Factors Associated With Patients' Willingness to Consider Joint Surgery After Completion of a Digital Osteoarthritis Treatment Program: A Prospective Cohort Study

Anna Cronström, Håkan Nero, Leif E Dahlberg, Anna Cronström, Håkan Nero, Leif E Dahlberg

Abstract

Objective: To examine patient willingness and a possible shift in willingness for surgery and to investigate factors associated with this shift, following participation in the digital nonsurgical osteoarthritis (OA) treatment program Joint Academy.

Methods: A total of 458 individuals (mean ± SD age 62 ± 5.6 years, 67% women) with diagnosed hip or knee OA were evaluated after 6 weeks in the Joint Academy program, comprising education and exercise as well as asynchronous chat with a physical therapist. Data describing joint pain, health-related quality of life (the EuroQol 5-domain [EQ-5D] questionnaire in 3 levels), walking difficulties, the 30-second chair stand test, and willingness to consider surgery were collected at baseline and at 6 weeks.

Results: At follow-up, 31% of those participants willing to consider surgery at baseline no longer considered surgery. Of those participants who were unwilling to consider surgery at baseline, 6% reconsidered and decided in favor of surgery at follow-up. Less pain and a higher EQ-5D score at 6 weeks were associated with the change from being willing to unwilling to consider surgery at follow-up (odds ratio [OR] 0.67-1.64; P < 0.05). Worse pain, a lower EQ-5D score, and having walking difficulties at 6 weeks, and a lower pain and EQ-5D score improvement were associated with the change from being unwilling to willing to consider surgery at 6 weeks (OR 0.51-4.30; P < 0.005).

Conclusion: Evidence-based nonsurgical OA treatment, at least delivered in a digital format, may reduce the need for surgery and should therefore be offered as the first-line treatment option to patients with hip and knee OA. The results also support the idea that such treatment programs have the potential to improve selection of patients for total joint replacement.

© 2018, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.

Figures

Figure 1
Figure 1
Flow chart of the inclusion process. OA = osteoarthritis.

