Supporting patients to prepare for total knee replacement: Evidence‐, theory‐ and person‐based development of a ‘Virtual Knee School’ digital intervention

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 26; no. 6; pp. 2549 - 2570
• Main Authors: Anderson, Anna M., McHugh, Gretl A., Comer, Christine, Joseph, Judith, Smith, Toby O., Yardley, Lucy, Redmond, Anthony C.
• Format: Journal Article
• Language: English
• Published: Oxford John Wiley & Sons, Inc 01-12-2023; John Wiley and Sons Inc; Wiley
• Subjects: Advisory groups; Citizen participation; Clinical outcomes; Coronaviruses; COVID-19; Design; Digital computers; digital intervention; Education; Intervention; intervention development; Knee; Knee replacement; Medical research; Meetings; mixed methods; Mixed methods research; Original; Orthopaedic implants; Pandemics; Patients; Perioperative care; prehabilitation; pre‐operative education; Project planning; Prototypes; Public involvement; Scholarships & fellowships; total knee replacement; Virtual reality; United Kingdom > UK
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.13855

IntroductionDigital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks.ObjectiveTo develop a pre-operative TKR education and prehabilitation digital intervention, the ‘Virtual Knee School’ (VKS).MethodsThe VKS was developed using an evidence-, theory- and person-based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think-aloud interviews with nine patients who were awaiting/had undergone TKR. Meta-inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773).ResultsMost participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants' feedback was used to refine the prototype's information architecture, design and content. Two meta-inferences were generated and recommend:1.Comprehensive pre-operative TKR education and prehabilitation support should be rapidly accessible in digital and non-digital formats.2.Pre-operative TKR digital interventions should employ computer- and self-tailoring to account for patients' individual needs and preferences.ConclusionsIntegrating evidence, theory and stakeholders' perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre-operative TKR care.Patient or Public ContributionPatient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototype and helped disseminate the project findings.