Using a Co-Designed Digital Self-Management Program to Prepare Patients for Hip or Knee Replacement Surgery: Pragmatic Pilot Study

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Abstract
Background: The aging population has resulted in more people living longer with musculoskeletal conditions who require hip and knee replacement surgery. Lengthening waiting lists continue to be a challenge for patients and health care services. Objective: This pragmatic study aimed to develop and test a digital self-management intervention (the HOPE [Help Overcome Problems Effectively] program) to better prepare patients waiting for hip and knee replacement surgery. Methods: The study used a pragmatic, pre-post with follow-up, single-arm design. All intervention and data collection components were delivered online. Patients were recruited from those on the waiting list for hip or knee surgery. Following iterative co-development of the intervention, the content was refined and optimized into a final version for testing. The resulting program was an 8-week intervention delivered via the HOPE 4 The Community (H4C) digital platform (powered by H4C). Data were collected at baseline (pre-HOPE program), 8 weeks (post-HOPE program), and 6-month follow-up. Patient-reported outcome measures related to preparation for surgery, quality of life, physical function, pain, mental well-being, self-efficacy, and physical activity. Resource usage data were collected to calculate health and social care costs. System Usability Scale data were collected post-HOPE program. Results: One hundred participants enrolled in the HOPE program. Of these, 57 (57%) consented to take part in the evaluation and returned the baseline questionnaire. Thirty-nine participants completed ≥5 of the 8 sessions and all surveys. Among the 25 participants who had surgery at 6 months, 23 (92%) felt better prepared due to the HOPE program. Median improvements in most outcomes were observed at 8 weeks, with several continuing to improve at 6 months. The Friedman test showed significant improvements over 6 months in self-efficacy (pain: P =.002; other symptoms: P <.01), pain ( P =.04), health status ( P =.02), and mental well-being ( P =.01). No significant changes were noted in physical activity. While the early cost analysis did not reach statistical significance, it indicated potential cost savings from reduced patient interactions with health care professionals. Sixty-four percent (25/39) of participants had surgery, and this likely contributed in part to improvements in outcomes. System usability was rated above average (mean score 70.1, SD 15.9). Conclusions: The results are promising in relation to participants attending the HOPE program feeling better prepared for surgery. A fully powered efficacy and cost-effectiveness trial is needed to determine the contribution of the HOPE program to outcomes, over and above the contribution of surgery.

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