• Pembrokeshire County Council Orthopaedic Preablement Service is a free service, designed to support patients to improve their health and wellbeing, before and after their scheduled hip or knee surgery.
• Due to the delays in scheduled surgery following the Covid 19 pandemic, many patients have deconditioned while waiting for surgery. 
• Preablement compliments the Prehabilitation Service run by Hywel Dda Health Board. The Rehabilitation Service is a virtual service whereas the Preablement Service is face to face in the patient’s own home. 
• Therefore, if the patient’s needs cannot be met by the virtual service, they may be referred to Preablement Service face to face service.
• Pembrokeshire County Council Preablement Project Team is led by an Occupational Therapist from the existing Reablement OT Team and a newly appointed Occupational Therapy Assistant. 
• These interventions can prevent further deconditioning and improve independence while waiting for surgery. Planning ahead should reduce any unnecessary delays in discharge from hospital and prepare patients for post op recovery.

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Pembrokeshire County Council Preablement Service aims to:

• Enhance general wellbeing prior to surgery 
• Prevent further deconditioning while waiting for surgery
• Optimise independent living skills while waiting for surgery
• Prepare patients for post-surgery recovery
• Reduce length of stay in hospital following surgery
• Potentially reduce the need for long term packages of care

Case Study: Following a referral from the Prehabilitation Service, an assessment of the patient was carried out in their own home to identify their current needs and challenges. Small aids and equipment were issued to support the patient with activities of daily living. Suggestions on how to arrange their environment were also made to support them pre and post-surgery. Advice was given on how to improve transfers to prevent further damage and pain in the affected joints. It was important to recognise not just the physical impact of delayed surgery but also the psychological impact. Therefore, the pre and post intervention questionnaire considered the patients psychological wellbeing.

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Patients received up to 3 visits from the Occupational Therapy Assistant:

1^st Visit was to identify needs

2^nd Visit was to deliver equipment and show the patient how to use it correctly

3^rd Visit was a follow up review

Individuals who received intervention from our service, were happy with the service they received and we were able to improve their patient journey whilst awaiting surgery. 

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They described physical improvements in their activities of daily living and also reported psychological improvements. Please see graph on following slide.

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The outcomes of the project have been limited by the fact that those patients involved have not yet had their surgery due to various delays. Therefore, we have not been able to identify any savings in hospital beds or any potential reductions in long term care. Therefore, the outcomes are limited to pre surgery.

Although numbers were small for the project the outcomes for those individuals were very positive.  They described improvements in their activities of daily living, reduced pain and improvement in their general wellbeing. 

The patients were asked to complete a pre and post intervention questionnaire.

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Outcome of pre and post questionnaires

We did not manage to recruit a qualified Occupational Therapist for this project, therefore we have relied on existing qualified Occupational Therapy staff within the Reablement Team.

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We initially struggled to find a cohort of patients awaiting scheduled orthopaedic surgery due to their needs being met by the Rehabilitation Services. 

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We widened the remit and set up meetings with the Cancer Services Lead but established that their needs were being met by the Cancer Rehabilitation Service. 

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By continuing to work closely with the orthopaedic Rehabilitation Service  we were able to identify a small cohort of patients whose needs could not be met via their virtual service and they were then referred to Preablement for a face to face assessment in their own home.

Senior Management were very supportive of the Project

Significant support from the Bevan Commission

Enthusiastic Preablement staff who were keen to ensure the project was a success

Good links with Rehabilitation Service and Teams meetings as required to discuss patients

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There is an ongoing need for a small number of patients to receive Preablement, if their needs cannot be met by current Rehabilitation virtual services.

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