Consensus recommendations for supporting people waiting for total hip and knee arthroplasty in Scotland: A modified Delphi study

Abstract Background Many people experience long waiting times for hip and knee replacement surgery, negatively impacting physical conditioning and quality of life, and therefore need evidence-informed strategies to support them while they are waiting. Objective To develop consensus-based recommendations for supporting people waiting for hip or knee replacement in Scotland. Design Three-round online modified Delphi study involving 17 people with experience of waiting for hip or knee replacement and 30 professionals involved in supporting them. Methods Two rounds of online survey and one online workshop. Participants rated agreement with 113 (round 1), 40 (round 2) and 20 (round 3) statements on a 5-point Likert scale, with consensus based on ≥70% agreement. Items were modified and added in subsequent rounds based on content analysis of participant comments. The final recommendations represent items that reached consensus in both participant groups after 3 rounds. Results 47 participants took part in round 1 (17 patients, 30 professionals), 41 in round 2 (13 patients, 28 professionals) and 23 in round 3 (8 patients, 15 professionals). Eighty-two of 113 statements reached consensus in round one, 20 of 40 in round two and 6 of 20 in round 3. The final recommendations comprise 108 statements relating to: preoperative education; patient optimisation; other interventions to support people waiting; and, strategies to support people waiting a long time for surgery. Conclusions These findings are an important step towards developing best practice guidance for supporting people waiting for hip and knee replacement in Scotland.