Does a Digital Self-Management Programme Prepare Patients for Hip or Knee Replacement Surgery: A Pragmatic Mixed Methods Pilot Study (Preprint)

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Abstract
BACKGROUND The ageing population has resulted in more people living for longer with musculoskeletal conditions who are in need of hip and knee replacement surgery. Lengthening waiting lists are increasingly a challenge for patients and healthcare services. OBJECTIVE This pragmatic study aimed to develop and test a digital self-management intervention (the Hope Programme) to better prepare patients waiting for hip and knee replacement surgery. METHODS The study employed a pragmatic, pre-post with follow-up single-arm design. All intervention and data collection components were delivered online. Following iterative co-development of the intervention, the content was refined and optimised into a final version for testing. The resulting programme was an eight-week intervention delivered via the Hope 4 The Community Interest Company (H4C) digital platform. Data were collected at baseline (pre Hope Programme), 8 weeks (post Hope Programme) and 6 months follow-up. Patient-reported outcome measures related to preparation for surgery, quality of life, physical function, pain, mental wellbeing, self-efficacy and physical activity. Resource utilisation data were collected to calculate the health and social care costs. System Usability Scale data and qualitative satisfaction data were collected post Hope Programme. RESULTS Thirty-nine participants completed ≥5 of the 8 sessions and all surveys. Among the 25 participants who had surgery at 6 months, 92% felt better prepared due to the Hope Programme. 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<.001), pain (P=.037), health status (P=.022), and mental wellbeing (P=.010). 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 healthcare 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), and post-programme feedback was positive, highlighting peer support, coping strategies, and better preparation for surgery. CONCLUSIONS The results are promising in relation to participants attending the Hope Programme feeling better prepared for surgery. A fully powered efficacy and cost effectiveness trial is needed to determine the contribution of the Hope Programme to outcomes, over and above the contribution of surgery.

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