Key result
The 8-week digital Hope Programme helped 92% of participants who underwent surgery feel better prepared, with significant improvements in self-efficacy (P<0.001) and mental wellbeing (P=0.010).
Why the study?
Lengthening waiting lists for hip and knee replacement surgery pose challenges, creating a need to develop and test interventions to better prepare patients waiting for surgery.
Does an 8-week digital self-management program improve patient-reported outcomes and preparation for surgery in patients waiting for hip or knee replacement?
Does an 8-week digital self-management program improve patient-reported outcomes and preparation for surgery in patients waiting for hip or knee replacement?
An 8-week digital self-management program shows promise in improving self-efficacy, pain, and mental wellbeing for patients awaiting joint replacement, though efficacy must be confirmed in a controlled trial.
May support digital perioperative support; leaves open need for randomized trials before practice change.
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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Horton et al. (2024) studied Patients waiting for hip and knee replacement surgery (n=39). Hope Programme (digital self-management intervention) was evaluated on Feeling better prepared for surgery (among those who had surgery). The 8-week digital Hope Programme helped 92% of participants who underwent surgery feel better prepared, with significant improvements in self-efficacy (P<0.001) and mental wellbeing (P=0.010).
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