What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis

Abstract

ObjectivesGeneral practitioners (GPs) are often the first health professionals to assess patients with osteoarthritis (OA). Despite clinical guideline recommendations for non-surgical intervention as first-line therapies, the most frequent referral from a GP for a person with knee OA is to an orthopaedic surgeon. The aim of our study was to explore patient factors that impact on the decision to progress to total knee replacement (TKR), including the experience of patients in general practice, their perceptions of their condition, and their access and use of community-based allied health interventions.DesignQualitative investigation using semi-structured interviews. The Candidacy framework was selected as a lens to examine the factors driving healthcare access. Data were analysed using a thematic analysis approach. Codes identified in the data were mapped to the seven Candidacy domains. Themes corresponding to each domain were described.SettingA public hospital in Melbourne, Australia.Participants27 patients with knee OA who were on a waiting list to undergo TKR.ResultsTen themes described factors influencing access and use of non-surgical interventions and decision-making for undergoing TKR: (1) History of knee problems, change in symptoms; (2) Physical and psychosocial functioning (Identification of Candidacy); (3) GP and social networks as information sources, access to care (Navigation); (4) Referral pathways (Permeability of services); (5) Communication of impact (Appearances at health services); (6) GP-Surgeon as the predominant referral pathway (Adjudications); (7) Physical activity as painful; (8) Beliefs about effectiveness of non-surgical interventions (Offers and resistance); (9) Familiarity with local system; and (10) Availability (Operating conditions and local production of Candidacy).ConclusionsUsing the Candidacy framework to analyse patients’ experiences when deciding to progress to TKR highlighted missed opportunities in general practice to orient patients to first try non-surgical interventions. Patients with knee OA also require improved support to navigate allied health services.

Current Status and Future Prospects for Shared Decision Making before and after Total Knee Replacement Surgery—A Scoping Review

“…Of the qualitative studies (RQ1), four studies had low rigor [ 39 , 42 , 43 , 44 ]. and six studies had high rigor [ 35 , 36 , 37 , 38 , 40 , 41 ].…”

“…Factors for this preference were: patients felt too old, patients felt that they suffered from unresolved severe comorbidity and they preferred other treatment modalities such as medication or physical therapy [ 39 ]. Patients who felt that they were ready to undergo surgery often could no longer cope with the symptoms of their OA [ 43 ]. Patients also perceived that non-surgical treatments were “band-aid solutions” that could not repair the damage to the knee [ 43 ].…”

“…Patients who felt that they were ready to undergo surgery often could no longer cope with the symptoms of their OA [ 43 ]. Patients also perceived that non-surgical treatments were “band-aid solutions” that could not repair the damage to the knee [ 43 ].…”

“… yes no no Barlow, 2016 [ 39 ] yes yes yes yes yes no no yes yes yes Kesternich, 2016 [ 41 ] yes yes yes yes no no ? no yes yes Kroll, 2007 [ 42 ] yes yes yes yes yes no no yes yes yes Suarez, 2010 [ 43 ] yes yes yes yes yes no no no yes no …”

Barriers to and Facilitators of Physical Activity among Korean Female Adults with Knee Osteoarthritis and Comorbidity: A Qualitative Study

“…Qualitative methods allow researchers to investigate individuals’ lives, understand the lived experiences, and describe the phenomena [ 14 ]. In previous qualitative studies on knee OA patients’ experiences of physical activity, the focus was on their perceptions of pain [ 15 ] or surgery [ 16 ]. These studies are limited in their ability to obtain information about the influences of comorbidity on physical activity in knee OA patients because comorbidities present new barriers to physical activity after arthroplasty [ 17 ].…”