Efficacy of two patient decision-making aids for patients eligible for TKA + THA

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
147 patients with advanced osteoarthritis of the knee or hip who were eligible for total knee arthroplasty (TKA) or total hip arthroplasty (THA) were randomized to receive two modes of patient decision-making tools for the purpose of comparing differences in patient knowledge, decision-making participation, satisfaction, and treatment preferences: (1) Educational DVD and booklet, or (2) Educational booklet only. When assessed at four weeks, both groups resulted in satisfactory improvements in various decision-aid related outcomes, such as patient knowledge score, confidence in decision making, and satisfaction with the intervention, however, the decision aids did not affect the willingness to participate in OA management. There were no Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Orthopaedic Research and Education Foundation.
Conflicts: None disclosed
Why was this study needed now?
Although total hip and total knee arthroplasty have well-documented success in patients with end-stage osteoarthritis (OA), there are several factors and risks that patients must consider prior to undergoing the operation. In order to aid this outcome-weighing process, shared decision making (SDM) between physicians and patients can be conducted. With this method, patients can make informed clinical decisions while taking into account their preferences and personally optimized outcomes. Despite the obvious benefits of SDM, there are multiple potential limitations to its practice, most importantly the lack of adequate time for the physician to participate and its possible intrusion with workflow. Additionally, an optimized clinical decision-making tool has yet to be created. Thus, the aim of this trial was to compare two patient decision aid programs in terms of educational efficacy (when compared to baseline), decision-making participation, and patient satisfaction.
What was the principal research question?
For patients eligible for total hip or total knee arthroplasty, how did two patient decision-making tools (DVD+booklet vs. booklet alone) compare in patient knowledge, decision-making participation, satisfaction, and treatment preferences?
Population: 147 patients with advanced osteoarthritis of the knee or hip were included in this trial. Patients were required to fulfill the following criteria: (1) limited range of motion in more than one direction of at least 10 degrees and/or presence of pain, (2) radiographically confirmed joint space narrowing greater than 0.5 mm, osteophyte formation, or a grade III-IV Kellgren-Lawrence scale score, and (3) were eligible for primary THA or TKA at time of study inclusion. All patients were allowed to review allocated study materials following consultation, both in an out of the medical office.
Intervention: DVD + booklet (Group 1): study materials (in the form of a DVD disc and a booklet) were given to patients that were developed by Health Dialog and the Foundation for Informed Medical Decision Making (n=66; mean age= 60+/-11, 34F).
Comparison: Booklet (Group 2): study materials were given in booklet form only (identical booklet as intervention) group (n=66; mean age= 63+/-11, 37F).
Outcomes: Patients were instructed to complete multiple baseline questionnaires, including the EuroQol five-dimensional questionnaire (EQ-5D), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the short-form 12 health survey (SF-12). Questionnaires were formatted to assess the primary outcomes of this study, which included patient knowledge, confidence in decision making, and satisfaction. Secondary outcomes included patient-rating of decision aid tool and patient preferences.
Methods: RCT: prospective
Time: Outcomes were assessed at baseline and after 2 and 4 weeks.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.