Patient and public involvement (PPI) in research has expanded rapidly, both nationally and internationally, with the aim of improving all aspects of the research process from commissioning to dissemination and evaluation. A PPI approach is recommended where researchers collaborate with the patient and/or public to help plan research projects, particularly where the focus is “new” knowledge about the lived experience. The aim of this article is to explore both patients’ and HCPs’ perspectives of what is THR surgery and the potential use of a simple, commercially available activity monitors in rehabilitation by advocating a PPI approach.
Total hip replacement (THR) is an effective treatment for most individuals who suffer from pain and loss of function due to end-stage symptomatic osteoarthritis (OA) of the hip. By 2030, the incidence of what is THR for OA is predicted to rise by 208% in Australia and 174% in the United States. Studies from the United Kingdom, Canada, Taiwan, and Denmark also predict increases in hip replacement surgery, although estimates vary widely. Eighty percent of those affected by hip OA report some degree of functional limitation and 25% cannot perform routine daily living activities such as getting dressed. The prevalence of hip OA is set to rise, along with its economic burden, both from high direct and indirect costs.
In 2016, the typical hip replacement patient in the United Kingdom was 69.8 years old (female) or 67.6 years old (male), and had a body mass index of 28.8. Few studies have used PPI to explore a patient’s decision to undergo THR. Dosanjh et al conducted interviews with patients regarding their decision to undergo hip replacement, concluding that decisions to undergo surgery were based upon increasing severity of limitations affecting their basic quality of daily living, relationships, and psychological well-being.
Patient-reported outcome measures (PROMs) have been introduced by national health systems and quality networks to ensure clinical standards and to supervise outcome after what is THR. Despite concerns over standardization, studies have shown an association between presurgical values and postoperative outcomes. However, discrepancies between PROMs and performance-based function are seen and a number of studies have suggested caution when only using subjective data as the measure of recovery. Additionally, compared with preoperative function, postoperative activity levels are low and many individuals become socially isolated following surgery. Specht et al explored the experience of individual undergoing THR during 12 weeks postdischarge from hospital. They found that there was a feeling of uncertainty among THR patients at being left on their own after discharge, which affected their self-management and recovery at home.
A paradigm shift in the management of patients pre- and postsurgery toward self-management has been advocated to improve patient surgical pathways. Thewlis et al objectively measured 24-hour activity profiles before and after THR, using a wrist-worn accelerometer. They found patients were inactive and slept poorly prior to what is THR and showed no improvement in 24-hour activity profiles 6 months postoperation. Commercial activity trackers and smartphone apps have been explored for monitoring and enhancing physical activity following surgery. However, very little evidence was found to support long-term efficacy of the technology in enhancing quality of life and patient monitoring post-THR.
