Abstract
BackgroundTo evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement.MethodsA prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients’ clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality.ResultsOf 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001).ConclusionsRecruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery.Trials registrationClinicalTrials.Gov NCT00743951
Highlights
To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement
The sports medicine physician assessed surgical eligibility using the 7-item Western Wait List Hip Knee Priority Tool (HKPT) [8] mapped onto the three criteria for total knee arthroplasty according to the clinical practice guidelines [1]
Feasibility Of the180 patients deemed appropriate for surgical consultation between February 2007 and April 2008, 142 (78.9%) were eligible and consented to participate
Summary
To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement. Osteoarthritis is a common, disabling, and costly disease. Optimal medical management of osteoarthritis includes both non-pharmacologic and pharmacologic interventions [1]. If medical therapy has failed, total joint arthroplasty (TJA) of the hip and knee is cost-effective [2,3,4]. Referral for TJA is increasing due to an aging population. Improving access while decreasing wait times for TJA is a priority for enhancing efficiency of care and patient satisfaction
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