Table 1.

Feedback from patient advisory groups, and its impact on design of intervention to improve rehabilitation.

Question	Feedback Received	Impact on Design of Intervention
What was particularly challenging during rehabilitation?	The amount of pain experienced following surgery differed between the people in the groups. Some felt very restricted in their activities as their pain was worse than expected, whilst others experienced less pain and were able to complete the exercises given.	Needs to be inclusive and benefit patients experiencing all levels of pain, with differing motivations for improving.
	Motivation varied. Some in the groups were very motivated to improve quickly, “to return to normal” as they had family or work commitments or wanted to continue with activities such as dance and yoga.
	Inconsistent information was given pre-surgery on resources available to help with rehabilitation, e.g., how to organise home, specialist exercise/swimming classes at local leisure centres.	Information to be available on accessing resources at the hospital and in the community.
	Lack of guidance on how long to continue with the exercise given, at what intensity, how to progress with the exercises and changes in range of motion to be expected—no more advanced exercises given. Some worried about performing exercises too quickly and coming off crutches too early.	Expert guidance required on type and intensity of post-surgery exercise, and how to progress exercises.
	Inconsistent information given on precautions to take after surgery, e.g., how long to wear compression stockings; time before they can drive; how long they have to sleep in a particular position; how to kneel (for total knee replacement surgery). Advice on how to get out of bed; taking laxatives and cut toenails also mixed.	Evidence-based guidance required on precautions required post-surgery, and how long these are necessary, along with advice on managing activities of daily living.
	Too much information online, hard to assess quality.
	Isolation. Lack of contact with other people. Inability to drive in weeks following surgery.	Contact with others who have had similar surgery, and time to talk together and compare notes/offer support.
What were the most important factors in rehabilitation?	Being able to speak to someone one-on-one.	Ability to speak face-to-face with a specialist health professional.
	Having expectations managed, and the setting of achievable goals.	Guidance from a specialist health professional.
	Having a good booklet giving information and contacts.	Online information/booklet providing current evidence and guidance, and contacts for local services and resources.
	Being advised on how to set up home and assistive equipment available.	Advice required on assistive equipment available for the home.
	Partner/carer having realistic expectations of patient following surgery, so they do not push too hard or hold patient back.	Intervention to include partners and carers so that they have appropriate expectations, and an understanding of the rehabilitation process.
	Other activities undertaken: walking, hydrotherapy, aqua aerobics, static cycling.	Include exercise in the intervention.
	Losing weight (if required).
	Having a follow-up telephone call with physios/nurses at 3–4 weeks.	Have regular access to a specialist health professional.
How could these factors be utilised in an intervention?	Have classes similar to those given to patients undergoing rehabilitation for cardiac surgery.
	Have education and exercise components, with Question and Answer session at the end.
	Hold in a big space accessible to communities such as church halls.
	Partners take part in group as well to join in with the social aspect and understand the recovery process better.
	Allow for time for people to socialise with other people in same situation.
	A follow-up telephone call with physios/nurses should occur at 3–4 weeks post-surgery as per NHS standard practice, and then start intervention at 6 weeks.
	Have trained facilitator with good knowledge of condition and rehabilitation, who has knowledge of medical history of those attending.
	Potential for online forum where people could ask questions, or the use of smartphones/apps.