Prehabilitation for frail patients undergoing hip and knee replacement in the UK: Joint PREP feasibility study for a randomised controlled trial

Khalid, Tanzeela, Ben-Shlomo, Yoav, Bertram, Wendy, Culliford, Lucy, Henderson, Emily J., Jepson, Marcus, Johnson, Emma, Mitchell, Alexandra, Palmer, Shea ORCID: https://orcid.org/0000-0002-5190-3264, Evans, Jonathan T., Whitehouse, Michael R. and Wylde, Vikki 2024. Prehabilitation for frail patients undergoing hip and knee replacement in the UK: Joint PREP feasibility study for a randomised controlled trial. BMJ Open 14 (9) , e084678. 10.1136/bmjopen-2024-084678

Preview

PDF - Published Version Available under License Creative Commons Attribution. Download (1MB) | Preview

Abstract

Objective: To determine the feasibility of conducting a randomised controlled trial (RCT) to evaluate a prehabilitation programme for frail patients undergoing total hip replacement (THR) or total knee replacement (TKR). Design: Randomised feasibility study with embedded qualitative work. Setting: Three NHS hospitals. Participants: Adults aged ≥65 years, frail and scheduled for primary THR or TKR. Intervention: Appointment with a physiotherapist to individualise a home-based exercise programme. Participants were encouraged to do the home exercises daily for 12 weeks pre-operative and were provided with a daily protein supplement. Participants were supported by six telephone calls over the 12-week intervention period. Outcome measures: Eligibility and recruitment rates, intervention adherence, data completion rates of patient-reported outcome measures, retention rates and acceptability of the trial and intervention. Qualitative interviews were conducted with participants and non-participants and analysed using thematic analysis. Results: Between December 2022 and August 2023, 411 patients were sent a screening pack. Of the 168 patients who returned a screening questionnaire, 79 were eligible and consented to participate, and 64 were randomised. Of the 33 participants randomised to the intervention, 26 attended the intervention appointment. Eighteen participants (69%) received all six intervention follow-up telephone calls. Nineteen participants (73%) completed an intervention adherence log; 13 (68%) adhered to the exercise programme and 11 (58%) adhered to the protein supplementation. The overall retention rate was 86% (55/64 overall) at 12 weeks. The 12-week follow-up questionnaire was returned by 46 of the 55 participants (84%) who were sent a questionnaire. Interviews with 19 patients found that the trial processes and intervention were generally acceptable, but areas of potential improvements were identified. Conclusions: This study demonstrated that a larger study is possible and has identified improvements to optimise the design of a RCT.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Healthcare Sciences
Subjects:	R Medicine > R Medicine (General)
Publisher:	BMJ Publishing Group
Funders:	National Institute for Health & Care Research, Research for Patient Benefit (RfPB)
Date of First Compliant Deposit:	18 September 2024
Date of Acceptance:	21 August 2024
Last Modified:	03 Oct 2024 14:19
URI:	https://orca.cardiff.ac.uk/id/eprint/171769

Actions (repository staff only)

Edit Item