A 45-minute session six weeks before surgery teaches children how to use walking aids, do pre-operative exercises, and plan their hospital discharge. This trial will test whether that session, called PREPARE KIDS, improves mobility two weeks after lower limb orthopaedic surgery compared to usual care alone. The problem is that children awaiting elective surgery—such as hip or knee corrections—often have no structured preparation. Without it, recovery can be slower, hospital stays longer, and families face more disruption. Current practice varies widely across NHS trusts, with no standardised prehabilitation programme for this age group. If the trial shows PREPARE KIDS is effective and cost-effective, the NHS could adopt it as routine care. That would mean shorter inpatient stays, fewer complications, and less time off work for parents. The researchers have designed the programme for easy uptake and plan to link with professional bodies to develop national guidelines, potentially informing a future NICE guideline on perioperative care in children.
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Objective: To assess clinical and cost-effectiveness of prehabilitation compared to usual care for children undergoing elective lower limb orthopaedic surgery. Design: Pragmatic, superiority, parallel group, multicentre randomised controlled trial with an embedded internal pilot, integrated process evaluation and economic analysis. Setting: 524 participants on paediatric orthopaedic surgery waiting lists in participating UK NHS Trusts (minimum 20 sites). Target population: Children aged 5-15 years awaiting elective lower limb surgery requiring inpatient stay of at least 1 night. Participants will be excluded if: they have ongoing physiotherapy programmes in place; they and/or their parent(s)/carer(s) are unable to comply with assessment procedures. Health technologies assessed: Participant will be randomised to either 1) a 45-minute prehabilitation session 6 weeks prior to surgery, which encompasses teaching use of relevant walking aids, preoperative exercises, and discussion about a pre-agreed discharge plan (including expected length of stay (LOS), and management of pain/function) in addition to usual care (PREPARE KIDS programme), or 2) usual care alone. Measurement of outcome: Follow-up will be by questionnaire 2, 6 and 12 weeks post operatively. The primary outcome is functional mobility at 2 weeks post operatively measured using the PROMIS-CAT Mobility Score for Children. PROMIS has been used in a range of paediatric orthopaedic studies, with strong correlation to traditional PROM tools. It is validated in children from age 5 years. Secondary outcomes include functional mobility, pain, and health-related quality of life of patients at 2, 6 and 12 weeks post operatively. At 12 weeks post operatively, resource use data (use of healthcare services, additional childcare services and carer time off work), health and wellbeing of carers, parental satisfaction and school absenteeism will be captured via questionnaire. Review of post-operative complications, LOS, outpatient contacts and hospital re-admissions will be captured at 12 weeks after review of medical records from sites. Timelines for delivery: Study duration will be 44 months including an internal pilot of 10 months. Anticipated impact and dissemination plans: Findings from the trial will inform NHS clinical practice for the management of children awaiting elective lower limb surgery. Prior to formal publication, we will inform the children and their parent(s)/carer(s) of the trial results using explainer videos and infographics to support written information. Our Patient and Public Involvement representatives will help inform how best to disseminate the trial results to other young people awaiting elective lower limb surgery and to the wider public. Our team is experienced in implementing research findings into practice and anticipate that the trial findings will have a substantial impact within 2-3 years . We have designed the PREPARE KIDS programme with ease of uptake and implementation in mind, should it prove effective . We will link with the British Society for Children’s Orthopaedic Surgery, the Association of Paediatric Chartered Physiotherapists, the Royal College of Nursing and the Association of Paediatric Anaesthetist of Great Britain and Ireland to ensure the guidelines are developed in conjunction with all relevant professionals. We hope that these will inform a NICE guideline perioperative care in children.
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