Dunphy, Emma;
(2022)
TRAK ACL: Development of a self-management Digital Health Intervention to support optimal care in ACL rehabilitation: Scoping Review, Qualitative Study and Feasibility RCT.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: Outcomes vary after Anterior Cruciate Ligament (ACL) reconstruction surgery and many patients do not return to previous levels of activity. This may be related to variations in evidence based rehabilitation care. It is NHS policy to avoid inappropriate variations in healthcare and to use digital health interventions (DHI) to improve access and outcomes. / Aim: This thesis explored causes of variability in care and the feasibility of a DHI to overcome them. / Objectives: 1. To identify resources used in trials of optimal ACL rehabilitation; 2. To explore stakeholder views around criteria for optimal care and reasons for variation. 3. To explore opinions of digital tools in evolving care models. 4. To determine the feasibility of undertaking a definitive randomised controlled trial (RCT) to determine effectiveness and cost-effectiveness of a specific DHI to support ACL rehabilitation. / Methods: Methods were selected to match objectives: Objective 1 was addressed with a systematically conducted scoping review; Objectives 2 & 3 through qualitative interviews with orthopaedic surgeons and physiotherapists; and Objective 3 by a randomised feasibility trial comparing a specific DHI plus Treatment as Usual (TAU) with TAU. / Results: The scoping review established that ACL rehabilitation in RCTs includes specialist equipment, a gym environment and an experienced physiotherapist. Interviews revealed that practitioners were committed to evidence-based care, but were sometimes limited by systemic factors, including lack of resources, infrequent appointments or ambiguous pathways of care. Interviewees cautiously welcomed DHIs to support care but identified concerns. Feasibility results showed 86% recruitment rate, 78% retention rate and 100% completion rate on 4 out of 5 outcomes including the primary outcome of a future trial, the Knee Osteoarthritis Outcome Score. Fidelity to the DHI showed user engagement was heavily skewed. / Conclusion: This work provides evidence to explain observed unacceptable variations in care for this patient group and suggests that a digital health intervention could help address these. A definitive trial is both warranted and feasible.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | TRAK ACL: Development of a self-management Digital Health Intervention to support optimal care in ACL rehabilitation: Scoping Review, Qualitative Study and Feasibility RCT |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10146681 |
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