Does face-to-face pre-operative joint replacement education reduce hospital costs in a regional Australian hospital? A descriptive retrospective clinical audit

Implementation of +PERTO® in Rehabilitation for Total Knee Arthroplasty: A Pilot Study

BACKGROUND/OBJECTIVES

Total knee Arthroplasty (TKA) is a prevalent treatment modality for degenerative knee diseases. Nevertheless, the success of the intervention is contingent on effective rehabilitation. The +PERTO® program (a Technological Rehabilitation Nursing Program) was developed as a mobile application comprising three phases to support patients during the perioperative period by providing exercises, information, and direct communication with healthcare professionals. The present study aims to evaluate the effects and usability of the +PERTO® program in patients undergoing total knee arthroplasty.

METHODS

In 2024, a hospital in northern Portugal conducted a pilot trial with eleven patients undergoing elective total knee arthroplasty. Researchers collected data both before surgery and six weeks after discharge. To evaluate effectiveness, software satisfaction, and usability, they used several assessment tools, including the Oxford Knee Score (OKS), SF-36v2, Visual Analog Scale (VAS), Short Physical Performance Battery (SPPB), QSEnf-10, and System Usability Scale (SUS). Researchers analyzed the data using both descriptive and inferential statistics. The hospital's ethics committee and board of directors approved the study.

RESULTS

There was a significant reduction in pain (p = 0.041) and improvement in knee functionality (p = 0.010), physical performance (p = 0.038), and quality of life (p < 0.05). Patient satisfaction was high (QSEnf-10: 3.8/4), and the usability of +PERTO® was considered excellent (SUS: 96.6/100).

CONCLUSIONS

The +PERTO® program proved to be an effective and innovative solution to support rehabilitation after TKA, promoting improvements in pain, functionality, and quality of life. This digital program stands out for its high rate of usability and its ability to modernize healthcare by providing a patient-centered approach.

Operationalising routinely collected patient data in research to further the pursuit of social justice and health equity: a team-based scoping review

BACKGROUND

Vast volumes of routinely collected data (RCD) about patients are collated by health professionals. Leveraging this data - a form of real-world data - can be valuable for quality improvement and contributing to the evidence-base to inform practice. Examining routine data may be especially useful for examining issues related to social justice such as health inequities. However, little is known about the extent to which RCD is utilised in health fields and published for wider dissemination.

OBJECTIVES

The objective of this scoping review is to document the peer-reviewed published research in allied health fields which utilise RCD and evaluate the extent to which these studies have addressed issues pertaining to social justice.

METHODS

An enhanced version of the Arksey and O'Malley's framework, put forth by Westphalm et al. guided the scoping review. A comprehensive literature search of three databases identified 1584 articles. Application of inclusion and exclusion criteria was piloted on 5% of the papers by three researchers. All titles and abstracts were screened independently by 2 team members, as were full texts. A data charting framework, developed to address the research questions, was piloted by three researchers with data extraction being completed by the lead researcher. A sample of papers were independently charted by a second researcher for reliability checking.

RESULTS

One hundred and ninety papers were included in the review. The literature was diverse in terms of the professions that were represented: physiotherapy (33.7%) and psychology/mental health professions (15.8%) predominated. Many studies were first authored by clinicians (44.2%), often with clinical-academic teams. Some (33.25%) directly referenced the use of their studies to examine translation of research to practice. Few studies (14.2%) specifically tackled issues pertaining to social justice, though many collected variables that could have been utilised for this purpose.

CONCLUSION

Studies operationalising RCD can meaningfully address research to practice gaps and provide new evidence about issues related to social justice. However, RCD is underutilised for these purposes. Given that vast volumes of relevant data are routinely collected, more needs to be done to leverage it, which would be supported by greater acknowledgement of the value of RCD studies.

Systematic review and narrative description of the outcomes of group preoperative education before elective major surgery

Background

Group preoperative education is becoming standard care for patients preparing for surgery, alongside optimisation of exercise, diet, and wellbeing. Although patient education is essential, the effectiveness of group education programmes or 'surgery schools' as a means of delivery is unclear. This review examines whether attending group preoperative education improves patient outcomes.

Methods

We systematically reviewed studies of group perioperative education before major elective surgery. Observational or intervention studies with a baseline group or control arm were included. All outcomes reported were collected and, where possible, effect estimates were summarised using random effects meta-analysis.

Results

Twenty-seven studies reported on 48 different outcomes after group education. Overall, there was a 0.7 (95% confidence interval 0.27-1.13) day reduction in mean length of stay. The odds ratio for postoperative complications after abdominal surgery was 0.56 (95% confidence interval 0.36-0.85; nine studies). Patient-centred outcomes were grouped into themes. Most studies reported a benefit from group education, but only postoperative physical impairment, pain, knowledge, activation, preoperative anxiety, and some elements of quality of life were statistically significant.

