Omar Ifrah, Wylde Vikki, Fogg Jodie, Whitehouse Michael, Bertram Wendy
Bristol Medical School, University of Bristol, Bristol, UK.
National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
BMC Musculoskelet Disord. 2025 Apr 29;26(1):421. doi: 10.1186/s12891-025-08637-5.
Over 215,000 total hip replacements (THRs) and total knee replacements (TKRs) take place annually in the UK. Joint replacement has the longest waiting times of elective surgical treatments, with some patients waiting up to two years for surgery in the NHS. Pre-operative education and support interventions could improve both pre-operative health and optimise post-operative outcomes. However, current pre-operative NHS service provision is heterogenous and poorly described. This study aimed to describe the current services and care provided to patients on NHS waiting lists for THR and TKR.
A link to a national online survey about pre-operative education and prehabilitation was sent to relevant healthcare professionals involved in the pre-operative care of patients waiting for THR or TKR surgery at a sample of high-, mid- and low-volume NHS hospitals in the UK. Participants were asked questions about what pre-operative education and pre-habilitation services were offered at their hospital, and any barriers or facilitators to delivering care. Frequency statistics were used to describe categorical data and free-text data were coded into categories.
Responses were received from 29 UK hospitals across seven regions. Pre-operative education was provided to patients at 28 hospitals, primarily at single session talks supplemented with booklets. Prehabilitation was provided to patients waiting for TKR at 17 hospitals and to patients waiting for THR at 14 hospitals. It comprised strengthening exercises and advice with written information. Three hospital respondents did not know if prehabilitation was provided before TKR and four hospitals before THR. Barriers to service provision include funding, staffing, facilities, and lack of awareness/evidence on how best to deliver services.
Prehabilitation services are not provided for all patients waiting for arthroplasty. Future work is needed to design and evaluate prehabilitation resources to optimise pre-operative health and improve patient outcomes after TKR and THR.
在英国，每年进行超过21.5万例全髋关节置换术（THR）和全膝关节置换术（TKR）。关节置换术在择期手术治疗中等待时间最长，在英国国家医疗服务体系（NHS）中，一些患者等待手术的时间长达两年。术前教育和支持干预措施可以改善术前健康状况并优化术后结果。然而，目前NHS的术前服务提供情况参差不齐且描述不佳。本研究旨在描述目前为NHS等待THR和TKR手术名单上的患者提供的服务和护理情况。
向英国高、中、低手术量的NHS医院样本中参与等待THR或TKR手术患者术前护理的相关医疗专业人员发送了一份关于术前教育和预康复的全国在线调查问卷链接。参与者被问及他们医院提供了哪些术前教育和预康复服务，以及提供护理的任何障碍或促进因素。使用频率统计来描述分类数据，并将自由文本数据编码为类别。
收到了来自英国七个地区29家医院的回复。28家医院为患者提供了术前教育，主要是通过单次讲座并辅以小册子。17家医院为等待TKR的患者提供了预康复服务，14家医院为等待THR的患者提供了预康复服务。预康复包括强化锻炼和书面信息建议。三名医院受访者不知道在TKR之前是否提供了预康复服务，四名医院受访者不知道在THR之前是否提供了预康复服务。服务提供的障碍包括资金、人员配备、设施以及缺乏关于如何最佳提供服务的认识/证据。
并非所有等待关节置换术的患者都能获得预康复服务。未来需要开展工作来设计和评估预康复资源，以优化术前健康状况并改善TKR和THR术后的患者结局。
