Using a Co-Designed Digital Self-Management Program to Prepare Patients for Hip or Knee Replacement Surgery: Pragmatic Pilot Study.

The study had no control group and was not powered to detect statistically significant changes, so outcome changes cannot be attributed to the program. Only 39 of 100 enrolled participants were included in the primary analysis, because the analysis used completers who returned follow-ups. Program noncompleters had slightly greater disease severity at baseline and were more likely to be male, in paid employment, or awaiting hip replacement, so the analyzed group may have had better outcomes than real-world users. By 6-month follow-up, 25 of 39 analyzed participants had had surgery, so it is difficult to separate program effects from surgery effects. The sample lacked diversity: all 39 completers were White, and age was reported by only 21 of 39. Usability was optional and completed by only 16 participants, so it may reflect a more positive user experience. The cost analysis included only 14 participants after excluding those who had surgery, and overall cost savings were not statistically significant. Participant feedback on surgery preparedness was mostly agreeable and gave limited critical information. Recruitment was self-selecting, so participants may have been more inclined to seek help or engage in self-help.

Coventry University and its spin-out social enterprise, H4C, developed the HOPE program. The evaluation was funded by a UK Research and Innovation Healthy Ageing Challenge Scaling Social Ventures competition award to H4C. H4C's platform powered the program.

Do not read the self-reported preparedness and outcome improvements as proof that the program works. This was a single-arm pilot with no control group, only 39 participants analyzed, and 25 of them had surgery by 6 months; surgery may have caused much of the improvement.