With up to 45 per cent of patients set to experience a fall within 12 months of hip or knee replacement surgery, fall prevention education has become a vital tool for healthcare practitioners working in the field of rehabilitation.
But when it comes to working with patients living in rural and remote areas, face-to-face instruction, education, and follow-up sessions are not always possible. That’s why many rehabilitation specialists have turned to the growing field of telehealth — using methods such as video-conferencing or information packages — to help bridge the gap and link patients in remote locations with health professionals and information.
UBC Physical Therapy students Michelle Cox, Aaron Dobie, Jayme Gordon, Paige Jackson, and Karyn Kraemer recently set out to determine the feasibility of a fall prevention telehealth program for individuals living in rural areas of B.C. Here, they share what they discovered during their feasibility study and where they see room to take the research further.
What was the focus of your research project?
Our research project aimed to assess the feasibility of delivering a falls prevention education program through telecommunication to post-operative hip and knee replacement patients living in rural and remote communities of British Columbia.
We adapted a pre-existing program from the University of Alberta called Finding Balance to be specific to our study population. The adapted program was delivered to participants either electronically or in paper form depending on participant preference. The participants then reviewed the information on their own time as self-directed learning.
Our research team then followed up with an in-depth telephone interview with four people who recently had knee replacement surgery to determine the participants’ opinions of the program’s content and length, and potential challenges to delivering it to rural and remote communities. We also asked for feedback from the participants on the use of telecommunication to deliver the program.
What did you discover?
We found that the content of the Finding Balance falls prevention program was useful and easy to comprehend, but participants felt that the information would have been useful if it was delivered earlier in their recovery, such as one week pre-operatively or immediately post-operatively while still an inpatient.
We also found that various methods of delivery need to be available because each participant reported a different preferred method of delivery — ranging from email, face-to-face, and handouts. Regardless of their preferred method, the most important aspect to each participant was having a healthcare professional who they could contact to ask clarifying questions about the content.
Participants also reported a lack of surgery pre-habilitation, which left them feeling under prepared for the recovery process. They reported that they would like education and exercises prior to their surgery in order to help with the recovery and to prevent adverse events, like falls.
MPT students conducted the feasibility study at University Hospital of Northern British Columbia (UHNBC) in Prince George.
Why do these results matter?
These results matter because, as is well evidenced by previous studies, 25-45 per cent of patients fall within 12 months of receiving a hip or knee replacement. In our study, three out of the four participants had experienced a fall since their surgery. An education session or handout could be useful to prevent falls and contribute to successful recovery after surgery.
Our findings also highlight the importance to further study the effects of early education on fall prevention among patients undergoing total joint replacement.
Looking back, what was the biggest takeaway, or lesson learned?
Interestingly, the biggest lesson we learned was not a direct focus of our initial study. However, it became increasingly evident that among our participants there is a general feeling of lack of preparation for total hip and knee replacement surgeries.
All participants cited a lack of pre-habilitation exercise and education that they felt would have helped them feel more equipped for their surgeries and the subsequent recovery process. Most felt that if the adapted Finding Balance program or something similar were delivered one week before or immediately after surgery, it could help reduce the risk of falls and lead to smoother recoveries from surgery.
Where do you see opportunities to take this research further in the years ahead?
The results of our study will help guide a larger scale study in collaboration with Dr. Allyson Jones at the University of Alberta to determine the feasibility of delivering a multi-modal falls prevention program to residents in rural and remote communities undergoing total joint replacement surgery.
As well, our findings could lead to new hypotheses in studying the education needs of patients and refine the pre-habilitation process. We anticipate that our work will contribute to improving the care for patients after joint replacement surgery.
Project supervisors:
Dr. Linda Li, Department of Physical Therapy
Robin Roots, Department of Physical Therapy
Results of this feasibility study were recently presented at the UBC Department of Physical Therapy MPT Research Day, held July 21, 2016. The annual event offers second-year students in the Master of Physical Therapy program an opportunity to showcase highlights from their research projects.