Bristol BRC researchers awarded £2.3 million for follow-on research

Bristol BRC researchers have been awarded £2.3 million by NIHR to study whether prehabilitation can help frail patients having total hip or knee replacement, following a successful Bristol BRC feasibility study.

The award will allow the researchers to perform a large randomised controlled trial to find out whether prehabilitation (prehab) helps frail patients recover better from total hip or knee replacement. Prehab is a programme to improve patients’ health and fitness before surgery.

The researchers want to find out if prehab improves frail patients’ mobility after surgery, and stops them needing to return to hospital.

The trial will involve 488 patients who are having hip or knee replacement at 20 NHS hospitals. All patients will receive their usual hospital care before surgery, but half will also be given prehab.

This will involve:

• A programme of exercises to do at home, tailored to individuals’ ability
• A daily protein supplement, in the form of a pot of jelly or a protein shake
• Regular telephone or video calls with a physiotherapist for 10 weeks, followed by monthly information leaflets

The researchers will ask all patients in the study about their health, for 6 months after their operation. They will compare people’s answers in the two groups to find out if the prehab programme helps. They are particularly interested in whether prehab helps patients to be more mobile after surgery, and stops them returning to hospital.

The feasibility study performed at Bristol BRC showed that the prehab programme was acceptable to patients, allowing the researchers to secure funding for the main study.

It also gave the researchers the chance to adapt and improve the prehab programme. Some patients found the exercises too hard, so exercises will be tailored to patients’ abilities.

This was the first study of prehab for frail patients having hip or knee replacement in the NHS.

The NHS performs more than 200,000 total hip and knee replacements each year. Up to a quarter of the patients undergoing these procedures are frail. Frail patients have a higher risk of death, admission to intensive care and readmission to hospital.

We know that exercise combined with protein supplements can improve the health of people who are frail. We hope our study will lead to more frail patients making a better recovery from hip and knee replacement operations.

Professor Vikki Wylde, Bristol BRC researcher and chief investigator on the new project, said:

“The feasibility study was vital for informing the design of the randomised trial.

“One of the key findings was that the standardised home exercise programme commonly used for patients undergoing hip or knee replacement was often too challenging for frail patients. Although participants were highly motivated to engage, the intensity of the exercises became a barrier.

“As a result, we are now developing a set of easier, more accessible exercises tailored specifically for frail patients.

“The Bristol BRC provided the research team with time and capacity to prepare the NIHR grant application after the feasibility study ended, which was crucial in enabling us to secure funding for the follow‑on randomised trial.”