Outcome measures in prehabilitation interventions for total hip and knee arthroplasty: A scoping review

Title : Outcome measures in prehabilitation interventions for total hip and knee arthroplasty: A scoping review

Abstract:

Objective: This scoping review aimed to map outcome measures collected in randomised controlled trials investigating prehabilitation interventions in total hip and knee arthroplasty, and timepoints of collection.

Data sources: A systematic search of MEDLINE, EMBASE, Web of Science, Cochrane, and CINAHL was conducted.  

Methods: This review followed the Joanna Briggs Institute Scoping Review methodology. Outcome domains, concepts of interest and assessment tools were characterised using the International Society for Pharmacoeconomics and Outcomes Research Framework, and timepoints for data collection were extracted. 

Results: Eighty-one trials (published between June 2001 and May 2024) were included. Most delivered unimodal prehabilitation, with exercise the most common intervention (n=34, 42%). The review identified 34 outcome concepts measured with 206 unique assessment tools. Patient-reported outcomes were collected in 91% of trials (n=74), and was the most heterogenous domain with 91 assessment tools. Observer-reported outcomes were reported in 90% of trials (n=73), with healthcare utilisation (e.g. hospital length of stay) the most common concept. Clinician-reported outcomes were reported in 69% of trials (n=56) and most frequently included post-operative complications. Performance-based outcomes, most commonly muscle strength, were collected in 68% of trials (n=55) and utilised 46 different tools. Biomarker outcomes were rare (n=6, 7%). Timing of outcome collection varied, with just under half the trials collecting both a pre-operative and post-operative timepoint. 

Conclusion: This review identified significant variability in outcome measures collected in prehabilitation trials for total hip and knee arthroplasty, highlighting the need for a core set of assessments to facilitate consistent reporting and robust meta-analyses of prehabilitation efficacy.

Clinical messages: 
•Evidence for prehabilitation effects on joint arthroplasty outcomes may be affected by heterogeneity in reported measures.? 
•Meaningful, valid and feasible outcomes and assessment tools in this population need to be identified to form a core outcome set for future reporting.

Biography:

Nicola is a senior orthopaedic physiotherapist at a major metropolitan hospital in Melbourne, Australia. She is in the final year of her PhD at the University of Melbourne and is a Melbourne Academic Centre for Health (MACH) Research Fellow. Her research focuses on optimising pre-operative care for people undergoing total hip and knee arthroplasty surgery. She investigates current orthopaedic prehabilitation practice, barriers and enablers to implementation, and strategies to deliver more personalised, evidence-based care. As part of her doctoral research, Nicola is developing a screening tool to identify modifiable risk factors before orthopaedic surgery and support stratified, needs-based prehabilitation.