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

Anna M. Anderson, Gretl A. McHugh, Christine Comer, Judith Joseph, Toby O. Smith, Lucy Yardley, Anthony C. Redmond

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Introduction: Digital 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. Objective: To develop a pre-operative TKR education and prehabilitation digital intervention, the ‘Virtual Knee School’ (VKS). Methods: The 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). Results: Most 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. Conclusions: Integrating 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 Contribution: Patient 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.

Original languageEnglish
Pages (from-to)2549-2570
Number of pages22
JournalHealth Expectations
Issue number6
Early online date22 Aug 2023
Publication statusPublished - Dec 2023


  • Total knee replacement
  • intervention development
  • TKR
  • replacement
  • pre-operative
  • prehabilitation
  • mixed methods
  • total knee replacement
  • pre-operative education
  • digital intervention

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