Opportunities to optimise care and choice in joint replacement surgery using a digitally delivered, holistic PreHab pathway

Eleanor R Bills; Anastasia Dimopoulos; Anne Lj Burke; Kathryn L Collins; Ecushla C Linedale; Vicki Hume; Jackie Yeoh; Sharyn Coles; Mandy Nolan; Kate Southam; Lesley Thomas; Melanie Ramsey; Jane M Andrews

doi:10.1177/10225536241234032

Opportunities to optimise care and choice in joint replacement surgery using a digitally delivered, holistic PreHab pathway

J Orthop Surg (Hong Kong). 2024 May-Aug;32(2):10225536241234032. doi: 10.1177/10225536241234032.

Authors

Eleanor R Bills¹, Anastasia Dimopoulos¹, Anne Lj Burke², Kathryn L Collins², Ecushla C Linedale^{3

4}, Vicki Hume⁵, Jackie Yeoh⁶, Sharyn Coles¹, Mandy Nolan⁷, Kate Southam⁸, Lesley Thomas⁹, Melanie Ramsey⁸, Jane M Andrews^{1

4}

Affiliations

¹ Surgery Program, Central Adelaide Local Health Network, Adelaide, AU-SA, Australia.
² School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, AU-SA, Australia.
³ Health Translation SA, South Australian Health and Medical Research Institute, Adelaide, AU-SA, Australia.
⁴ School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, AU-SA, Australia.
⁵ Cancer Program, Central Adelaide Local Health Network, Adelaide, AU-SA, Australia.
⁶ Adelaide Primary Healthcare Network, Adelaide, AU-SA, Australia.
⁷ Allied Health, Calvary Adelaide Hospital, Adelaide, AU-SA, Australia.
⁸ Orthopaedic and Trauma Services, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, AU-SA, Australia.
⁹ Orthopaedic Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, AU-SA, Australia.

PMID: 38767054
DOI: 10.1177/10225536241234032

Abstract

Purpose: To describe the implementation and evaluation of a hospital-initiated, community-based, digital prehabilitation program (My PreHab Program: MPP) for adults referred for elective joint replacement.

Methods: MPP was implemented July 2022 and comprises a personalised digital health screen that guides the provision of self-management resources. Adults (>18 years) referred and accepted, or already waitlisted, for total knee/hip replacement surgery were eligible. Individuals requiring category 1 (urgent) or emergency surgery and those without a mobile phone were excluded. Implementation and intervention outcome measures (program adoption, equity of reach, fidelity, acceptability, appropriateness, feasibility, engagement, preliminary surgical outcomes) were explored via study-specific measures and hospital records.

Results: Of those invited (N = 689), 77.8% participated. Participants and non-participants were similar in key demographic variables except regional invitees were more likely to participate than metropolitan (88.0% vs 75.4%, p = .002) and non-participants tended to be older (median age = 69.0 vs 64.0, p = .005). Participants reported on average four modifiable risk factors: most commonly chronic pain (79.1%), obesity (57.3%), and frailty (40.9%). Most participants (80.4%) reviewed all resources provided and reported action/intention to address issues identified (90.9%). Participants perceived MPP as acceptable (3.2/5), appropriate (3.3/5), and feasible (3.4/5). Early trends for participants progressing to surgery (n = 33) show a reduced length of stay (MPP = 4.3, baseline = 5.3 days).

Conclusion: MPP demonstrated high adoption, fidelity, and participant engagement. It is acceptable, appropriate and feasible and has the potential to be scaled-up digitally at low-cost. Modifiable risk factors were prevalent and early indications suggest this preoperative intervention may benefit both patients and the healthcare system.

Keywords: arthroplasty; health promotion; length of stay; patients; perioperative medicine; postoperative complications; state medicine.

MeSH terms

Aged
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee*
Female
Humans
Male
Middle Aged
Preoperative Exercise