Conclusion

This review presents a summary of published evidence available for group preoperative education. While these data lend support for such programmes, there is a need for adequately powered prospective studies to evaluate the effectiveness of preoperative education on clinical outcomes and to evaluate whether behaviour change is sustained. Furthermore, the content, timing and mode of delivery, and evaluation measures of preoperative education require standardisation.

Systematic review protocol

PROSPERO (166297).

Does Participation in Virtual or In-Person Preoperative Education Relate to Reduced Length of Stay After Total Joint Arthroplasty?

Background

Advancements in surgical procedures for total joint arthroplasty (TJA) have resulted in more effective procedures with more rapid recovery. To prepare patients for surgery, many organizations offer a preoperative "joint class," which has been associated with reduced length of stay (LOS). Virtual modes of education are increasingly favored for those having TJA.

Purpose

To determine whether participation in an individually administered preoperative educational session ("Prehab") relates to reduced LOS or increased likelihood of same-day discharge (SDD) for those undergoing TJA. Additionally, to establish whether and the virtual mode of education provision is superior or inferior to the in-person mode with regards to LOS benefits.

Methods

The author conducted a case-control study of 2532 patients who had a primary or revision TJA between January 2022 and August 2022 at a single institution. Data were obtained from the electronic medical record. A total of 1118 patients attended Prehab; 1414 patients did not. Patients were included if they were over the age of 18 and had a total hip arthroplasty (THA) or total knee arthroplasty (TKA) during the study period. T-tests, chi-square χ2 tests, and binomial logistic regression were used to evaluate the LOS and SDD outcomes for those who participated in Prehab compared with those who did not.

Results

Those receiving Prehab in any form had shorter LOS than those who had not. Those receiving virtual Prehab had the shortest LOS. There was no difference in the rate of SDD for outpatient-class patients.

Conclusion

Preoperative education is associated with LOS benefits to patients undergoing TJA. The virtual mode of education provision is at minimum non-inferior, and may be superior, to the in-person mode. The lack of statistically significant between-group differences for SDD outcomes may be explained by a lack of SDD-specific educational content provided during Prehab.

A scoping review of prehabilitation interventions for arthroplasty patients

Background

Osteoarthritis (OA) is a long-term condition that causes significant impairment, and because of the increasing prevalence of OA, the demand for arthroplasty will continue to rise. However, the demand will not be matched by availability, because of prioritisation of trauma-related surgeries. Implementing prehabilitation could assist physiotherapists in having an impact on improving access by reducing the length of stay.

Objectives

The aim of our scoping review was to explore, map and identify trends and gaps to better inform the content of a prehabilitation programme.

Method

In our scoping review, studies between 1995 and 2020 were identified and included based on inclusion and exclusion criteria and study methodology described by Arksey and O'Malley. The results were collated and summarised as a narrative synthesis.

Results

A total of 200 articles were identified and exported from four databases of which 48 articles were included in the final analysis. Regarding the efficacy of prehabilitation interventions, 21 studies reported significant results supporting prehabilitation, whereas 11 studies reported non-significant results.

Conclusions

Prehabilitation could be a valuable adjunct in reducing length of hospital stay and improving functional outcomes in adults undergoing total joint replacement.

Clinical implications

The scoping review described the information available on prehabilitation in lower limb arthroplasty patients and could potentially inform the design of a prehabilitation programme suitable for use in the South African public health context.

Modifiable factors influencing length of stay after total knee arthroplasty

PURPOSE

This cohort study aims to investigate the current Rapid-Recovery-(RR)-pathway at an orthopaedic surgery hospital centre and to identify preoperative, intraoperative, and postoperative factors that are significantly associated with prolonged hospital Length of Stay (LOS) after total knee arthroplasty (TKA).

METHOD

A total of 194 patients undergoing primary TKA were included in this retrospective study. Sociodemographic data documented were age, gender, body mass index, living situation, and the clinical diagnosis. Factors affecting patient constitution and laboratory data for serum level of Hb and CRP were assessed preoperatively and postoperatively. In addition, we collected patients' data for attendance of patient education, planned discharge to rehabilitation facilities, and levels of postoperative pain.

RESULTS

In univariate group comparisons, prolonged LOS was significantly associated with increased age, elevated C-reactive-Protein-level, and decreased haemoglobin level. Patients experiencing prolonged LOS also showed significant association with higher prevalence of comorbidities, female gender, living as widow, preoperative anticoagulation, requirement of blood transfusion, and planned discharge to rehabilitation facilities. However, after multivariate logistic regression, only planned discharge to rehabilitation facility, non-attendance of preoperative patient education, female gender, and increased pain levels were identified as significant predictors for prolonged LOS.

CONCLUSION

Efficient pain therapy and thorough patient education have a positive effect on treatment outcome after TKA in a RR-setting.