How do patients and health care professionals perceive de-implementation of routine follow-ups after total hip or knee arthroplasty? Protocol for a nested qualitative study within a hybrid effectiveness de-implementation trial

Abstract

Background: Total hip and knee arthroplasties significantly improve the quality of life for patients with severe osteoarthritis. However, some patients experience complications that require follow-up care. Amid rising demand for these arthroplasties, debates have emerged around the value of routinely scheduled follow-ups (RFUs). This qualitative study, nested within a hybrid effectiveness de-implementation trial that assesses quantitative differences between RFU and check-ups on-demand (COD), will explore and compare the patients' and health care professionals' (HCPs) experiences with, and perceptions about, RFU and COD at 1 and 10 years after total hip and knee arthroplasty.

Materials and methods: First, a pre-study reference panel will be organised to prepare a focus groups topics guide. Subsequently, 2 methods of data collection will be used: 8 focus groups with total of 80 participants from the main trial and 10 in-depth interviews with different HCPs. Thematic analysis using a deductive approach will be performed on anonymised transcripts to identify key themes. For this, the comparative case study framework and the Theoretical Framework of Acceptability will be used. Findings will be used to inform the transition from RFU to COD if deemed acceptable by patients and HCPs.

Fig 1. Adapted SPIRIT Schedule of Enrollment, Interventions, and Assessments summarising all 3 work packages of the nationwide hybrid effectiveness de-implementation trial.

a This part of the study recruits patients scheduled for total hip or knee arthroplasty. A staggered crossover process is used whereby each of the 10 participating hospitals/sites – in a randomised order – sequentially closes recruitment for RFU and (after a two-month transitioning phase) initiates recruitment for COD. b During WP1 and WP2 assessments, outcomes include PROMIS physical function, healthcare consumption (clinical visits, radiographs), the number and type of complications and surgical interventions, health related quality of life, pain, satisfaction and healthcare costs. c This part of the study recruits patients who had total hip or knee arthroplasty 10 years ago. Only the RFU and Active COD cohorts will be assessed. For a Passive COD cohort, only retrospective registry data will be collected. d Participants are enrolled in WP2 approximately 10 years after undergoing total hip or knee arthroplasty. Therefore, the time points referred to as “3-month”, “6-month”, and “1-year” assessments should be understood as 10 years + 3 months, 10 years + 6 months, and 11 years after surgery. These labels reflect the time elapsed since enrolment in this follow-up phase, not since the original procedure. COD, check-up on demand; HCP, health care professional; RFU, regular follow-up; WP, Work Package.