The decision‐making threshold and the factors that affect it: A qualitative study of patients' decision‐making in knee replacement surgery

Barlow, Timothy; Scott, Patrícia; Thomson, Lauren; Griffin, Damian R.; Realpe, Alba

doi:10.1002/msc.1190

Cited by 11 publications

(20 citation statements)

References 16 publications

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“…This work-directed approach could enhance patient’s expectations and lead to less discontentment after TKA. This corresponds with the conclusion of Barlow et al that unfulfilled patient’s expectations resulted in discontentment after TKA [ 12 ]. This also corresponds to the patients’ suggestions that more physical therapy sessions and a specialized rehabilitation center could improve the motivational support received from the physical therapists.…”

Section: Discussionsupporting

confidence: 90%

“…Mahdi et al stated that unfulfilled patients expectations resulted in discontentment after TKA [ 11 ]. The personal situation of the individual patient, like the ability to work, is an important aspect in the patient’s perspective stated by Barlow et al [ 12 ]. A study by Gautreau concluded that patients experienced the rehabilitation period as a period of uncertainty which could be better addressed to enhance the outcome after TKA.…”

Section: Introductionmentioning

confidence: 99%

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Beneficial and limiting factors in return to work after primary total knee replacement: Patients’ perspective

Pahlplatz

Schafroth

Krijger

et al. 2021

WOR

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BACKGROUND: Return to work (RTW) is an important outcome in Total Knee Arthroplasty (TKA). At present, 70–80%of TKA patients return to work within three to six months. OBJECTIVE: What are patients’ perspectives regarding beneficial and limiting factors in RTW after TKA? METHODS: Focus groups were formed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Three major topics were explored: 1. What was beneficial for RTW after TKA; 2. What was limiting for RTW after TKA; and 3. What additional care would benefit RTW after TKA? RESULTS: Data saturation was reached after four focus groups, comprising 17 participants—nine men and eight women (median age 58, range 52–65). The focus group study identified four main themes that contributed to a successful RTW namely rehabilitation (medical) like post-operative physical therapy, patient characteristics (personal), like motivation to RTW, occupational characteristics (work-related) like build-up in work tasks and medical support (medical) like availability of a walker or crutches. CONCLUSION: According to participants, factors within the following four themes can contribute to a successful return to work: occupational, patient, rehabilitation and medical care. Incorporating these factors into the integrated care pathway for the “young” TKA patients may increase the chances of a successful RTW.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Beneficial and limiting factors in return to work after primary total knee replacement: Patients’ perspective

Pahlplatz

Schafroth

Krijger

et al. 2021

WOR

View full text Add to dashboard Cite

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“…There are no agreed criteria for patients to have a knee replacement and the decision to proceed with TKA is typically a patient’s preference-based decision. 51…”

Section: Discussionmentioning

confidence: 99%

Morphological Assessment of MACI Grafts in Patients with Revision Surgery and Total Joint Arthroplasty

Beck

Wood

Vertullo³

et al. 2019

CARTILAGE

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Objective To compare the histological and immunohistochemical characteristics of matrix-assisted chondrocyte implantation (MACI) grafts between patients with revision surgery and patients with total joint arthroplasty. Methods Biopsies of MACI grafts from patients with revision and total joint arthroplasty. The graft tissue characteristics and subchondral bone were examined by qualitative histology, ICRS (International Cartilage Repair Society) II scoring and semiquantitative immunohistochemistry using antibodies specific to type I and type II collagen. Results A total of 31 biopsies were available, 10 undergoing total knee arthroplasty (TKA) and 21 patients undergoing revision surgery. Patients in the clinically failed group were significantly older (46.3 years) than patients in the revision group (36.6 years) ( P = 0.007). Histologically, the predominant tissue in both groups was of fibrocartilaginous nature, although a higher percentage of specimens in the revision group contained a hyaline-like repair tissue. The percentages of type I collagen (52.9% and 61.0%) and type II collagen (66.3% and 42.2%) were not significantly different between clinically failed and revised MACI, respectively. The talar dome contained the best and patella the worst repair tissue. Subchondral bone pathology was present in all clinically failed patients and consisted of bone marrow lesions, including edema, necrosis and fibrosis, intralesional osteophyte formation, subchondral bone plate elevation, intralesional osteophyte formation, subchondral bone cyst formation, or combinations thereof. Conclusions MACI grafts in patients with revision and total joint arthroplasty were predominantly fibrocartilage in repair type, did not differ in composition and were histologically dissimilar to healthy cartilage. Clinically failed cases showed evidence of osteochondral unit failure, rather than merely cartilage repair tissue failure. The role of the subchondral bone in relation to pain and failure and the pathogenesis warrants further investigation.

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“…This finding is consistent with that of Selten et al (), who found that most patients trusted their doctor and did not question their decisions about treatment choices in knee or hip OA. This acceptance of treatment choices may be explained as a preference among patients for a paternalistic relationship with healthcare professionals, whereby patients play a passive role when making decisions about undergoing TKR (Barlow, Scott, Thomson, Griffin, & Realpe, ; Suarez‐Almazor, Richardson, Kroll, & Sharf, ). However, a study conducted by Yeh et al () reported that patients deciding whether or not to undergo TKR stated that they would follow the advice and recommendations of their physicians, except when it came to having surgery.…”

Section: Discussionmentioning

confidence: 99%

Investigating the motives of patients with knee OA undergoing a TKR: A qualitative interview study

Traumer

Sørensen

Kusk

et al. 2018

Musculoskeletal Care

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Objective: Total knee replacement (TKR) is generally considered effective as treatment of pain and functional limitations in end-stage knee osteoarthritis (OA). However, many patients delay surgery for months or are unwilling to undergo TKR despite pain and functional limitations. Hence, a qualitatively assessment of what actually affects the patient's decision to undergo TKR would be important. Therefore, the purpose of this study was to investigate the motives of patients with knee OA choosing to undergo TKR and to explore the factors considered important during their decision-making process.Methods: Eleven patients undergoing TKR were recruited from the outpatient orthopedic department. Using an interview guide, in-depth semi-structured interviews were conducted at participants' home. All interviews were recorded, transcribed and a thematic analysis was performed.Results: The analysis revealed that the interaction between doctor and patient emerged as a factor highly influential on patients' decision-making process with patients choosing the treatment option suggested by the doctor. Using x-rays, revealing no cartilage between the bones, as a reason for choosing to undergo TKR was a legitimate argument among patients. The prospect of avoiding taking high doses of pain-relieving medication and hearing positive experiences of others who had undergone TKR motivated patients to undergo TKR. However, negative experiences of others were neglected. Conclusions:Patients' decision-making process was influenced by several factors, with some factors being more influential than others. Knowledge of which factors patients consider important in relation to their decision to undergo TKR can facilitate and support shared decision-making regarding TKR. KEYWORDS decision-making process, experiences, knee osteoarthritis, patient-doctor interaction, qualitative research, total knee replacement

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The decision‐making threshold and the factors that affect it: A qualitative study of patients' decision‐making in knee replacement surgery

Abstract: An awareness of the deliberation phase, the factors that influence it, the stress associated with it, preferred models of care, and the influence of the decision-making threshold will aid useful communication between doctors and patients.

Cited by 11 publications

References 16 publications

Beneficial and limiting factors in return to work after primary total knee replacement: Patients’ perspective

Beneficial and limiting factors in return to work after primary total knee replacement: Patients’ perspective

Morphological Assessment of MACI Grafts in Patients with Revision Surgery and Total Joint Arthroplasty

Investigating the motives of patients with knee OA undergoing a TKR: A qualitative interview study

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