations on pre-operative TKR education and prehabilitation. Methods A UK-based, three-round, online modified Delphi study was conducted with a 60-member expert panel. All panellists had experience of TKR services as patients (n = 30) or professionals (n = 30). Round 1 included initial recommendations developed from a mixed methods rapid review. Panellists rated the importance of each item on a five-point Likert scale. Panellists could also suggest additional items in Round 1. Rounds 2 and 3 included all items from Round 1, new items suggested in Round 1 and charts summarising panellists’ importance ratings from the preceding round. Free-text responses were analysed using content analysis. Quantitative data were analysed descriptively. All items rated as ‘Important’ or ‘Very important’ by at least 70% of all respondents in Round 3 were included in the final set of recommendations. Results Fifty-five panellists (92%) (patients n = 26; professionals n = 29) completed Round 3. Eighty-six recommendation items were included in Round 1. Fifteen new items were added in Round 2. Rounds 2 and 3 therefore included 101 items. Seventy-seven of these reached consensus in Round 3. Six items reached consensus amongst patient or professional panellists only in Round 3. The final set of recommendations comprises 34 education topics, 18 education delivery approaches, 10 exercise types, 13 exercise delivery approaches and two other treatments. Conclusions This modified Delphi study developed a comprehensive set of recommendations that represent a useful resource for guiding decision-making on the content and delivery of pre-operative TKR education and prehabilitation. The recommendations will need to be interpreted and reviewed periodically in light of emerging evidence.

Physiotherapy in an advanced rehabilitation pathway for patients after hip and knee arthroplasty: A proposal

“…There is a lack of evidence of the physiotherapy protocol in the ARP (Anderson et al 2021). Thus, the proposed study investigates the physiotherapy protocol on how early mobilisation and increased frequency of physiotherapy treatments, that is, twice per day, for participants after hip or knee arthroplasty surgery on POD 0 in a private hospital in SA…”

Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review

“…• Rapid reviews generally produce similar conclusions to systematic reviews [23]. • The review had to be completed in a defined period of time because its findings were required to inform the online modified Delphi study mentioned above [21].…”

THE IMPACT: Education Level Has a Relativity for The Recovery of Total Knee Arthroplasty: a meta-analysis of randomized controlled trials

“…while the junior high school patients have received a complete 9-year compulsory education, it is meaningful to be set as a group alone. In this study, the patients were divided into four groups: illiterate, elementary school, junior high school and high school above level, which was in line with the educational status in western China in the 1960s [6] and was a more reasonable classi cation.…”

“…The main grumbles of the patients after osteoarthritis are mainly about the pains and the restricted range of motion [5] (ROM). The limitation in function accompanied by increasing pain will eventually affects the patient's well-being which is not only social but emotional, which doesn`t meet the primary propose of TKA by alleviating pain and majorization physical function and quality of life [6,7] .…”