Comparing the acceptability and treatment fidelity of digital pre-operative education to face-to-face physiotherapy pre-operative education in patients awaiting elective thoracic surgery: A pilot feasibility randomised controlled trial.

Group 2: Digital pre-operative education The objectives of this feasibility pilot study are to investigate whether pre-operative physiotherapy education delivered via digital video has similar acceptability and treatment fidelity as education delivered face-to-face in patients undergoing thoracic surgery. Eligible participants will be randomly allocated by concealed allocation to receive either face-to-face pre-operative education by a physiotherapist (Group 1) or digital video pre-operative education via a laptop, tablet, or mobile device (Group 2). Post-operative physiotherapy input will reflect current practice at The Prince Charles Hospital (TPCH) and be delivered by the ward physiotherapist, including education, mobilisation, and respiratory care. Discharge from physiotherapy will follow criteria as per current practice for both groups, and information provided at discharge will be consistent. Investigators at TPCH will screen pre-admission clinic (PREAC), theatre and thoracic surgical ward lists daily for eligible patients. Potential participants will be met by one of the investigators (either in PREAC or on the ward, depending on where the patient is identified by the investigators) and provided with verbal information about the trial as well as a written information sheet (appendix 1). Once consented, trial participants will be randomly allocated to receive either face-to-face pre-operative physiotherapy education (group 1), or digital video pre-operative physiotherapy education (group 2). Participants allocated to group 2 will receive digital video pre-operative education; a 15 minute professionally made, educational video shown on a laptop, tablet, phone, or other device. Participants will also be provided with a link to the video, allowing them to watch it as many times as they like on a personal device (reflecting the likely clinical practice when implemented). As with the face-to-face group, the location and timing of when these participants receive their pre-operative education is based on when they were consented (i.e. those consented in pre-admission clinic will be shown the digital video whilst in pre-admission clinic, and those recruited and consented on the ward will be shown the digital video while on the ward). The patients in this group will receive the video as their primary source of education, and as they are not seeing a physiotherapist to provide this education, a subjective assessment will not be undertaken prior to surgery. Any information which is usually gathered as part of a pre-operative review will be collected by the ward physiotherapist post-operatively as part of a standard initial patient assessment. After the investigator consents the patient and they are allocated to receive digital video education, the investigator will provide the participant with the tablet containing the digital video, as well as a link to the video to take with them, and will then leave the patient to watch the education and collect the tablet at a later time. After watching the digital video and prior to having surgery, a ward physiotherapist will as the participant if they have any questions about the video, and will answer accordingly. Any questions asked will be documented. Digital video education includes the same type of information that is provided in face-to-face education listed above, including education on deep breathing exercises (with and without an incentive spirometer), supported coughing, circulation exercises, early mobility, and the rationale for all these interventions. Additionally, the video includes demonstrations of deep breathing exercises, supported cough and animations to support the educational content. This group will not have the opportunity to practice the incentive spirometer prior to surgery but will be provided with an incentive spirometer post-operatively by the ward physiotherapist. Adherence to the intervention will be monitored via recorded semi-scripted interviews on day 3-5 post-operatively and will include questions to check participant recall of receiving intervention as well as recall of content.