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Guidance assessment consultation document for HTG10887 Digital platforms to support preparation before and rehabilitation after primary elective hip or knee replacement surgery: early-use assessment

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1 Recommendations

Can be used during the evidence generation period

1.1

Four digital platforms can be used in the NHS during the evidence generation period as options to support preparation before and rehabilitation after primary elective hip or knee replacement surgery. The technologies are:

1.2

The companies are responsible for ensuring that data collection and analysis takes place. They must confirm that agreements are in place to generate the evidence. NICE will contact the companies annually to confirm that evidence is being generated and analysed as planned. NICE may revise or withdraw the guidance if these conditions are not met.

1.3

At the end of the evidence generation period (3 years), the companies should submit the evidence to NICE in a format that can be used for decision making. NICE will review the evidence and assess if the technology can be routinely adopted in the NHS.

More research is needed

1.4

More research is needed on 15 digital platforms to support preparation before and rehabilitation after primary elective hip or knee replacement surgery before they can be funded by the NHS. The technologies are:

  • for hip or knee replacement surgery:

    • ForPatientApp

    • getUBetter

    • Good Boost

    • Huma

    • Joint Academy

    • moveUP

    • myrecovery

    • Phio

    • PreActiv

    • QuestPrehab

    • Slider

    • Sword Thrive

  • for hip replacement surgery:

    • BPMpathway

    • Physitrack

  • for knee replacement surgery:

    • GoWellHealth.

What this means in practice

Can be used with evidence generation

The digital platforms in recommendation 1.1 can be used as options in the NHS during the evidence generation period (3 years) and paid for using core NHS funding. During this time, more evidence will be collected to address any uncertainties. Companies are responsible for organising funding for evidence generation activities.

After this, NICE will review this guidance and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.

Potential benefits of use in the NHS during the evidence generation period

  • Access: Digital platforms allow more consistent and timely access to preparation and rehabilitation programmes for hip or knee replacement surgery. Personalised programmes delivered through digital platforms could improve self-management and may reduce the frequency and duration of face-to-face physiotherapy appointments.

  • System benefit: Improving self-management may free up access to face-to-face physiotherapy services for people who need them. Monitoring of progress and healthcare professional communication channels within digital platforms may help people escalate to face-to-face physiotherapy more efficiently if self-management does not meet their needs.

  • Clinical benefit: Randomised controlled trial (RCT) evidence suggests that digital platforms may improve quality of life, joint-specific function, mobility and functional performance, and reduce pain and readmission rates.

  • Resources: Digital platforms could reduce the number of face-to-face appointments needed and their duration. They may also reduce length of hospital stay by providing more comprehensive support during preparation for surgery.

  • Equality: Digital platforms allow people to remotely engage with treatment, which can reduce the barriers relating to geographic variation in physiotherapist availability.

Managing the risk of use in the NHS during the evidence generation period

  • Costs: Early results from the economic modelling show that some digital platforms could be cost effective.

  • Resources: Implementing digital platforms to support preparation and rehabilitation for primary elective hip or knee replacement surgery could lead to an increase in the number of people needing physiotherapy. This is because it could identify more people who need face-to-face support.

  • Clinical assessment: Healthcare professionals should check before and after surgery whether self-directed rehabilitation using digital platforms is suitable for the person having a hip or knee replacement. Digital platforms should not replace face-to-face physiotherapy for people who need it.

  • Safety: Digital platformshave safety features to monitor progress, and to identify poor engagement or potential surgical complications. These can alert healthcare professionals to review the information or suggest to the user to contact their healthcare professional for advice.

  • Equality: Some people may find it more difficult to use or engage with digital platforms and may need additional support. This includes:

    • people who are less familiar with using digital technologies or who 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).

More research is needed

There is not enough evidence to support funding the digital platforms in recommendation 1.4 in the NHS.

Access to these digital platforms should be through company, research or non-core NHS funding, and clinical or financial risks should be managed appropriately.

What evidence generation is needed

Evidence generation is needed to compare the digital platforms in recommendation 1.1 with standard care in NHS settings. Digital platforms should be used both before and after surgery. More evidence needs to be generated on:

  • health-related quality of life

  • healthcare resource use, including length of hospital stay, physiotherapy contacts and readmissions

  • adverse events

  • patient engagement and adherence.

The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.

What research is needed

More research is needed on the digital platforms in recommendation 1.4 in NHS settings. Research should be comparative and should ideally be in the form of RCTs. The research should study digital platforms used both before and after surgery. The studies should report on:

  • health-related quality of life

  • length of hospital stay

  • adverse events

  • patient selection criteria

  • escalation to face-to-face physiotherapy

  • patient engagement and adherence

  • physiotherapist time spent supporting patients.

Why the committee made these recommendations

Standard care to help people mentally and physically prepare for hip or knee replacement surgery includes advice on exercises, lifestyle changes and self-directed rehabilitation. But the level of support varies. Digital platforms can support preparation for surgery and rehabilitation, and may help recovery from elective hip or knee replacement surgery.

Evidence on the clinical effectiveness of digital platforms to support preparation before and rehabilitation after primary elective hip or knee replacement surgery varies and is limited for some platforms. RCT evidence available for some of the digital platforms suggests they could work as well as or better than standard care.

Early economic modelling suggests that the digital platforms may be cost effective. But there are uncertainties in the model, including the assumptions used to estimate health-related quality of life and length of hospital stay.

Assuming no health-related quality of life gain or reduction in length of hospital stay in the model, 4 out of 5 digital platforms with RCT evidence may be cost effective for hip or knee replacement, or both. So, these digital platforms can be used during the evidence generation period.

For the remaining digital platforms, there is not enough evidence or the available evidence is not certain enough to recommend using these during an evidence generation period for hip or knee replacement, or both. So, more research is needed on these digital platforms.