Abstract
BackgroundGender disparities in total knee arthroplasty utilization may be due to differences in perceptions and expectations about total knee arthroplasty outcomes. This study evaluates the impact of a decision aid on perceptions about total knee arthroplasty and decision-making parameters among patients with knee osteoarthritis.MethodsPatients with moderate to severe knee osteoarthritis viewed a video about knee osteoarthritis treatments options, including total knee arthroplasty, and received a personalized arthritis report. An adapted version of the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain and physical function expectations following total knee arthroplasty before/after the intervention. These scores were compared to an age- and gender-adjusted means for a cohort of patients who had undergone total knee arthroplasty. Decision readiness and conflict were also measured.ResultsAt baseline, both men and women had poorer expectations about post-operative pain and physical outcomes compared with observed outcomes of the comparator group. Following the intervention, women’s mean age-adjusted expectations about post- total knee arthroplasty pain outcomes improved (Pre: 27.0; Post: 21.8 [p =0.08; 95% CI −0.7, 11.0]) and were closer to observed post-TKA outcomes; whereas men did not have a significant change in their pain expectations (Pre: 21.3; Post: 19.6 [p = 0.6; 95% CI −5.8, 9.4]). Women also demonstrated a significant improvement in decision readiness; whereas men did not. Both genders had less decision conflict after the intervention.ConclusionsBoth women and men with osteoarthritis had poor estimates of total knee arthroplasty outcomes. Women responded to the intervention with more accurate total knee arthroplasty outcome expectations and greater decision readiness. Improving patient knowledge of total knee arthroplasty through a decision aid may improve medical decision-making and reduce gender disparities in total knee arthroplasty utilization.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0473-x) contains supplementary material, which is available to authorized users.
Highlights
Gender disparities in total knee arthroplasty utilization may be due to differences in perceptions and expectations about total knee arthroplasty outcomes
While several factors may explain these gender differences [6,7], some studies have suggested that women may not be as well informed about total knee arthroplasty (TKA) as an option for knee OA compared with men [1,8]
Eligible participants were between 55–85 years of age, able to speak and read English, and had moderate to severe knee OA, defined as having a score of >39 on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [1,11]
Summary
Gender disparities in total knee arthroplasty utilization may be due to differences in perceptions and expectations about total knee arthroplasty outcomes. Women who undergo total knee arthroplasty (TKA) have more severe knee OA and greater functional disabilities than do men at the time of surgery [4]. While several factors may explain these gender differences [6,7], some studies have suggested that women may not be as well informed about TKA as an option for knee OA compared with men [1,8]. In a populationbased study of patients with moderate to severe knee osteoarthritis, only 33 percent of women versus 42 percent of men reported having ever discussed arthroplasty with a physician, and of these patients 19 percent of women and 26 percent of men had ever discussed arthroplasty with an orthopedic surgeon [1]. After adjustment for age and disease severity, women were still significantly less likely to have discussed arthroplasty with either a physician or with an orthopedic surgeon
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