What Do Patients Expect From Total Knee Arthroplasty? A Delphi Consensus Study on Patient Treatment Goals

Lange, Toni; Schmitt, Jochen; Kopkow, Christian; Rataj, Elisabeth; Günther, Klaus‐Peter; Lützner, Jörg

doi:10.1016/j.arth.2017.01.053

Cited by 57 publications

(49 citation statements)

References 29 publications

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“…(A) Effect of different ratings scales on the percentage main goals The aim of the Delphi study [34] related to this manuscript was to identify global "main treatment goals" of patients, who were scheduled for TKA. To investigate the influence of different rating scales on the resulting consensus, we compared the proportion of proposed treatment goals that reached consensus on "main goals" between the three scales, as a prerequisite of the actual Delphi study [34]. To enable comparability of the results, treatment goals rated on the five-point scale as "very important" or rather on the nine-point scale as "9, 8, 7" were mapped as a "main goal".…”

Section: Effects Of Using Different Rating Scales On Consensusmentioning

confidence: 99%

Comparison of different rating scales for the use in Delphi studies: different scales lead to different consensus and show different test-retest reliability

Lange

Kopkow

Lützner

et al. 2020

BMC Med Res Methodol

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Background: Consensus-orientated Delphi studies are increasingly used in various areas of medical research using a variety of different rating scales and criteria for reaching consensus. We explored the influence of using three different rating scales and different consensus criteria on the results for reaching consensus and assessed the test-retest reliability of these scales within a study aimed at identification of global treatment goals for total knee arthroplasty (TKA). Methods: We conducted a two-stage study consisting of two surveys and consecutively included patients scheduled for TKA from five German hospitals. Patients were asked to rate 19 potential treatment goals on different rating scales (threepoint, five-point, nine-point). Surveys were conducted within a 2 week period prior to TKA, order of questions (scales and treatment goals) was randomized. Results: Eighty patients (mean age 68 ± 10 years; 70% females) completed both surveys. Different rating scales (threepoint, five-point and nine-point rating scale) lead to different consensus despite moderate to high correlation between rating scales (r = 0.65 to 0.74). Final consensus was highly influenced by the choice of rating scale with 14 (three-point), 6 (five-point), 15 (nine-point) out of 19 treatment goals reaching the pre-defined 75% consensus threshold. The number of goals reaching consensus also highly varied between rating scales for other consensus thresholds. Overall, concordance differed between the three-point (percent agreement [p] = 88.5%, weighted kappa [k] = 0.63), five-point (p = 75.3%, k = 0.47) and nine-point scale (p = 67.8%, k = 0.78). Conclusion: This study provides evidence that consensus depends on the rating scale and consensus threshold within one population. The test-retest reliability of the three rating scales investigated differs substantially between individual treatment goals. This variation in reliability can become a potential source of bias in consensus studies. In our setting aimed at capturing patients' treatment goals for TKA, the three-point scale proves to be the most reasonable choice, as its translation into the clinical context is the most straightforward among the scales. Researchers conducting Delphi studies should be aware that final consensus is substantially influenced by the choice of rating scale and consensus criteria.

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Section: Effects Of Using Different Rating Scales On Consensusmentioning

confidence: 99%

Comparison of different rating scales for the use in Delphi studies: different scales lead to different consensus and show different test-retest reliability

Lange

Kopkow

Lützner

et al. 2020

BMC Med Res Methodol

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“…2016, Lange et al. 2017) have advocated knee range of motion, knee pain, and physical function as distinct and important post-TKA outcomes, no studies have developed a prediction model to provide individualized predictions on these outcomes separately. Thus, we aimed to create a prediction model for post-TKA knee range- of motion, knee pain, and walking limitations.…”