References

    1. Lam V, Teutsch S, Fielding J. Hip and knee replacements: a neglected potential savings opportunity. JAMA 2018;319:977–8.
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780–5.
    1. Dowsey MM, Gunn J, Choong PF. Selecting those to refer for joint replacement: who will likely benefit and who will not? Best Pract Res Clin Rheumatol 2014;28:157–71.
    1. Bozic KJ, Stacey B, Berger A, Sadosky A, Oster G. Resource utilization and costs before and after total joint arthroplasty. BMC Health Serv Res 2012;12:73.
    1. Cobos R, Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, et al. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord 2010;11:249.
    1. Riddle DL, Jiranek WA, Hayes CW. Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis Rheumatol 2014;66:2134–43.
    1. Dunbar MJ, Richardson G, Robertsson O. I can't get no satisfaction after my total knee replacement: rhymes and reasons. Bone Joint J 2013;95 Suppl A:148–52.
    1. Jevsevar DS. Treatment of osteoarthritis of the knee: evidence‐based guideline. J Am Acad Orthop Surg 2013;21:571–6.
    1. Thorstensson CA, Garellick G, Rystedt H, Dahlberg LE. Better management of patients with osteoarthritis: development and nationwide implementation of an evidence‐based supported osteoarthritis self‐management programme. Musculoskeletal Care 2015;13:67–75.
    1. Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D): evidence‐based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord 2017;18:72.
    1. Davis AM, Kennedy D, Wong R, Robarts S, Skou ST, McGlasson R, et al. Cross‐cultural adaptation and implementation of Good Life with osteoArthritis in Denmark (GLA:D): group education and exercise for hip and knee osteoarthritis is feasible in Canada. Osteoarthritis Cartilage 2018;26:211–9.
    1. Smink AJ, Dekker J, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW, et al. Health care use of patients with osteoarthritis of the hip or knee after implementation of a stepped‐care strategy: an observational study. Arthritis Care Res (Hoboken) 2014;66:817–27.
    1. Kroon FP, van der Burg LR, Buchbinder R, Osborne RH, Johnston RV, Pitt V. Self‐management education programmes for osteoarthritis. Cochrane Database Syst Rev 2014;1:CD008963.
    1. Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long‐term follow‐up of a randomised trial. Ann Rheum Dis 2015;74:164–9.
    1. Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt‐Nielsen L, Simonsen O, et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015;373:1597–606.
    1. Nero H, Dahlberg J, Dahlberg LE. A 6‐week web‐based osteoarthritis treatment program: observational quasi‐experimental study. J Med Internet Res 2017;19:e422.
    1. Smittenaar P, Erhart‐Hledik JC, Kinsella R, Hunter S, Mecklenburg G, Perez D. Translating comprehensive conservative care for chronic knee pain into a digital care pathway: 12‐week and 6‐month outcomes for the Hinge Health program. JMIR Rehabil Assist Technol 2017;4:e4.
    1. Li LC, Cott C, Jones CA, Badley EM, Davis AM, PEOPLE meeting participants . Improving primary health care in chronic musculoskeletal conditions through digital media: the PEOPLE meeting. JMIR Res Protoc 2013;2:e13.
    1. Li LC, Sayre EC, Kopec JA, Esdaile JM, Bar S, Cibere J. Quality of nonpharmacological care in the community for people with knee and hip osteoarthritis. J Rheumatol 2011;38:2230–7.
    1. Wright JG, Hawker GA, Hudak PL, Croxford R, Glazier RH, Mahomed NN, et al, for the Toronto Arthroplasty Research Group Writing Committee . Variability in physician opinions about the indications for knee arthroplasty. J Arthroplasty 2011;26:569–75.
    1. Coyte PC, Hawker G, Croxford R, Attard C, Wright JG. Variation in rheumatologists’ and family physicians’ perceptions of the indications for and outcomes of knee replacement surgery. J Rheumatol 1996;23:730–8.
    1. Mota RE, Tarricone R, Ciani O, Bridges JF, Drummond M. Determinants of demand for total hip and knee arthroplasty: a systematic literature review. BMC Health Serv Res 2012;12:225.
    1. Hawker GA, Wright JG, Badley EM, Coyte PC, for the Toronto Arthroplasty Health Services Research Consortium . Perceptions of, and willingness to consider, total joint arthroplasty in a population‐based cohort of individuals with disabling hip and knee arthritis. Arthritis Rheum 2004;51:635–41.
    1. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, for the STROBE Initiative . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344–9.
    1. Dahlberg LE, Grahn D, Dahlberg JE, Thorstensson CA. A web‐based platform for patients with osteoarthritis of the hip and knee: a pilot study. JMIR Res Protoc 2016;5:e115.
    1. EuroQol Group . EuroQol: a new facility for the measurement of health‐related quality of life. Health Policy 1990;16:199–208.
    1. Payakachat N, Ali MM, Tilford JM. Can the EQ‐5D detect meaningful change? A systematic review. Pharmacoeconomics 2015;33:1137–54.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005;14:798–804.
    1. Dobson F, Hinman RS, Hall M, Marshall CJ, Sayer T, Anderson C, et al. Reliability and measurement error of the Osteoarthritis Research Society International (OARSI) recommended performance‐based tests of physical function in people with hip and knee osteoarthritis. Osteoarthritis Cartilage 2017;25:1792–6.
    1. Bender R, Lange S. Adjusting for multiple testing: when and how? J Clin Epidemiol 2001;54:343–9.
    1. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain 2004;8:283–91.
    1. Toye FM, Barlow J, Wright C, Lamb SE. Personal meanings in the construction of need for total knee replacement surgery. Soc Sci Med 2006;63:43–53.
    1. Barlow T, Griffin D, Barlow D, Realpe A. Patients’ decision making in total knee arthroplasty: a systematic review of qualitative research. Bone Joint Res 2015;4:163–9.
    1. National Library of Medicine . . Evaluation of a web‐pbased platform for osteoarthritis treatment. identifier: NCT03328741; 2017. URL: .
    1. Nero H, Dahlberg J, Dahlberg LE. Joint academy: a six‐week online treatment program for osteoarthritis [abstract]. Osteoarthritis Cartilage 2018;26 Suppl 1:S315.
    1. Elwyn G, Miron‐Shatz T. Deliberation before determination: the definition and evaluation of good decision making. Health Expect 2010;13:139–47.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe