Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial

Abstract

The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).

Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee

“…19 Although our original RCT found no overall effect of the decision aid on wait times, patients at the community site waited a median of 20 days less for surgery than controls; there were no differences between groups at the academic site. 7 Our subgroup analysis showed no statistically significant differences between academic and community sites for wait times. This suggests that original trial differences in median wait times at the community site are likely accounted for in the hip OA patient sample, which we excluded in this study.…”

“…7 Our methods are described briefly here, with additional details published elsewhere. 7 Research ethics board approval was obtained at each participating hospital.…”

“…Quality of the decision was measured as a knowledge test score greater than 66% and whether the patient's predicted probability of having surgery matched their actual choice. 5,7 The predicted probability of surgery was calculated using a logistic regression equation derived from items that assessed the patient's values from the validated Hip and Knee Decision Quality Instrument. 14 We screened for decisional conflict using the validated 4-item SURE test.…”

“…[5][6][7] In Canada and the United States, randomized controlled trials (RCTs) evaluating decision aids for patients considering TKA showed that patients who used decision aids were more knowledgeable, had more realistic expectations, achieved better decision quality (i.e., extent that informed decisions were consistent with patient preferences), were more prepared for the surgical consultation, and had reduced decisional conflict (i.e., uncertainty about the best treatment option). [7][8][9] Orthopedic surgeons also reported improved satisfaction and consultation efficiency when their patients were exposed to a decision aid. 9 A Canadian trial showed that decision aids resulted in lower costs and more quality-adjusted life years for patients considering total joint arthroplasty.…”

“…10 In a larger study, we evaluated a decision aid in 2 clinics using different presurgical evaluation approaches for total joint arthroplasty. 7 At the academic clinic, most patients were scheduled for a 15-to 20-minute presurgical assessment with a sports medicine physician or advanced practice physiotherapist (Table 1). At the community clinic, patients were scheduled for a 45-minute presurgical assessment with an advanced practice physiotherapist or nurse practitioner.…”