The development and evaluation of a co-designed pre-rehabilitation and education program for patients undergoing a shoulder replacement surgery
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.