Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study

Abstract Background 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 not satisfied post-operatively. Optimising pre-operative education prehabilitation could help improve patient outcomes pre- post-operatively; however, current care varies widely. Definitive evidence on optimal content delivery is lacking. This study aimed to develop evidence- consensus-based recommendations prehabilitation. Methods A UK-based, three-round, online modified Delphi was conducted with a 60-member expert panel. All panellists had experience services as ( n = 30) or professionals 30). Round 1 included initial developed from mixed methods rapid review. Panellists rated importance each item five-point Likert scale. also suggest additional items 1. Rounds 2 3 all 1, new suggested charts summarising panellists’ ratings preceding round. Free-text responses were analysed using analysis. Quantitative data descriptively. ‘Important’ ‘Very important’ by at least 70% respondents final set recommendations. Results Fifty-five (92%) (patients 26; 29) completed 3. Eighty-six recommendation Fifteen added 2. therefore 101 items. Seventy-seven these reached consensus Six amongst professional only The comprises 34 topics, 18 approaches, 10 exercise types, 13 approaches two other treatments. Conclusions comprehensive that represent useful resource for guiding decision-making will need be interpreted reviewed periodically light emerging evidence.