Do patient information booklets on total hip and knee replacement surgeries prescribe exercise regimes that follow ERAS principles?

Authors: Burgess, L. and Wainwright, T.

Introduction Total hip replacement (THR) and total knee replacement (TKR) are two of the most common orthopaedic surgeries that occur in the United Kingdom (UK) each year. Enhanced recovery after surgery (ERAS) programmes aim to decrease convalescence across procedures, morbidity and length of stay. The post-operative physiotherapy routine is standardised across hospitals, however the pathway has been criticised for not containing the correct ingredients for promoting acceleration of return to function. This research aims to analyse the current exercise protocol prescribed to patients within information booklets following THR and TKR in comparison to ERAS principles.

Methods A random sample of twenty UK NHS hospital THR and TKR patient information booklets were sourced using a web based methodology. A flowchart of exercise prescription components was formulated from a review of 5 trial booklets. A content analysis was conducted on the patient information booklets.

Results 40% of the information booklets sourced identified their pathways to be ERAS. 50-55% of the hospitals stated their patients would be mobilised on the day of surgery. 90% of THR and 100% of TKR guidelines suggested the use of bed exercises for rehabilitation. 15% of THR and 35% of TKR booklets suggested functional exercise as a method of rehabilitation. Strength or resistance based exercises were proposed in 40% of THR and 55% of TKR booklets.

Conclusions Many patient information booklets do not follow ERAS principles for fast-track rehabilitation. The exercise prescription procedure is non-specific, and the physiotherapy routines prescribed could be considered outdated.

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