Anderson Anna M, Comer Christine, Smith Toby O, Drew Benjamin T, Pandit Hemant, Antcliff Deborah, Redmond Anthony C, McHugh Gretl A
Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK.
NIHR Leeds Biomedical Research Centre, Leeds, UK.
BMC Musculoskelet Disord. 2021 Apr 14;22(1):352. doi: 10.1186/s12891-021-04160-5.
Over 90,000 total knee replacement (TKR) procedures are performed annually in the United Kingdom (UK). Patients awaiting TKR face long delays whilst enduring severe pain and functional limitations. Almost 20% of patients who undergo TKR are not satisfied post-operatively. Optimising pre-operative TKR education and prehabilitation could help improve patient outcomes pre- and post-operatively; however, current pre-operative TKR care varies widely. Definitive evidence on the optimal content and delivery of pre-operative TKR care is lacking. This study aimed to develop evidence- and consensus-based recommendations on pre-operative TKR education and prehabilitation.
A UK-based, three-round, online modified Delphi study was conducted with a 60-member expert panel. All panellists had experience of TKR services as patients (n = 30) or professionals (n = 30). Round 1 included initial recommendations developed from a mixed methods rapid review. Panellists rated the importance of each item on a five-point Likert scale. Panellists could also suggest additional items in Round 1. Rounds 2 and 3 included all items from Round 1, new items suggested in Round 1 and charts summarising panellists' importance ratings from the preceding round. Free-text responses were analysed using content analysis. Quantitative data were analysed descriptively. All items rated as 'Important' or 'Very important' by at least 70% of all respondents in Round 3 were included in the final set of recommendations.
Fifty-five panellists (92%) (patients n = 26; professionals n = 29) completed Round 3. Eighty-six recommendation items were included in Round 1. Fifteen new items were added in Round 2. Rounds 2 and 3 therefore included 101 items. Seventy-seven of these reached consensus in Round 3. Six items reached consensus amongst patient or professional panellists only in Round 3. The final set of recommendations comprises 34 education topics, 18 education delivery approaches, 10 exercise types, 13 exercise delivery approaches and two other treatments.
This modified Delphi study developed a comprehensive set of recommendations that represent a useful resource for guiding decision-making on the content and delivery of pre-operative TKR education and prehabilitation. The recommendations will need to be interpreted and reviewed periodically in light of emerging evidence.
在英国，每年进行超过90,000例全膝关节置换术（TKR）。等待TKR的患者面临长时间的延误，同时忍受着剧痛和功能受限。几乎20%接受TKR手术的患者术后不满意。优化术前TKR教育和术前康复可能有助于改善患者手术前后的预后；然而，目前术前TKR护理差异很大。缺乏关于术前TKR护理最佳内容和实施方式的确切证据。本研究旨在制定基于证据和共识的术前TKR教育和术前康复建议。
对一个由60名专家组成的小组进行了一项基于英国的三轮在线改良德尔菲研究。所有小组成员都有作为患者（n = 30）或专业人员（n = 30）参与TKR服务的经验。第一轮包括从混合方法快速综述中得出的初步建议。小组成员用五点李克特量表对每个项目的重要性进行评分。小组成员在第一轮中也可以提出其他项目。第二轮和第三轮包括第一轮中的所有项目、第一轮中提出的新项目以及总结上一轮小组成员重要性评分的图表。使用内容分析法分析自由文本回复。对定量数据进行描述性分析。在第三轮中至少70%的所有受访者评为“重要”或“非常重要”的所有项目都纳入了最终建议集。
55名小组成员（92%）（患者n = 26；专业人员n = 29）完成了第三轮。第一轮纳入了86项建议项目。第二轮增加了15个新项目。因此，第二轮和第三轮包括101个项目。其中77项在第三轮中达成共识。6项仅在患者或专业小组成员的第三轮中达成共识。最终建议集包括34个教育主题、18种教育实施方法、10种运动类型、13种运动实施方法和其他两种治疗方法。
这项改良德尔菲研究制定了一套全面的建议，为指导术前TKR教育和术前康复的内容和实施决策提供了有用的资源。需要根据新出现的证据定期对这些建议进行解释和审查。
