Quality statement 1: Preoperative rehabilitation advice for hip and knee replacement
Giving tailored and easy to understand advice on preoperative rehabilitation helps people optimise their health while waiting for hip or knee replacement. Preoperative rehabilitation helps prepare people for surgery, increases their ability to manage any complications, promotes understanding of and engagement with postoperative rehabilitation, and prepares them for life with a joint replacement.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Data source: Data can be collected from information recorded locally by provider organisations, for example, from clinical protocols. The Getting It Right First Time (GIRFT) orthopaedic surgery follow-up report (2020) includes the proportion of trusts who offer elective orthopaedic surgery and provide preoperative care that includes education and identifying patients at risk of a poor functional outcome for total knee replacement.
Proportion of adults who will have hip or knee replacement who receive advice on preoperative rehabilitation when they are listed for surgery.
Numerator – the number in the denominator who receive advice on preoperative rehabilitation when they are listed for surgery.
Denominator – the number of adults who will have hip or knee replacement.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
a) Average health gain and improvement rate associated with patient-reported outcome measures (PROMs) for hip or knee replacement.
Data source: NHS Digital's PROMs collect pre- and post-operative data from patients having elective inpatient hip or knee replacement funded by NHS England. Health gain is reported at national, commissioning and provider levels. Improvement rates are reported at national and provider levels.
b) The percentage of patients reporting the results of their hip or knee replacement as 'excellent' or 'very good' and that their problems are 'much better' or a 'little better' after their operation.
Service providers (secondary care services) ensure that local arrangements are in place and staff are available to give advice on preoperative rehabilitation to adults when they are listed for hip or knee replacement.
Healthcare professionals (such as physiotherapists, occupational therapists or specialist nurses) ensure they know what preoperative rehabilitation advice to give adults when they are listed for hip or knee replacement. Information should be tailored to the person's needs, circumstances and preferences. Healthcare professionals ensure that they have training on how to deliver the advice effectively. This includes delivering the advice in a format that can be easily understood by adults who are to have hip or knee replacement and their family members or carers.
Commissioners ensure that they commission services that give advice on preoperative rehabilitation to adults when they are listed for hip or knee replacement.
Adults who are to have a hip or knee joint replacement receive advice on how they can look after their health and wellbeing while they are waiting to have their operation and after they have had it.
Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157 (2020), recommendations 1.1.3, 1.1.4 and 1.2.1
exercises to do before and after surgery that will aid recovery
lifestyle, including weight management, diet and smoking cessation
information on preparing for surgery, including steps people can take to optimise their recovery
wellbeing, including physical and mental health, and emotional wellbeing (see NICE's guidance on lifestyle and wellbeing)
maximising functional independence and quality of life before and after surgery
information about what to expect before, after and during surgery, including length of hospital stay, recovery and rehabilitation.
Advice should be tailored to the person's individual needs, circumstances and preferences. Information should be specific to the procedure they are being offered and delivered in a format that they and their family members or carers can easily understand. Patient resources from the Centre for Perioperative Care are an example of advice that can be given to people on how to prepare for planned surgery. [NICE's guideline on joint replacement (primary), recommendations 1.1.3, 1.1.4 and 1.2.1, and evidence review C]
Providers should make reasonable adjustments to support adults with additional needs so that they can participate in preoperative rehabilitation which helps them prepare for surgery and postoperative recovery. This may involve delivering assessment and education outside the hospital environment (for example, home assessment for adults with complex needs who are to have hip replacement; see the Royal College of Occupational Therapists' 2017 practice guideline on occupational therapy for people undergoing total hip replacement (member-only access). Additional needs include physical, sensory or learning disabilities, or cognitive impairment. Adults with communication difficulties or who do not speak or read English should also be supported. Adults should be invited to bring a relative, friend or carer, or have access to an interpreter (including British Sign Language) or advocate if needed. Adults (including family members or caregivers) with cognitive impairment may need more time to process the information. Advice should be given in a way that is culturally appropriate.