DOS 2020

DOS Kongressen 2020 · 195 Patient and public involvement in the Danish PROHIP trial: A thematic exploration of key stakeholder input, experiences, and perceptions. Thomas Frydendal, Kristine Sloth Thomsen, Inger Mechlenburg, Lone Ramer Mikkelsen, Søren Overgaard, Kim Gordon Ingwersen, Corrie Myburgh Department of Physiotherapy, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Elective Surgery Centre , Silkeborg Regional Hospital, Silkeborg, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Background: Total hip arthroplasty (THA) and exercise provide improved function and reduced pain for hip osteoarthritis. Current treatment selection is based on low evidence as no randomised controlled trials (RCTs) are available. Furthermore, low recruitment rates and intervention crossover are common in RCTs comparing sur- gery to exercise. Patient and public involvement (PPI) may improve trial design and implementation of research findings. Thus, a PPI protocol was embedded into the Progressive Resistance Training versus Total Hip Arthroplasty in Patients with End- stage Hip Osteoarthritis (PROHIP) trial. Purpose / Aim of Study: To explore context-relevant key stakeholder input in order to optimise the design and execution of a planned comparative RCT. Materials and Methods: Fourteen patients undergoing THA, two orthopaedic surgeons and two physiotherapists, and four political stakeholders were recruited. Six focus group interviews were conducted according to group status using semi- structured interview guides. Interviews were recorded, transcribed verbatim and thematic analysed. Findings / Results: Three key themes emerged: (1) Patient recovery expectations, (2) The influence of professional authority, and (3) Inconsistent health care provider communication. Theme 1 suggested that patients experienced their hip problem as disabling and considered recovery without THA unlikely. However, after THA, expec- tations for a quick return to activities of daily living were high. Theme 2 highlighted that both surgeons and physiotherapists claimed expert knowledge and clashed regarding explanatory and management frameworks. Therefore, patients may feel pressured into choosing between THA or exercise. Finally, theme 3 indicated that health care providers tended to use a management narrative best suited to their preferred intervention. Therefore, patients risk being medicalised differently. Conclusions: Patients, orthopaedic surgeons and physiotherapists may introduce systematic bias into the PROHIP trial. Methodological considerations to improve trial design may include development of a neutral patient information narrative delivered by an independent health care provider group during enrolment and a prospective cohort study investigating the external validity. 174.