Feasibility of a Community-Based Aquatic Exercise and Peer Support Intervention (Good Boost+) for Adults on Knee Replacement Waiting Lists: A Randomised Hybrid Type 1 Effectiveness-Implementation Feasibility Trial

Research Question Can a future randomised hybrid effectiveness-implementation trial of Good Boost+ for people wait listed for knee replacement surgery be conducted? Background Current NHS wait times for knee replacement are long. While waiting, people can experience deteriorating health leading to poorer outcomes after surgery. Good Boost+ is a community-based personalised aquatic and land exercise training and peer support prehabilitation intervention for people wait listed for knee replacement surgery. Evidence about its effectiveness and acceptability is limited. Aim To determine the feasibility of recruitment, retention and adherence to a trial implementing the Good Boost+ intervention for individuals on waiting lists for primary total knee replacement. Objectives Primary To determine whether feasibility progression criteria are met based on: the number of eligible patients recruited to the trial, the rate of retention at 8 weeks, the adherence rate to the Good Boost+ programme, and the proportion of participants with missing outcome data at 8 weeks. Secondary To assess the acceptability of Good Boost+ to patients wait listed for knee replacement, NHS professionals and leisure centre staff. To determine an appropriate primary outcome measure for a definitive effectiveness-implementation hybrid trial assessing the effectiveness and implementation of Good Boost+ for individuals wait listed for primary total knee replacement. To identify determinants of implementation to inform the development of an implementation strategy to optimise adoption and implementation of Good Boost+. Design A parallel, two arm, assessor blinded, randomised controlled feasibility trial with a mixed methods study of acceptability and a qualitative study to identify determinants of implementation. Setting Elective orthopaedic wait lists and outpatient clinics at three South London NHS Trusts. Participants Adults registered on a wait list for primary knee replacement surgery: 48 participants NHS and leisure staff: 10 – 15 participants. Intervention Usual pre-operative NHS care plus Good Boost+ (a six-week personalised community-based aquatic and land exercise training and peer support intervention). Aquatic group exercise sessions are delivered in community swimming pools. Land exercise sessions are undertaken in private settings with the option to join a virtual group. Personalised exercise programmes are delivered via applications on a tablet or smartphone and generated using Artificial Intelligence. Comparator Usual pre-operative NHS care. Primary outcome The percentage of eligible patients recruited to the trial. Secondary outcomes Rate of retention at 8 weeks, adherence rate to the Good Boost+ programme, proportion of participants with missing outcome data at 8 weeks, acceptability of Good Boost+ and determinants of implementation. Timeline for delivery Trial duration 24 months: 6 months set up, 6 months recruitment, 3 months follow up, 9 months data cleaning and analysis, reporting and dissemination. Anticipated impact and dissemination This research will inform new models of prehabilitation. Understanding about the acceptability of cost-sharing for prehabilitation in the NHS, the acceptability of usual care and Good Boost+ to patients, along with barriers and enablers of Good Boost+ will be generated. We will disseminate the findings of this study with our patient research partners through webinars and social media, conference presentations and journal articles.