8 Week Orthopaedic Prehabilitation Plan

Key Objectives

Provide a tool for the remote management of patients before their surgery.

Outcome measures

Equip patients with the tools they need to support self-management pre-operatively, as well as provide the tools they need to interact digitally rather than relying on a face to face consultations.

Current Baselines

A large waiting list means it is difficult to support all patients face to face. Patients who aren’t supported pre-operatively may not have effective outcomes. Additionally, the rural nature of the deployment means that patients are traveling large distances.

Workflow:

Patients: invited to join Orthopaedic Prehab team via token invite letter

Patients: Views care plans, library and has access to the team

Waitlist team: tell patients to complete 8 week care plan and utilise library resources

Waitlist team: adds appointment for replacement surgery

PKB: alerts patient to appointment and appointment letter

Patients: read appointment letter and appointment time

Patient: attends for hip/knee replacement

Example care plan template code for 8 Week Orthopaedic Prehabilitation Care Plan HTML

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<li style="list-style:inherit; margin-left: 15px;"><a href="#week1">Week 1 Introduction to Prehabilitation</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#week2">Week 2 Osteoarthritis</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#week3">Week 3 Healthy Eating with Arthritis</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#week4">Week 4 Psychology</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#week5">Week 5 Pain Management</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#week6">Week 6 Health and Wellbeing</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#week7">Week 7 Fatigue and occupation</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#week8">Week 8 Next steps</a></li>

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<h2>Week 1 Introduction to Prehabilitation</h2>

<h3>Introduction to Prehabilitation</h3>

<p>Welcome to week one of the Orthopaedic Prehabilitation Programme. We understand that you are on the waiting list for a joint replacement. The aim of our programme is to maintain and improve your fitness levels, educate you about a healthy lifestyle and prepare you for your upcoming surgery. The key elements are exercise, healthy eating, psychological well-being and managing day-to-day activities. Prehabilitation prior to surgery will help you be as fit as you can be for when you have a date for your operation. Evidence also shows that it can improve outcomes and reduce complications following your surgery.</p>

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<p>In this section you will find a set of videos that have been designed to help to support you as you begin your journey to build strength, increase stamina to enable you to perform your day-to-day activities. The first video will provide you with some of the background information and a guide of where to start - we recommend that you watch this video before you complete the physical activity video.</p>

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<p>Below is the first exercise video which focuses on mobility. You can buy some extra equipment seen in the videos to make some exercises more challenging, such as therabands and weights. We do recommend that you wear supportive and enclosed footwear (such as trainers) and loose, comfortable and cool clothing. Make sure you also have a glass or bottle of water at hand, should you need it. A standard chair is also needed to perform these exercises.</p>

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<p>We recommend that you complete the exercise activity video twice per week.</p>

<p>We recommend that you complete the EQ5DL questionnaire at this point and also at the end of the programme. It will help demonstrate your progress throughout the coming 8 weeks.</p>

<p><b>Activity</b>: Navigate to "send a consultation" on the homepage or within Events and Messages, and complete EQ5DL</p>

<p>The exercise tracker for the weekly exercises can be printed out and used to track your activity levels. This can be viewed in your library or accessed using the following <a href="/library/manageLibrary.action" target="_blank">link</a>. Also, the <a href="/test/myMeasurements.action" target="_blank">measurement section</a> can be used to track your daily activity levels. </p>

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<h2>Week 2 Osteoarthritis</h2>

<p>Welcome to week 2 of the Orthopaedic Prehabilitation Programme. This week's information video focuses on osteoarthritis which is the reason most of you are on the waiting list for surgery. The video has been designed to educate you on osteoarthritis and its management including healthy eating tips. There are two videos on osteoarthritis, one specific to the hip, the other to the knee.</p>

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<p>This week's exercise video focuses on function which is important to enable you to manage day to day activities before and after your planned surgery. We would again encourage you to fill in the exercise tracker/diary in the <a href="/library/manageLibrary.action" target="_blank">library</a> as you complete the exercises.</p>

