Process evaluation of an integrated personalized eHealth programme after total and unicompartmental knee arthroplasty-Results of the multicenter ACTIVE randomized controlled trial

Patients receiving knee arthroplasty often experience limited guidance in resuming daily life activities. The ACTIVE (enhAncing soCietal parTicipation with an IndiVidualized integratEd care programme) trial evaluated the effectiveness of an intervention designed to enhance recovery and return to daily activities in working-age knee arthroplasty patients. We conducted a process evaluation assessing whether the intervention was delivered as intended and exploring patient experiences, attitudes and the factors that explain how and why the intervention unfolded in practice, to guide future improvements in both the intervention and its implementation. A process evaluation was carried out alongside the multicenter randomized controlled ACTIVE trial. Data were analysed using the Linnan and Steckler framework, measuring reach, dose delivered, dose received and patients' attitudes throughout the follow-up. Among patients in the intervention group only, data were collected using questionnaires, a study database and a logbook of the eHealth programme. We additionally performed six interviews with patients to gather in-depth information regarding positive and negative experiences with the intervention. A total of 145 patients were randomized to the intervention group, of which 133 started follow-up. All components of the intervention were delivered as planned, and 100% of eligible patients received access to the eHealth programme. Adherence was high, with 99% of patients logging into the programme at least once. Patients reported that the intervention was supportive and motivating. The activity tracker was scored highest with a mean of 7.8 (standard deviation [SD] 1.4) and 7.9 (1.4) out of 10 at 6 weeks and 6 months postoperatively, respectively. Patients with disabling comorbidities or atypical recovery trajectories felt that recovery recommendations did not adequately address their specific needs. The intervention was delivered and used as intended and seems ready for successful implementation for working-age knee arthroplasty patients with a typical course of recovery. To accommodate patients with atypical recovery trajectories, the intervention should incorporate greater flexibility. N/A.