Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Collaborative Specialization

Musculoskeletal Health Research

Supervisor

MacDermid, Joy C.

Abstract

A joint replacement surgery is a common treatment for end stage osteoarthritis. The rates of shoulder osteoarthritis are on the rise, which means more older adults will be resorting to shoulder replacement surgeries to help improve their quality of life. Since surgery can be a stressful experience for older adults, healthcare centers rely on using patient education programs to help educate patients prior to surgery. However, these current programs lack patient engagement and adherence.

This thesis focuses on creating a preoperative education program for patients prior to surgery, that uses a co-design approach to improve adherence and engagement for older adults. This multiple methods thesis focused on first assessing the current published literature of preoperative programs to understand the frameworks and content being used. We found that current programs were traditionally focused on lower limb replacements, and rarely used frameworks to guide creation or had patient involvement. Then we used a mixed methods of both a survey and qualitative interviews to investigate what patients and clinicians wanted in the program, the delivery platforms and how to increase their adherence to the program. Summarizing all these findings we were able to launch PREPS, which stands for Pre-Rehab and Education Program before Surgery. PREPS was a multimodal program of both a booklet and website that covered a variety of topics that were deemed both clinically important and relevant to patients. Currently PREPS is being evaluated in a feasibility pilot trial to investigate recruitment rates, adherence, satisfaction and retention rates. Interim results show that PREPS has achieved a steady recruitment rate per month, over 80% adherence rates and over 90% satisfaction rates with the program and overall study.

Overall, findings suggest that PREPS was satisfactory in recruitment, retention, adherence, and acceptability. Recommendations learnt from this pilot trial will help to guide a future multi-centered trial to determine the effects of the PREPS program on patients receiving a shoulder replacement. In conclusion, using a co-design approach to creating education programs will allow for better engagement, and more clinically impactful research.

Summary for Lay Audience

This thesis looked at creating an education and exercise program for patients prior to having a shoulder replacement. The first study looked at reviewing the current literature to best understand the current strategies used within current joint replacement preoperative programs. We found that these programs were lacking engagement due to the absence of patient involvement during the creation of the program. Study 2 and 3 then investigated though both a national survey of 355 individuals and 19 interviews of what patients and clinicians would prefer for content, what platforms are most accessible and how to best engage older adults. Using the information gained from these three studies and our patient partner team, we created a preoperative education and rehab program before surgery (PREPS). PREPS is an online program with a written booklet, covering important topics prior to surgery. PREPS was then evaluated in a pilot randomized control trial to understand the feasibility of the program. This trial took place at the Roth|McFarlane Hand and Upper Limb Center in London Ontario, where patients were randomized to either receiving PREPS prior to surgery or standard of care. While the trial is still on-going, interim results has shown that PREPS is well received and feasible. PREPS has shown successful adherence rates to both the program and its exercises. Future work will look to investigate PREPS in a fully powered randomized control trial across Canada to best investigate the affects PREPS has on postoperative outcomes after a shoulder replacement.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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