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<p><b>Activity</b>: Prompts / considerations for week 2:</p>

<label class="cp_label" for="cp_week2Changes">What healthy changes can I make during the next week to increase my activity levels and improve my eating?</label>

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<p>For more information on OA please refer to your <a href="/library/manageLibrary.action" target="_blank">library</a></p>

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<h2>Week 3 Healthy Eating with Arthritis </h2>

<p>Welcome to week 3 of the Orthopaedic Prehabilitation Programme. This week's information video focuses on healthy eating. The video below provides the background information and guidance linked to this topic. </p>

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<p>This week's exercise video focuses on strength which is important to maintain and improve prior to your surgery. We would again encourage you to fill in the exercise tracker/diary as you complete the exercises.</p>

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<p>We recommend that you complete the Health and Lifestyle Questionnaire at this point and also at the end of the programme. It will help demonstrate your progress with healthy eating throughout the coming 8 weeks.</p>

<p><b>Activity</b>: Navigate to "send a consultation" on the homepage or within Events and Messages, and complete Health and Lifestyle Questionnaire</p>

<p>Please use <a href="https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/" target="_blank">this calculator</a> to check your body mass index (BMI) and find out if your weight is healthy for your height. If your BMI is high, it means that it would be beneficial to lower your weight. If your BMI is low, you may want to follow some advice to build yourself up.</p>

<p>Please note, if you are aged 65 or over and your BMI is below 30, losing weight is not generally recommended. Instead, you should focus on eating a balanced diet and increasing exercise.</p>

<p>If you would like further information on the topics that are being discussed during this week please refer to your <a href="/library/manageLibrary.action" target="_blank">library</a></p>

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<h2>Week 4 Mental Wellbeing</h2>

<p>Welcome to week 4 of the Orthopaedic Prehabilitation Programme. This week's information video focuses on psychological well being and mindfulness. When trying to make a change to your lifestyle you can sometimes be confronted by negative thoughts. The aim of the video this week is to provide you with some tools to overcome these negative thoughts in order to keep moving forward. </p>

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<p>The video below gives you an introduction to a mindfulness activity. </p>

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<p>If you found this beneficial, please refer to the library for further mindfulness activities.</p>

<p>This week's exercise video focuses on cardiovascular function which plays an important role in helping the body meet the demands of activity, exercise and stress. We would again encourage you to fill in the exercise tracker/diary as you complete the exercises.</p>

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<p><b>Activity</b>: Prompts / considerations for week 4:</p>

<p>Write down 3 positive things that you've achieved in the last 24 hours</p>

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<p>Doing an activity like this can promote a positive mindset.</p>

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<h2>Week 5 Pain Management</h2>

<p>Welcome to week 5 of the Orthopaedic Prehabilitation Programme. This week's information video focuses on pain and its management. We understand pain is the most common symptom and reason for your planned joint replacement. However, it is vital to manage your pain as best you can while waiting for surgery. If pain is not managed it could result in deconditioning and therefore affect day to day living, mood and quality of life.</p>

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<p>This week's exercise video focuses on balance which is an important component of fitness. Improving your balance can help with performing daily activities and prevent falls. People awaiting joint replacement surgery may be more at risk of falling due to pain and deconditioning. A consequence of a fall may be detrimental to your planned surgery. We would again encourage you to fill in the exercise tracker/diary as you complete the exercises.</p>

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<label class="cp_label" for="cp_week5_1">My goal for this week is to (e.g. walk more, take the stairs more often);</label>

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<label class="cp_label" for="cp_week5_3">Where will I do it? (e.g. at home, on way to work);</label>

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<h3>Monday</h3>

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<h3>Tuesday</h3>

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<h3>Wednesday</h3>

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<h3>Thursday</h3>

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<h3>Friday</h3>

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<h3>Saturday</h3>

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<h3>Sunday</h3>

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<p>Within your <a href="/library/manageLibrary.action" target="_blank">library</a> there are useful links to: </p>

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<li style="list-style:inherit; margin-left: 15px;">Information about painkillers</li>

