Fig 1.
Adapted SPIRIT Schedule of Enrollment, Interventions, and Assessments summarising all 3 work packages of the nationwide hybrid effectiveness de-implementation trial.
a This part of the study recruits patients scheduled for total hip or knee arthroplasty. A staggered crossover process is used whereby each of the 10 participating hospitals/sites – in a randomised order – sequentially closes recruitment for RFU and (after a two-month transitioning phase) initiates recruitment for COD. b During WP1 and WP2 assessments, outcomes include PROMIS physical function, healthcare consumption (clinical visits, radiographs), the number and type of complications and surgical interventions, health related quality of life, pain, satisfaction and healthcare costs. c This part of the study recruits patients who had total hip or knee arthroplasty 10 years ago. Only the RFU and Active COD cohorts will be assessed. For a Passive COD cohort, only retrospective registry data will be collected. d Participants are enrolled in WP2 approximately 10 years after undergoing total hip or knee arthroplasty. Therefore, the time points referred to as “3-month”, “6-month”, and “1-year” assessments should be understood as 10 years + 3 months, 10 years + 6 months, and 11 years after surgery. These labels reflect the time elapsed since enrolment in this follow-up phase, not since the original procedure. COD, check-up on demand; HCP, health care professional; RFU, regular follow-up; WP, Work Package.