Mixed-Methods Feasibility Study to Test Uptake of Quality Indicator Resources for Rehabilitation After Total Hip and Knee Replacement: Feasibility Outcomes

Objectives We developed evidence-based quality indicators (QIs) to address care gaps in total hip (THR) and knee replacement (TKR) rehabilitation.[1] A feasibility study was designed to test methods (recruitment, consent, retention, engagement) for a stepped-wedge cluster randomized trial to implement 10 post-acute QIs using online toolkits. Methods We conducted a 9-month mixed methods, pragmatic feasibility study at 2 outpatient settings. Following 3 months of providing usual rehabilitation care, we led site-specific focus groups with clinicians to identify barriers and facilitators to QI implementation. With help of clinical champions, we then provided a 45-minute training webinar, introduced the clinician toolkit (QUICK-TJR) and 6 weeks later, the patient toolkit (EQUIP-TJR). This transition phase was followed by a 3-month maintenance phase with ongoing toolkit access. Clinical champions identified potentially eligible patients at time of discharge and provided contact information to a research coordinator. After confirming eligibility, we asked consenting patients to complete a REDCap online questionnaire and audited their chart using a standardized form. We collected QI adherence data continuously (chart audits, patient questionnaires) and prepost study (clinician questionnaire). We analyzed feasibility data descriptively. Results Sixteen clinicians (100%) at a private clinic and hospital outpatient department consented; 14(88%) participated in baseline focus groups/interviews; 100% completed the initial clinician QI questionnaire and 15(94%) participated in or viewed the webinar. Post-webinar, 93% said they intended to access the toolkit within the next week and 100% agreed the resources would positively impact their care of THR/TKR patients. Initially, 14 accessed the online toolkit; this decreased to 7/14(50%) in the maintenance phase. Clinician retention was good with 88% completing the final questionnaire and 100% end of study discussions. In total, 46 patients following primary THR (n=10) or TKR (n=36) participated; well below anticipated levels during the Mar.-Nov. 2024 study period. There were 66 patients deemed eligible by clinicians; we screened 59(89%) and 7(11%) did not respond to calls; 49(83%) were confirmed eligible and 46(94%) provided consent. All had their chart audited and 31(67%) completed the QI questionnaire. Of the 22 patients who had access to the EQUIP toolkit in the later phases, 5(23%) accessed it and 4(80%) agreed it helped them engage in their own care. Conclusion Study feasibility was confirmed with the high rates of recruitment, consent and retention by both clinicians and patients. Despite good initial clinician engagement, there was limited uptake of QI resources among clinicians and patients overall. This will be addressed prior to the planned trial. References [1.] Westby MD. Osteoarthritis Cartilage 2018;26:370-82.