A scoping review of prehabilitation interventions for arthroplasty patients.

Background: Osteoarthritis (OA) is a long-term condition that causes significant impairment, and because of the increasing prevalence of OA, the demand for arthroplasty will continue to rise. However, the demand will not be matched by availability, because of prioritisation of trauma-related surgeries. Implementing prehabilitation could assist physiotherapists in having an impact on improving access by reducing the length of stay. Objectives: The aim of our scoping review was to explore, map and identify trends and gaps to better inform the content of a prehabilitation programme. Method: In our scoping review, studies between 1995 and 2020 were identified and included based on inclusion and exclusion criteria and study methodology described by Arksey and O'Malley. The results were collated and summarised as a narrative synthesis. Results: A total of 200 articles were identified and exported from four databases of which 48 articles were included in the final analysis. Regarding the efficacy of prehabilitation interventions, 21 studies reported significant results supporting prehabilitation, whereas 11 studies reported non-significant results. Conclusions: Prehabilitation could be a valuable adjunct in reducing length of hospital stay and improving functional outcomes in adults undergoing total joint replacement. Clinical implications: The scoping review described the information available on prehabilitation in lower limb arthroplasty patients and could potentially inform the design of a prehabilitation programme suitable for use in the South African public health context.

Scoping review protocol of prehabilitation interventions for primary arthroplasty.

Background: Osteoarthritis (OA) ranks fifth among all forms of disability worldwide and primary replacement arthroplasty is the treatment of choice in late-stage OA. The current situation in South Africa is that the waiting lists for arthroplasty are extensive with steep costs. According to many studies, physiotherapists can have an impact on this situation by implementing prehabilitation. Objectives: The aim of our study is to identify the trends in the literature regarding the content of prehabilitation programmes as well as the gaps. Method: The methodology will involve a literature search and the methodology as proposed by the Joanna Briggs Institute guidelines. The literature searches will be conducted in electronic databases and peer-reviewed journal studies will be included based on predetermined inclusion criteria. Two reviewers will screen all citations and full-text articles and the first author will abstract the data. Results: The results will be organised into themes and sub-themes, summarised, and reported as a narrative synthesis. Conclusion: The proposed scoping review will map the breadth of knowledge available on the topic of prehabilitation in terms of exercise prescription principles, pre-operative optimisation and gaps. Clinical implications: This scoping review is the first part of a study that aims to design a prehabilitation programme suitable for the South African public health user as the demographic and physical characteristics of its health users are unique and dependent on the context.

Experiences and effects of telerehabilitation services for physiotherapy outpatients in a resource-constrained public health set-up in the backdrop of the COVID-19 pandemic: A proposal.

BACKGROUND: The announcement of a national lockdown in South Africa had country-wide impact on the delivery of health services. Strategies included prioritisation of patients and protecting patients who were considered at risk, resulting in the need for cancellation and temporary termination of many outpatient therapy services. This necessitated the urgent need to come up with a way of delivering physiotherapy rehabilitation services to patients in a more non-traditional format. Telerehabilitation allows for the provision of services by using electronic communication, thus ensuring that patients are still able to access necessary rehabilitation services. METHODS/DESIGN: This is a prospective, mixed method study with participants recruited from the outpatient physiotherapy department of Chris Hani Baragwanath Academic Hospital (CHBAH). Telerehabilitation services will be provided via the patients' preferred method of communication. On discharge, participants and therapists will be asked about their experiences of telerehabilitation. DISCUSSION: Because of the current coronavirus disease 2019 (COVID-19) pandemic, patients are unable to receive traditional face-to-face physiotherapy services. Telerehabilitation offers a suitable alternative to treatment, but the feasibility, outcome and experiences of offering these services in the public health system have not been studied. CONCLUSION: This study will determine whether telerehabilitation is a feasible service that can be offered in the COVID-19 pandemic, as well as post-pandemic, to enable physiotherapists to access those patients who are often unable to attend physiotherapy because of transport costs and various other reasons for non-attendance. CLINICAL IMPLICATIONS: The results of this study may indicate a way of managing patients in situations where face to face therapy cannot be undertaken. PROTOCOL IDENTIFICATION: Pan African Clinical Trial Registry, PACTR202103637993156.