{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:55:04Z","timestamp":1790686504306,"version":"4.1.0"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.26007.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000}},{"DOI":"10.12688\/wellcomeopenres.26007.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000}}],"reference-count":21,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009053","name":"Wellcome Trust DBT India Alliance","doi-asserted-by":"publisher","award":["IA\/CPHI\/20\/1\/505224"],"award-info":[{"award-number":["IA\/CPHI\/20\/1\/505224"]}],"id":[{"id":"10.13039\/501100009053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Background Physical rehabilitation after knee arthroplasty is essential for improving functional outcomes. However, adherence to rehabilitation is poor. We developed a multicomponent mobile application TeleREhabilitation after knee ArThroplasty (TReAT app) comprising education, exercise videos, an e-diary for self-monitoring progress, two-way communication, and remote therapy planning to facilitate home-based rehabilitation. The TReAT trial is a 1:1 randomized controlled superiority trial to evaluate the clinical and cost-effectiveness of the intervention against usual care, with an embedded process evaluation. This paper reports the protocol for process evaluation. Methods and analysis Consenting individuals undergoing knee arthroplasty at a public and private tertiary care hospital in Delhi, who are able to use a smartphone will be randomized to either app-based or usual home-based rehabilitation and followed up at 3 and 6 months to assess knee-related functional outcomes. A mixed-methods convergent parallel design supported by a logic model will be used for a process evaluation. Data from screening log, backend app analytics, interviews with end users, and researcher notes will contribute to the evaluation based on RE-AIM framework. Researcher notes will be quantified and, consolidated with app analytics to summarise fidelity, and adoption. Thematic analysis of interviews will provide insights into contextual factors influencing intervention adoption during the trial and intention to use the TReAT app beyond the trial period. To explore potential association between use of intervention components and outcomes, correlations between functional outcomes, knowledge score and rehabilitation self-efficacy will be examined. Conclusions The process evaluation will provide insights into the potential uptake and scalability of TReAT intervention. Comparing findings across public and private healthcare settings will enhance understanding of how the intervention functions in different contexts. The findings will inform implementation strategies to improve rehabilitation care using mHealth interventions in India. Trial registration The trial was registered prospectively with the Clinical Trial Registry of India (CTRI\/2024\/06\/068838).<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.26007.3","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:59:20Z","timestamp":1790683160000},"page":"207","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Process evaluation protocol of a trial evaluating app-based post knee arthroplasty telerehabilitation strategy in India"],"prefix":"10.12688","volume":"11","author":[{"given":"Siaa","family":"Girotra","sequence":"first","affiliation":[{"name":"New Delhi Delhi The George Institute for Global Health India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6370-1774","authenticated-orcid":false,"given":"Purnima","family":"Shrivastava","sequence":"additional","affiliation":[{"name":"New Delhi Delhi The George Institute for Global Health India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-7271","authenticated-orcid":false,"given":"Sandhya Kanaka","family":"Yatirajula","sequence":"additional","affiliation":[{"name":"New Delhi Delhi The George Institute for Global Health India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devarsetty","family":"Praveen","sequence":"additional","affiliation":[{"name":"New Delhi Delhi The George Institute for Global Health India"},{"name":"Camperdown New South Wales The George Institute for Global Health"},{"name":"Manipal Karnataka Prasanna School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchika","family":"Madan","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine New Delhi Delhi All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Grover","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation New Delhi Delhi Indraprastha Apollo Hospitals"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Orthopedics New Delhi Delhi All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahil","family":"Batra","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine New Delhi Delhi All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavuk","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Orthopedics New Delhi Delhi All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Orthopedics New Delhi Delhi Indraprastha Apollo Hospitals"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Maddison","sequence":"additional","affiliation":[{"name":"Geelong Victoria Deakin University Institute for Physical Activity and Nutrition"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3044-0560","authenticated-orcid":false,"given":"Niveditha","family":"Devasenapathy","sequence":"additional","affiliation":[{"name":"New Delhi Delhi The George Institute for Global Health India"},{"name":"Manipal Karnataka Prasanna School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12891-015-0469-6","article-title":"Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis.","volume":"16","author":"N Artz","year":"2015","journal-title":"BMC Musculoskelet. 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Res."},{"key":"ref16","first-page":"67-100","article-title":"A model incorporating the rationale and purpose for conducting mixed-methods research in special education and beyond.","volume":"4","author":"K Collins","year":"2006","journal-title":"Learning disabilities: a contemporary journal."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1069-1074","DOI":"10.1093\/eurjcn\/zvag046","article-title":"Data saturation and information power: sample size in qualitative research-when is enough and how to assess?","volume":"25","author":"S Roberts","year":"2026","journal-title":"Eur J Cardiovasc Nurs."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1136\/bmj.i1174","article-title":"Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist.","author":"S Agarwal","year":"2016","journal-title":"BMJ."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e12424","DOI":"10.2196\/12424","article-title":"Considerations for improved mobile health evaluation: retrospective qualitative investigation.","volume":"8","author":"S Dick","year":"2020","journal-title":"JMIR Mhealth Uhealth."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e47843","DOI":"10.2196\/47843","article-title":"Mobile and Computer-Based Applications for Rehabilitation Monitoring and Self-Management After Knee Arthroplasty: Scoping Review.","volume":"12","author":"S Pritwani","year":"2024","journal-title":"JMIR Mhealth Uhealth."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"pzad084","DOI":"10.1093\/ptj\/pzad084","article-title":"Systematic development of standards for mixed methods reporting in rehabilitation health sciences research.","volume":"103","author":"M Tovin","year":"2023","journal-title":"Phys. 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The funding agency has no role in the design, management, analysis, and reporting of the trial. The George Institute for Global Health, New Delhi, India is the trial sponsor. The sponsor is responsible for the conceptualization of the trial, study design, data management, trial monitoring, interpretation of accruing data, and writing of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}