Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study

Abstract

Background An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. Methods Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. Results Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. Conclusions Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.

Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study

“…In this context, research has focused on the orthopedic clinician's use of digital technologies [1,17], for instance, in supporting their educational development [18], guiding clinical decision support [19], managing care referrals [20], and building the patient-clinician relationship [21,22]. Recognizing and understanding the potential unmet needs of elective orthopedic surgery patients is central to motivating healthier behavior change, improving their recovery, and optimizing overall surgical success in the short and long term [23][24][25].…”

Introducing Virtual Prehabilitation to a UK Elective Total Hip Replacement service to improve patient outcomes: An overview of the literature and proposed implementation plan

“…The literature review provides moderate evidence prehabilitation improves patient outcomes when undergoing elective THR surgery 21-23 and strong evidence virtual services are effective, feasible, and acceptable to patients. 20-22,25,26…”

Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review

“…Conversely, three participants did not recommend pre-operative physiotherapy because they did not find it helpful or felt that the same exercises could be obtained online [75]. In a qualitative study by Sharif et al [84], health professionals identified that web-based written information, mobile health, and remote monitoring technologies could play a role in pre-operative exercise provision, encouragement, and/or monitoring.…”

“…Furthermore, the COVID-19 pandemic has highlighted the need for remote models of care [104,105]. Using digital tools to deliver TKR care remotely offers multiple potential benefits, such as improved service efficiency and greater patient engagement [84,104]. Conversely, this review identified few studies that investigated the effectiveness of digital tools.…”