Introducing a specified on-line multimodal prehabilitation approach for total knee replacement surgery candidates using data from the COVID-19 pandemic: An exploratory field-based, pre-post, mixed methods implementation pilot study.

IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Laura Garland, Jamie Gibson, Rashida Pickford, Gareth D Jones
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引用次数: 0

Abstract

Rationale: Individuals waiting for total-knee-replacement surgery are at risk of developing morbidities and frailty which may affect their postoperative recovery. Multi-modal prehabilitation could mitigate these unintentional effects.

Aims and objectives: To implement and evaluate a specified online multi-modal prehabilitation intervention in patients waiting for total-knee-replacement surgery in a large urban acute hospital trust.

Method: A non-randomised, pre/post analysis implementation pilot with a nested qualitative study was conducted and is reported following the standards for implementation studies (StaRI) guidance. Of 35 listed cases, 12 (34%) were eligible, recruited, and completed an 8-week multi-modal online intervention incorporating 5 modalities (i) cardiovascular exercise, (ii) strength/balance function, (iii) smoking cessation, (iv) opioid use, (v) nutritional intake. Interventions were specified using the Rehabilitation Treatment Specification System, where rehabilitation treatment theory accounts for discrete treatment components. Two participated in an online qualitative interview post-intervention. Process evaluation included intervention fidelity, eligibility/recruitment/retention rates, and clinical outcomes included knee function, frailty, gait velocity, anxiety/depression, and quality of life.

Results: Five participants (42%) completed the intervention and were retained at follow-up. The intervention was delivered online at specified doses, frequency/durations indicative of high respective adherence, quantity, and exposure fidelity. There was significant improvement in median oxford knee score (p = 0.015), gait velocity (p = 0.040) and anxiety (p = 0.023). The interview revealed 5 themes; surgery preconceptions, motivation, acceptability, postoperative experiences, and future recommendations confirming acceptance of the intervention by virtue of adhering to the treatment exposure delivered as planned.

Conclusion: The specified multi-modal prehabilitation was acceptable, implementable, and demonstrated evidence of preliminary efficacy. Further experimental pilot work that represents the spectrum of frailty, obesity, quality of life, and comorbidities associated with total-knee-replacement surgery is indicated.

利用 COVID-19 大流行病的数据,为全膝关节置换手术候选者引入特定的在线多模式康复训练方法:一项基于现场的探索性、前后混合法实施试点研究。
理论依据:等待全膝关节置换手术的患者有可能出现病态和虚弱,这可能会影响他们的术后恢复。多模式康复训练可减轻这些意外影响:目的:对一家大型城市急症医院中等待全膝关节置换手术的患者实施特定的在线多模式康复干预并进行评估:方法:开展了一项非随机、前/后分析实施试点,并进行了嵌套定性研究,报告遵循了实施研究标准(StaRI)指南。在列出的 35 个病例中,有 12 个(34%)符合条件、被招募并完成了为期 8 周的多模式在线干预,其中包含 5 种模式:(i) 心血管锻炼;(ii) 力量/平衡功能;(iii) 戒烟;(iv) 阿片类药物的使用;(v) 营养摄入。干预措施采用康复治疗规范系统,其中康复治疗理论说明了离散治疗的组成部分。两人参加了干预后的在线定性访谈。过程评估包括干预的忠实度、资格/招募/保留率,临床结果包括膝关节功能、虚弱程度、步速、焦虑/抑郁和生活质量:结果:五名参与者(42%)完成了干预,并在随访中保留了下来。干预以规定的剂量、频率/次数在线进行,表明各自的依从性、数量和暴露忠实度都很高。牛津膝关节中位数评分(p = 0.015)、步速(p = 0.040)和焦虑(p = 0.023)均有明显改善。访谈揭示了 5 个主题:手术前概念、动机、可接受性、术后体验和未来建议,通过坚持按计划进行治疗暴露,证实了对干预的接受程度:结论:指定的多模式术前康复训练是可接受的、可实施的,并证明了初步疗效。需要进一步开展实验性试点工作,以反映与全膝关节置换手术相关的各种虚弱、肥胖、生活质量和合并症。
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来源期刊
CiteScore
4.80
自引率
4.20%
发文量
143
审稿时长
3-8 weeks
期刊介绍: The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
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