s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S391 694 PRIMARY CARE PHYSICIANS ONLY MODERATELY CONFIDENT IN DECIDING WHICH PATIENTS TO REFER FOR TOTAL JOINT ARTHROPLASTY OF THE HIP AND KNEE E. Waugh, E. Badley, C. Borkhoff, A. Davis, S. Dunn, M. Gignac, S. Jaglal, H. Kreder, J. Sale, G. Hawker. Univ. of Toronto, Toronto, ON, Canada Purpose: Total joint arthroplasty (TJA) is highly effective in the management of advanced hip and knee osteoarthritis (OA), when non-surgical therapies fail. Our prior research demonstrated under-use of TJA among individuals aged 55þ years with moderate to severe hip/knee OA. Recently, with increasing longevity and obesity, and secular trends in perceptions of TJA from one of ‘managing disability’ to ‘disability prevention’, concerns have been raised about possible overuse of TJA. In Canada, primary care physicians (PCPs) are responsible for referrals to orthopaedic surgery for TJA. Thus, inappropriate underor over-use of TJA may be partly a consequence of uncertainty among PCPs about indications for TJA. We sought to determine the level of confidence among PCPs in deciding which patients to refer for TJA and to identify key PCP characteristics associated with their reported confidence. Methods: PCPs were recruited from among those providing care to participants of an established community cohort with hip/knee OA in Ontario, Canada. Physicians completed a mailed or online questionnaire. Information collected included demographic and practice characteristics, and their perceptions regarding indications, contraindications, barriers, risks and effectiveness of TJA. Level of confidence was measured from 1, ‘not confident at all’ to 10, ‘highly confident’ in response to the question “How confident are you in deciding which patients should be referred to orthopaedic surgery for consideration of hip or knee replacement?” Theywere asked to indicatewhether “lack of clarity regarding indications for surgery is a factor discouraging them from referring patients for TJA” (not at all/rarely/sometimes/often/all the time). Descriptive analyses were conducted using proportions, means, medians as appropriate. Multiple linear regression was used to determine the key independent variables associated with level of confidence. Results: 214 physicians participated (58% response rate) (64.6% aged 50þ years, 45% female, 77% > 15 years of practice, 67.5% urban practice location vs. rural, 62.7% group vs. solo practice, 30.2% in academic practice). The majority (67.5%) reported seeing 10 patients with moderate to severe hip/knee OA in the previous 2 weeks; 5.7% reported seeing > 20 patients. One-third (35%) referred 5 patients/year for TJA surgical consult; 30.7% referred > 10 patients/year. Compared with male respondents, female physicians weremore likely to have practiced 15 years (p<0.0001), report seeing fewer OA patients (p1⁄40.0004), practice in an urban location (p1⁄40.003), and be in an academic (p1⁄40.03) or group practice (p1⁄40.003). 44% of respondents reported “lack of clarity regarding surgical indications” sometimes/often/all the time. Lack of clarity was associated with fewer years of practice (p1⁄40.017). The average response on the confidence scale was 6.95 1.60 (range: 110) indicating amoderate level of confidence in deciding which patients to refer for TJA. In bivariate analysis, a lower confidence level was associated with sex (female) (p1⁄40.0001), 15 years of practice (p1⁄40.004), group practice (p1⁄40.0025), and lack of clarity regarding indications for surgery (p<0.0001). Confidence was not associated with volume of OA patients or number of referrals for TJA surgical consult. In multivariable analysis, lower confidence was significantly associated with female sex (b1⁄4 0.60, 95%CI: 0.18-1.02, p1⁄40.005) and reporting lack of clarity of surgical indications (b 1⁄4 1.05, 95% CI: 0.65-1.45, p<0.0001). Conclusion: Our results emphasize the need among PCPs for increased guidance regarding indications for TJA to increase their level of confidence in their decision-making process. This may be particularly beneficial for physicians with fewer years of clinical experience. Ultimately, improved decision-making may contribute to better surgical outcomes through better selection of appropriate candidates. 695 “IT’S PART OF WHO I AM NOW:” A QUALITATIVE ANALYSIS EXPLORING THE IMPACT OF SPORT-RELATED KNEE JOINT INJURY ON YOUNG ADULTS’ PERSPECTIVES OF PHYSICAL ACTIVITY AND OSTEOARTHRITIS A.M. Ezzat y, M. Brussoni y, J. Whittaker z, C. Emery z. yUniv. of British Columbia, Vancouver, BC, Canada; zUniv. of Calgary, Calgary, AB, Canada Purpose: To understand the experience of young adults who sustained a sport-related intra-articular knee joint injury 3 to 10 years previously as adolescents and its impact on their current attitudes and beliefs about physical activity and osteoarthritis. Methods: Employing qualitative methods guided by grounded theory, this study explored the experiences of injury among youth sport participants. Semi-structured in-depth interviews were conducted with a purposive sample of young adults who sustained an intra-articular knee injury in the past 3 to 10 years during sport participation (median years since injury1⁄47.0, range1⁄44.3, 9.7). Participants were recruited from within a larger historical cohort study where quantitative data was collected on numerous clinical, structural, physiological, and behavioural long-term knee injury outcomes conducted at the Sport Injury Prevention Research Centre, University of Calgary. Selection aimed to recruit a sample that included individuals from both sexes whose current level of physical activity ranged from a low to high participation based on the Godin-Shephard Leisure-Time Physical Activity Questionnaire. Additionally, participants with more severe injuries were targeted in an attempt to recruit interviewees whose knee injury had resulted in a greater personal impact. Interviews were recorded and transcribed verbatim. Data analysis used a constant comparative method to develop conceptual labels and categories, axial coding, and selective coding to reveal main themes. NVivo 10 software was used to manage and organize the data. Results: Thirteen one-on-one interviews were conducted with nine women and four men (ages 16 to 26 years old). Findings revealed participants had embraced a sense of acceptance of their knee injury both in relation to its influence on their athletic potential and the possibility of future knee osteoarthritis. They expressed how their knee required protection and ongoing self-evaluation before engaging in certain activities. Participants’ athletic identity was evolving, influenced by their knee injury, as well as other factors such as shifting life priorities. Conclusions: This study provides novel insight into the attitudes and beliefs of young adults who have sustained a sport-related knee injury. Rehabilitation professionals should consider the psychological aspects of the injury experience in youth. Education supporting positive beliefs and addressing concerns about osteoarthritis in young adults with a history of intra-articular knee injury may aid in promoting their future joint health. These results will inform the development of strategies in how best to address the psychological aspects of knee injury. 696 CHARACTERISTICS OF CHECK (COHORT HIP & COHORT KNEE): AFTER 7 YEARS OF FOLLOW-UP J. Wesseling y, M. Boers z, M.A. Viergever y, F.P. Lafeber y, J. Dekker zx, J.W. Bijlsma y. yUniv. Med. Ctr. Utrecht, Utrecht, Netherlands; zVU Univ. Med. Ctr., Amsterdam, Netherlands; xReade, Ctr. for Rehabilitation and Rheumatology, Amsterdam, Netherlands Purpose: The Cohort Hip & Cohort Knee (CHECK) study included participants with early symptomatic osteoarthritis (OA) and studied changes in clinical, radiological and biochemical variables. We present the results of 7 years of follow up. Methods: Between October 2002 and September 2005 a cohort was formed of 1002 participants aged 45-65 years with symptomatic OA
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Jul 7, 2023
Carolyn A Emery 