Development of a Virtual Knee School 1.0
Research type
Research Study
Full title
Development and process evaluation of a pre-operative education and prehabilitation digital intervention for patients awaiting total knee replacement: a Virtual Knee School
IRAS ID
262809
Contact name
Anna Anderson
Contact email
Sponsor organisation
University of Leeds
ISRCTN Number
ISRCTN11759773
Duration of Study in the UK
2 years, 1 months, 31 days
Research summary
Research Summary
Can we develop a pre-operative care website for patients waiting for total knee replacement surgery – a Virtual Knee School?\n\nTotal knee replacement (TKR) is a very common operation mainly carried out in older people with knee arthritis. Although TKR surgery is usually successful, around one in six patients are not satisfied with their recovery following TKR surgery. \n\nProviding pre-operative care, such as information and exercises, can help patients prepare for TKR surgery and recover better after surgery. However, current pre-operative TKR services vary, do not meet all patients’ needs and are expensive to deliver. Providing pre-operative TKR care using a website could help improve this, but existing TKR websites have many limitations. We aim to address this by developing a new website, the ‘Virtual Knee School’ (VKS), using five phases:\n\n1. We will develop recommendations on pre-operative TKR care by asking experts to complete online questionnaires. \n2. We will use group discussions with patients to explore what might encourage patients to use the VKS or prevent them from using it. \n3. We will use theory (ideas about what affects people’s behaviour) to guide how we develop the VKS.\n4. We will develop an early version of the VKS based on the findings of Phases 1-3 and use patient feedback to gradually improve it.\n5. We will give patients access to the VKS, monitor how they use it for four weeks, and explore their views of it using questionnaires and interviews.\n\nWe will recruit participants through UK hospital(s) and possibly social media. This application covers Phases 2-5 only. \n\nThis project is funded by the National Institute for Health Research (NIHR) [HEE/NIHR ICA Programme Clinical Doctoral Research Fellowship (ICA-CDRF-2018-04-ST2-006)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Summary of results
We worked with patients, professionals and Patient and Public Involvement representatives (patients/carers/members of the public) to develop a new website, the Virtual Knee School.
• The website provides pre-operative care (information and an exercise plan) to help patients prepare for having a total knee replacement.Research phases to prepare for this study
• Phase 1a: we reviewed 52 studies on pre-operative knee replacement care. Our review showed that evidence in this area is patchy.
• Phase 1b: we carried out surveys with 30 patients and 30 professionals to develop agreed recommendations on pre-operative knee replacement care.Research phases during this study
• Phase 2: we carried out group discussions with 14 patients. These suggested that the Virtual Knee School should account for differences in patients’ individual needs/preferences and be tailored to the pre-operative phase of the care pathway.
• Phase 3: we used theories (ideas) about people’s behaviour to help guide the Virtual Knee School development and research process.
• Phase 4: we used the findings of phases 1–3 to develop an early version of the Virtual Knee School. We then gradually improved it based on interviews with nine patients. Most participants liked the Virtual Knee School and felt it has many benefits, such as being realistic and reassuring. A few participants felt aspects of its content or digital format did not meet their needs. We improved the website by changing its design, structure and content.Overall conclusions
1. Patients should have quick access to a wide range of pre-operative knee replacement care in digital and non-digital formats.
2. Pre-operative knee replacement digital tools should allow patients to tailor the tool themselves and include automatically tailored features.Main benefits
• The pre-operative knee replacement care recommendations and overall conclusions can be used to help improve care for patients waiting for a knee replacement.
• The Virtual Knee School is ready to be used in future research so that we can find out if it benefits patients.REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
20/YH/0095
Date of REC Opinion
19 Mar 2020
REC opinion
Favourable Opinion