Intervention Reporting in Prehabilitation Trials for Older Adults Undergoing Total Hip or Knee Arthroplasty

Abstract

Background: Prehabilitation is defined as the process of improving an individual’s functional capacity to tolerate an upcoming stressor. In the surgical context, potential benefits of prehabilitation include reducing length of stay in hospital, postoperative pain, and complications. The objective of this review is to evaluate the completeness of intervention reporting details and changes in quality of this reporting over time for total hip (THA) or knee arthroplasty (TKA) prehabilitation interventions using the Template for Intervention Description and Replication (TIDieR) Checklist. Methods: MEDLINE, EMBASE, CENTRAL, and Google Scholar were searched from inception to May 3, 2024, to identify published articles or protocols of randomized controlled trials reporting prehabilitation interventions for adults undergoing elective THA or TKA. Two independent reviewers completed screening and data extraction. Results: From 1278 unique search results, 191 full-text studies were assessed for eligibility, and 84 studies met inclusion criteria (n=54 TKA, n=15 THA, n=15 TKA/THA). Included studies were published from 1992 to 2024. Prehabilitation intervention modalities reported across studies included exercise (n=51), multimodal programs (n=14), behavioural (n=6), nutritional supplementation or weight loss (n=3), and other (n=10). The mean (standard deviation) TIDieR score was 7.7 (1.8), indicating moderate reporting quality overall. The proportion of studies reporting each item completely were as follows: name (100%), rationale (100%), materials (65%), procedures (85%), providers (25%), mode of delivery (75%), location (67%), dose and duration (86%), tailoring (31%), modifications (5%), planned adherence (37%), and actual adherence (35%). Conclusions: The reporting quality of interventions in the majority of prehabilitation RCTs was moderate. The TIDieR framework can be used to support evaluation and replication of prehabilitation for THA and TKA by identifying key intervention components. Quality of intervention reporting was similar between trials published before TIDieR was introduced in 2014 and post-TIDieR. This review highlights the varied landscape of THA/TKA prehabilitation.