Usefulness, Efficacy, and Satisfaction with a Web-based Integrated Clinical Pathway for Patients with Knee Cartilage Damage with Emphasis on an Online Exercise Program

The project addresses several challenges of modern society by investigating the treatment of patients with knee cartilage damage (injuries and osteoarthritis), which are among the most common musculoskeletal conditions in developed countries; introducing an integrated clinical pathway (ICP) that enables multidisciplinary treatment; supporting the digital and green transition strategy; including an interdisciplinary approach to increase adherence in the implementation of online health programs. Thus, the object of the study (an online ICP for patients with knee cartilage defects with a focus on an online exercise program) will be studied extensively, including: Interdisciplinarity: the communication, information technology and health aspects. A quantitative and qualitative approach involving key stakeholders (patients and health professionals) and the application of a descriptive cross-sectional study and a prospective observational study. An upgrade of the existing project (ARRS, L7-2631-3824-2020). A review of existing studies has revealed several research problems, namely a lack of research on 1) the course and quality of existing treatment offered to patients with knee cartilage damage; 2) perceptions of a web-based application focused on an online exercise program; an evaluation of the acceptability and quality of the web-based program prototype; 3) the effectiveness of an online exercise program with communication support and the use of rating scales (WOMAC and KOOS). The aim is to explore the starting points and create a prototype of an online ICP for patients with knee cartilage damage, focusing on an online exercise program and its implementation. We will achieve a comprehensive view through an interdisciplinary approach and the use of qualitative and quantitative methodology, as well as the inclusion of patients' and health professionals' perspectives. In the first 4 months, we will analyze the existing literature and submit a request for a positive assessment of the ethical adequacy of the research (WP1). In a 4 to 10-month cross-sectional descriptive study, we will conduct a mixed-methods survey (WP2) to collect data on the course and quality of existing treatment for patients with cartilage damage, patients' and health professionals' views on multi-stakeholder involvement in ICP for patients with cartilage damage, patients' and health professionals' perceptions of an online ICP with a focus on an online exercise program, and acceptance of the online ICP prototype. We will use in-depth interviews with patients with knee cartilage damage (N = 16) and health professionals (N = 16), an online survey of health professionals (N = 100), and a mixed-methods survey of patients (N = 100). A prototype ICP application will be created over a period from 4 to 14 months, focusing on an online exercise program for patients with knee cartilage defects that includes information, education, motivation, monitoring, and patients' communication with the medical staff (WP3). To evaluate the efficacy of the prototype using the WOMAC and KOOS rating scales, we will conduct a prospective observational study over a period from 14 to 32 months, involving patients with knee cartilage damage and proven knee OA (N = 300) undergoing the intervention and a control group with no intervention (N = 300) (WP4). The intervention begins with an examination by an orthopedist who diagnoses and establishes the baseline data, followed by patient education provided by a physiotherapist, 3 months of independent exercise done by the patient, and the final measurement of outcomes performed by an orthopedist. To optimize the user experience, we will elicit patients' and health professionals' opinions on acceptability, satisfaction, reasons for discontinuity, and improvements to the prototype (WP5), using the same methods and participants as in WP2 and including patients from WP4 (N = 300) in the survey. During the final 5 months, we will improve the prototype.