<li style="list-style:inherit; margin-left: 15px;">Use of heat and ice for pain relief </li>

<li style="list-style:inherit; margin-left: 15px;">Use of walking aids and braces </li>

<li style="list-style:inherit; margin-left: 15px;">Information on dietary supplements for pain relief</li>

<li style="list-style:inherit; margin-left: 15px;">Mindfulness for pain management</li>

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<h2>Week 6 Health and Wellbeing</h2>

<p>Welcome to week 6 of the Orthopaedic Prehabilitation Programme. This week's information video focuses on health and wellbeing. Your health and wellbeing is important both before and after surgery. The following video provides you with some useful tips on maintaining your health and wellbeing throughout your wait for surgery. </p>

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<p>This week's exercise video focuses on flexibility which has many positive effects on the body. Maintaining good range of movement prior to surgery has shown improved outcomes following joint replacement surgery. We would again encourage you to fill in the exercise tracker/diary as you complete the exercises.</p>

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<p>Prompts / considerations for week 6:</p>

<p>What activities have I enjoyed over the last six weeks?</p>

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<label class="cp_label" for="cp_week6Surprise">Have I been surprised with what I have achieved?</label>

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<label class="cp_label" for="cp_week6Try">Is there anything new I'd like to try? </label>

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<p>If you struggle to sleep, use the link to the <a href="https://sleep-calculator.com/" target="_blank">sleep calculator</a> for further advice. Visit the <a href="/library/manageLibrary.action" target="_blank">library</a> for more information</p>

<p>For more information and advice on the topic this week, please access your library for further resources. </p>

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<h2>Week 7 Fatigue and occupations </h2>

<p>Welcome to week 7 of the Orthopaedic Prehabilitation Programme. This week's information video focuses on fatigue and day to day activities. Fatigue can be a resulting factor whilst awaiting a joint replacement due to activities becoming more difficult and the body being more strained. It is important that daily activities are managed as best as they can be. </p>

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<p>This week's exercise video is another set of exercises that focuses on mobility and strength. We would again encourage you to fill in the exercise tracker as you complete the exercises.</p>

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<p>In the library, there is a planner for you to complete which will make you think about how you use your energy for day to day activities. It will make you think about areas where you can make some adjustments to improve quality of life.</p>

<p>Access your <a href="/library/manageLibrary.action" target="_blank">library</a> for further resources on how to plan, pace and prioritise your day </p>

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<h2>Week 8 Next steps </h2>

<p>Welcome to week 8 and the final part of the Orthopaedic Prehabilitation Programme. This week's information video will talk you through the next steps moving forward which will include how you manage chronic conditions that you may have that can influence your surgery and its outcomes. There are also additional videos this week on falls and some useful resources you can refer to in your library.</p>

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<p>This week's exercise part is a copy of the exercises we would encourage you to do following your surgery. These exercises are also important to do before your operation as it specifically targets the muscles you need to work on after your joint replacement. Familiarising yourself with these exercises is also a good idea as you will be going through them during your stay in hospital. Please click on <a href="https://gateway.physiotools.com/Print/P.aspx?PrintDataId=2bc607ec74a74a5_6253AA5A&PtVer=201901" target="_blank">this link</a> to access the week 8 exercises.</p>

<p>The EQ5DL questionnaire was completed in week 1, please complete it again to demonstrate your progress and it can also highlight areas to continue to work on while you wait for surgery.</p>

<p><b>Activity</b>: Navigate to "send a consultation" and complete EQ5DL</p>

<p>The Health and Lifestyle Questionnaire questionnaire was completed in week 1, please complete it again to demonstrate your progress with healthy eating.</p>

<p><b>Activity</b>: Navigate to "send a consultation" and complete Health and Lifestyle Questionnaire</p>

<p>Well done for completing the programme. But your journey doesn't need to end here. You can continue to use these videos, links and resources to continue the good work. get to reward yourself for overcoming your barriers to exercise and making progress on your goals. Look back through the programme to re-visit certain sections that you need to continue to work on.</p>

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