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

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Health Services Research

Background:

• Over 90,000 total knee replacement (TKR) procedures occur annually in the UK, with significant patient delays causing pain and functional limitations.
• Nearly 20% of TKR patients report dissatisfaction post-surgery, highlighting a need for improved pre-operative care.
• Current pre-operative TKR education and prehabilitation vary widely, lacking definitive evidence for optimal content and delivery.

Purpose of the Study:

• To develop evidence- and consensus-based recommendations for pre-operative total knee replacement (TKR) education and prehabilitation.
• To address the lack of standardized and optimal pre-operative care for TKR patients.
• To improve patient outcomes and satisfaction by optimizing pre-operative TKR strategies.

Main Methods:

• A UK-based, three-round, online modified Delphi study involving 60 expert panellists (30 patients, 30 professionals).
• Initial recommendations were derived from a mixed-methods rapid review, with panellists rating importance and suggesting new items.
• Consensus was reached on items rated 'Important' or 'Very important' by at least 70% of respondents in Round 3.

Main Results:

• Fifty-five panellists completed the study, with 101 items considered across three rounds.
• Seventy-seven items achieved consensus, forming the final set of recommendations.
• The recommendations include 34 education topics, 18 delivery approaches, 10 exercise types, 13 exercise delivery approaches, and two other treatments.

Conclusions:

• A comprehensive set of recommendations for pre-operative TKR education and prehabilitation was developed.
• These recommendations serve as a valuable resource for decision-making in TKR pre-operative care.
• Periodic review and interpretation in light of emerging evidence are necessary.