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Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty

et al. 2019

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Background and purpose — Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA), mainly because of pain and restricted physical function. We developed a prediction model for 6-month knee range of motion, knee pain, and walking limitations in patients undergoing TKA surgery. Patients and methods — We performed a prospective cohort study of 4,026 patients who underwent elective, primary TKA between July 2013 and July 2017. Candidate predictors included demographic, clinical, psychosocial, and preoperative outcome measures. The outcomes of interest were (i) knee extension and flexion range of motion, (ii) knee pain rated on a 5-point ordinal scale, and (iii) self-reported maximum walk time at 6 months post TKA. For each outcome, we fitted a multivariable proportional odds regression model with bootstrap internal validation. Results — At 6 months post TKA, around 5% to 20% of patients had a flexion contracture ³ 10°, range of motion < 90°, moderate to severe knee pain, or a maximum walk time £ 15 minutes. The model c-indices (the probabilities to correctly discriminate between 2 patients with different levels of follow-up TKA outcomes) when evaluating these patients were 0.71, 0.79, 0.65, and 0.76, respectively. Each postoperative outcome was strongly influenced by the same outcome measure obtained preoperatively (all p-values < 0.001). Additional statistically significant predictors were age, sex, race, education level, diabetes mellitus, preoperative use of gait aids, contralateral knee pain, and psychological distress (all p-values < 0.001). Interpretation — We have developed models to predict, for individual patients, their likely post-TKA levels of knee extension and flexion range of motion, knee pain, and walking limitations. After external validation, they can potentially be used preoperatively to identify at-risk patients and to help patients set more realistic expectations about surgical outcomes.

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“…Individualized education about postoperative outcome should lead to more realistic patient expectations [4e6]. Previous research has identified specific expectations of TKA patients that are considered most important [7,8], and expectations that are most often not fulfilled in TKA patients [9]. Expectations from both these categories are useful to address in preoperative education, and include expectations on pain relief and improvement in walking, stair negotiation, performance of daily activities, change in position, kneeling, and squatting [8,9].…”

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confidence: 99%

Development of Preoperative Prediction Models for Pain and Functional Outcome After Total Knee Arthroplasty Using The Dutch Arthroplasty Register Data

Tolk

Waarsing

Steenbergen

et al. 2020

The Journal of Arthroplasty

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Background: One of the main determinants of treatment satisfaction after total knee arthroplasty (TKA) is the fulfillment of preoperative expectations. For optimal expectation management, it is useful to accurately predict the treatment result. Multiple patient factors registered in the Dutch Arthroplasty Register (LROI) can potentially be utilized to estimate the most likely treatment result. The aim of the present study is to create and validate models that predict residual symptoms for patients undergoing primary TKA for knee osteoarthritis. Methods: Data were extracted from the LROI of all TKA patients who had preoperative and postoperative patient-reported outcome measures registered. Multivariable logistic regression analyses were performed to construct predictive algorithms for satisfaction, treatment success, and residual symptoms concerning pain at rest and during activity, sit-to-stand movement, stair negotiation, walking, performance of activities of daily living, kneeling, and squatting. We assessed predictive performance by examining measures of calibration and discrimination. Results: Data of 7071 patients could be included for data analysis. Residual complaints on kneeling (female 72%/male 59%) and squatting (female 71%/male 56%) were reported most frequently, and least residual complaints were scored for walking (female 16%/male 12%) and pain at rest (female 18%/male 14%). The predictive algorithms were presented as clinical calculators that present the probability of residual symptoms for an individual patient. The models for residual symptoms concerning sit-to-stand movement, stair negotiation, walking, activities of daily living, and treatment success showed acceptable discriminative values (area under the curve 0.68-0.74). The algorithms for residual complaints regarding kneeling, squatting, pain, and satisfaction showed less favorable results (area under the curve 0.58-0.64). The calibration curves showed adequate calibration for most of the models. Conclusion: A considerable proportion of patients have residual complaints after TKA. The present study showed that demographic and patient-reported outcome measure data collected in the LROI can be used to predict the probability of residual symptoms after TKA. The models developed in the present study predict the chance of residual symptoms for an individual patient on 10 specific items concerning treatment success, functional outcome, and pain relief. This prediction can be useful for individualized expectation management in patients planned for TKA.

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What Do Patients Expect From Total Knee Arthroplasty? A Delphi Consensus Study on Patient Treatment Goals

Cited by 57 publications

References 29 publications

Comparison of different rating scales for the use in Delphi studies: different scales lead to different consensus and show different test-retest reliability

Comparison of different rating scales for the use in Delphi studies: different scales lead to different consensus and show different test-retest reliability

Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty

Development of Preoperative Prediction Models for Pain and Functional Outcome After Total Knee Arthroplasty Using The Dutch Arthroplasty Register Data

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