6 Implementation considerations

The following considerations around implementing the evidence generation process have been identified through working with system partners.

Users can access the digital technologies through a variety of referral pathways, including self-referral without medical oversight. It is important to capture the referral pathway of the study participants. This will ensure like-for-like comparisons of various populations to enable future subgroup analyses.
Conventional management for mild to moderate symptoms of hip or knee osteoarthritis may be offered by various healthcare professionals and may involve multiple allied healthcare professionals and various medical interventions. Details around conventional management should be reported during evidence generation to minimise the risk of bias and accurately assess costs for cost comparisons.

NHS trusts should take into account the costs of the digital technologies used in this assessment when implementing the technologies. When negotiating with companies, trusts should also consider the upfront costs for implementing a technology, staff and user training, integration with NHS systems and providing smart devices that need an internet connection.

Face-to-face management sessions for mild to moderate symptoms of hip or knee osteoarthritis should be available for people with conditions that are not indicated for use with the digital technologies or who decline using the technologies.
People who are eligible to use a technology in line with its intended use but who are excluded for any other reason should be described in the reporting of future evidence.
There is a risk that using digital technologies could widen the gap in access to managing these conditions. Support and resources may be needed for:
- people who are less familiar with using digital technologies or have limited access to equipment or the internet
- neurodivergent people
- people with learning disabilities
- people with visual, hearing or cognitive impairments
- people who have problems with manual dexterity
- people who have difficulties reading, writing or understanding health-related information (including people who cannot read English).
- who are experiencing homelessness
- who are living in a multiple occupancy household
- who are living in residential care.

Reporting intervention-related adverse events (for example, worsening pain) is essential to assess any risk associated with the use of the technologies in the NHS.

ISBN: [to be added at publication]

Digital technologies for managing mild to moderate symptoms of hip or knee osteoarthritis