Pre-habilitation for patients awaiting total knee replacement in the United Kingdom National Health Service:A review of publicly facing information

INTRODUCTION: Approximately 14,000 - 21,500 individuals per year are dissatisfied with the outcome of their Total Knee Replacement (TKR) in the UK National Health Service (NHS). National Institute of Clinical Excellence (NICE) guidelines recommend that future research should evaluate whether a 'full programme of pre-habilitation' can improve outcomes for patients awaiting TKR. The aim of this review was to describe current pre-habilitation practice for patients awaiting TKR in the UK NHS, to inform future research. METHODS: Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of UK NHS Trusts that included detail about pre-habilitation for patients awaiting TKR. One reviewer extracted data, and a second reviewer verified this. RESULTS: Fifty PIS, nine information videos and one web page from 59 NHS Trusts were identified. NHS Trusts most commonly provide patients with advice on pre-operative rehabilitation via a single appointment, combined with a PIS (36/59; 61.0%). NHS Trusts use appointments, PIS and video to provide patients awaiting TKR with information regarding pain control (46/58; 79.3%), exercise therapy (46/58; 79.3%), what to expect on the day of surgery and in-patient stay (58/58; 100%), lifestyle interventions (27/58; 46.6%), and adverse events (44/58; 75.9%). CONCLUSION: NHS Trusts commonly provided patients awaiting TKR with 'advice on pre-operative rehabilitation', however no NHS Trust provided a comprehensive programme of pre-habilitation. The results of this study will inform the development of a comprehensive, multi-modal pre-habilitation programme, to be tested in a future high-quality randomised controlled trial

Stressing out over long noncoding RNA

Genomic studies have revealed that humans possess far fewer protein-encoding genes than originally predicted. These over-estimates were draw from the inherent developmental and stimuli-responsive complexity found in humans and other mammals, when compared to lower eukaryotic organisms. This left a conceptual void in many cellular networks, as a new class of functional molecules was necessary for “fine-tuning” the basic proteomic machinery. Transcriptomics analyses have determined that the vast majority of the genetic material is transcribed as noncoding RNA, suggesting that these molecules could provide the functional diversity initially sought from proteins. Indeed, as discussed in this review, long noncoding RNA (lncRNA), the largest family of noncoding transcripts, have emerged as common regulators of many cellular stressors; including heat shock, DNA damage and metabolic deprivation. These stimuli, while divergent in nature, share some common stress-responsive pathways, notably inhibition of cell proliferation. This function intrinsically makes lncRNA regulators of the stress response potential tumor suppressor or proto-oncogenic genes. As the list of functional RNA molecules continues to rapidly expand it is becoming increasingly clear that the significance and functionality of this family may someday rival that of proteins