Orthopaedic virtual prehabilitation programme helping patients to wait well and reduce risk of pre-operative deterioration
Introduction
Keeping patients well, supported and fit for surgery whilst they wait is imperative to the patient’s overall recovery and prehabilitation, post surgery. Hospitals also benefit by less cancelled operations and providing more remote care. Providing them with the right care and information to fully support their prehabilitation is crucial but how to deliver this, particularly if your patients are infirm or live a long way from hospital can be difficult.
Hywel Dda Health Board decided to use PKB to support part of their rehabilitation programme using an extremely comprehensive Care Plan and getting patients to monitor their symptoms and track measurements.
The Problem
Like many Trusts across the UK, appointment waiting lists have built up in Wales due to factors including a backlog from the Covid-19 pandemic. Across the Hywel Dda Health Board more than 4000 orthopaedic patients had their treatment delayed with a significant impact both on their physical and psychological wellbeing. Patients are also spread across a large geographic area, resulting in high travel costs and inconvenience for patients as well as impacting the environment. The Orthopaedic Prehabilitation Service at Hywel Dda wanted to implement a remote care model to support and care for patients - allowing patients to feel supported and avoid deterioration - while they wait without the need for travel.
The Solution
All patients are offered access to PKB with a focus on providing an eight-week care plan to patients awaiting hip or knee replacement surgery, promoting their overall well-being and reducing the risk of deterioration before their scheduled appointments.
The Orthopaedic prehabilitation team consists of a physiotherapist, occupational therapist, dietician and a psychologist. The eight week plans, created as care plans on the PKB platform, incorporate tailored exercise routines and lifestyle recommendations. The plan is separated week by week into categories ranging from physical and mental health, eating and living well and exercising with Osteoarthritis. The plan sits in the patient’s PKB record and allows them to follow the videos and activities at their own pace.
The inclusion of activities such as completing EQ5D questionnaires (a PROM which allows patients to report their level of pain and ability to complete normal activities) and tracking measurements and symptoms on the platform means patients' progress and adherence to the care plan can be monitored remotely. This gives patients an idea of their progress and when to seek further information. Additionally, patients can access a library of resources through the platform, fostering self-care and informed decision-making. The clinical team developed educational materials related to pre-surgery preparation, post-operative care, and general musculoskeletal health.
The majority of patients within the team are 65+ and supported with any queries about the PKB platform by the orthopaedic prehabilitation team members and the waiting list support call handlers. The PKB platform can be accessed in 22 languages including Welsh and can be used with a screen reader. Additionally, carers can be given access to patient records to help them navigate the platform.
I feel that PKB has offered patients advice, information and guidance to motivate them to improve their health and wellbeing while they await their orthopaedic surgery and this in turn will improve their future health.
The Outcomes/Impact
The Orthopaedic Prehabilitation team is able to use PKB to provide a secure, virtual preventative model of care - empowering patients with proactive health measures to reduce the likelihood of deterioration before their scheduled hip or knee replacement surgery.
It was important that the patients feel supported and cared for when they are not attending face-to-face classes or clinics. Having a full care plan and library promotes a sense of being cared for even in a virtual environment. Moving to virtual patient management with remote monitoring and communication has reduced the need for in-person visits, optimising healthcare resources. The service hopes in future to look into whether use of PKB meant reduced length of stay for the patient.
For those who are able to work through the 8 Week care plan independently, it has reduced clinical time.
The Waiting List Support Service is a key source of support and information for patients in the Health Board awaiting their hip or knee replacement surgery. Within a few months of the health board using PKB for the 8 Week Orthopaedic prehab plan, a number of Waiting List Support Service staff members were given access to and training about the PKB offering. This allowed them to refer any patient awaiting treatment or seeking advice about their treatment to the platform and to assist them with creating an account and accessing support resources. As of January 2024 the PKB Orthopaedic Prehabilitation team has over 560 registered patients.
Learnings and future development
Some of the [patients registered on PKB] were in a different tier and have completed the 12-week virtual programme with us, and using PKB has allowed them to continue with the good work and have access to exercises and resources to achieve their goals prior to surgery and after surgery.
The virtual prehab programme has proved to be a great success and continues to enhance the service the team can provide to their patients. Following the success of these digital offerings, this year the service will expand the provision of resources as part of a Hywel Dda Health Board Joint School team on the PKB platform.
Patients within this team, due to launch Spring 2024, will be given information on what to expect during their hospital stay, how to prepare for their hip or their knee surgery, and will also focus on recovery - what to do post-surgery and once you are back at home supporting them across the perioperative pathway.
