Evaluating the Joint Academy App for Patients Awaiting Hip and Knee Surgery: A Mixed Methods Study (Preprint)

BACKGROUND With increasing demand for hip and knee joint replacement surgeries, there is a growing need for strategies to support patients during extended waiting periods. Self-management programs for osteoarthritis (OA) delivered via a mobile application (app), offer a promising approach to enhance physical function, reduce pain, and potentially minimise pre- and postoperative complications. However, further research is needed to evaluate both their clinical impact and how patients engage with these digital tools. OBJECTIVE To explore participants’ engagement with, and clinical outcomes from, using a mobile app to support self-management while awaiting hip or knee joint replacement surgery. METHODS This exploratory intervention study used a mixed methods design. Quantitative data were collected from 116 NHS Highland patients awaiting hip or knee replacement surgery who enrolled in the Joint Academy app, a digital OA management program. Outcomes included joint-specific pain scores (NRS), and sit-to-stand performance measured at baseline and six months. A purposive subsample of 20 participants (hip n=8, knee n=12) took part in semi-structured interviews to explore user engagement and perspectives. Qualitative data were analysed thematically using an interpretive description approach. RESULTS Quantitative findings indicated statistically significant improvements in joint-specific pain (NRS) and physical function (sit-to-stand test) for all participants. However, when examining joint-specific patient-reported outcome measures, only participants awaiting knee replacement showed improvement on the Knee injury and Osteoarthritis Outcome Score (KOOS), which assesses perceived knee stiffness, pain, and function. No comparable change was observed on the Hip disability and Osteoarthritis Outcome Score (HOOS), which assesses hip-related pain and function. Eight individuals elected to come off the waiting list. Thematic analysis of interview data identified five key themes: reassurance, motivation, convenience, timing, and expectations. Many participants described the app as a source of reassurance and motivation, appreciating its flexible and accessible format. However, several participants felt the intervention was introduced too late in their care pathway, limiting its potential benefits. Views were mixed regarding the app’s influence on surgical decision-making. CONCLUSIONS The Joint Academy app supported improvements in pain and function and was generally well-received by participants awaiting joint replacement. Earlier introduction of app-based self-management tools may enhance patient outcomes during the preoperative period and warrants further investigation. CLINICALTRIAL N/A