Triggers and decision‐making patterns for receiving total knee arthroplasty among older adults with knee osteoarthritis: A qualitative descriptive study

Hsu, Kuo-Yao; Tsai, Yun‐Fang; Yeh, Wen‐Ling; Chen, Dave W.; Chen, Ching-Yen; Wang, Yiwen

doi:10.1111/jocn.14557

Cited by 12 publications

(7 citation statements)

References 28 publications

(46 reference statements)

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“…Participants discussed how the impact of OA on their lives and the failure of prior treatments prompted them to consider injections. The influence of ineffective prior treatments has been described as a motivating factor for patients who undergo TKR as well (17). A study by Selten et al demonstrated that participants were most concerned about a treatment's efficacy, accessibility, and potential side effects (10), which are concerns that our participants shared.…”

Section: Discussionmentioning

confidence: 78%

Patient Perspectives Surrounding Intraarticular Injections for Knee Osteoarthritis: A Qualitative Study

Lenhard

Williams

Lape

et al. 2022

Arthritis Care & Research

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Objective. Intraarticular (IA) injections are used frequently for knee osteoarthritis (OA), but little is known about patients' attitudes toward these therapies. We aimed to better understand patients' perceptions of the facilitators of and barriers to IA injections for knee OA.Methods. We conducted a qualitative, descriptive, exploratory study and held focus groups and individual interviews with participants with knee OA, including some who had and some who had not received IA injections. We conducted a thematic analysis to identify themes describing the factors that participants found influential when deciding whether to try an IA injection.Results. We held 3 focus groups with 12 participants and conducted 3 individual interviews (15 participants total). We identified the following 4 themes that shaped participants' decisions to receive a specific injection: 1) the impact of OA on participants' lives; 2) participants' attitudes and concerns, including desire to avoid surgery, willingness to accept uncertain outcomes, and concerns about side effects and dependence; 3) the way participants gathered and processed information from physicians, peers, and the internet; and 4) the availability of injectable products. Participants weighed the desire to regain function and delay surgery with concerns about side effects, uncertain efficacy, and costs. Conclusion.Participants were concerned about the effectiveness, toxicity, availability, and cost of injectable products. They balanced disparate sources of information, uncertain outcomes, limited product availability, and other injection-related concerns with a desire to decrease pain. These findings can provide clinicians, investigators, and public health professionals with insights into challenges that patients face when making injection decisions.

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Section: Discussionmentioning

confidence: 78%

Patient Perspectives Surrounding Intraarticular Injections for Knee Osteoarthritis: A Qualitative Study

Lenhard

Williams

Lape

et al. 2022

Arthritis Care & Research

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“…17,21,64,67,79,93,114,117,120,137,140,159,164 We included findings from 118 reports (105 unique samples) published between 1998 and 2021. 1–5,7,9–13,15,16,18,20,22–27,31 , 33,34,37,39,40,43-46,48,49 , 52–58,60,61,63,65,66,68–78 , 80-82,86-92,94-101 , 103–105,108–110,112,113,115,118,119 , 121,122,124-130,132-134,141-147 , 149–155,158,160–162,165–169 Table 2 presents the author, year of publication, country, condition, number of participants, and age. Most studies explored the experience of knee and hip osteoarthritis, and 30 of these specifically aimed to understand decision-making for hip or knee joint replacement surgery.…”

Section: Resultsmentioning

confidence: 99%

Qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain

Toyé

Seers

Barker

2022

Pain

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“…In the present study, knee pain VAS was shown to be an independent predictive factor for determining whether to have surgery in adjusted multivariate logistic regression analysis. Previous studies have shown that the main triggers for undergoing TKA are severe pain and inability to walk [ 5 ]. Osteoarthritic pain affected their daily life including activities, mood, walking ability, and social activities [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Reaching this threshold defines the decision-making process [ 4 ]. However, previous studies did not distinguish between medial or lateral tibiofemoral (TF) OA, and there has been no analysis of objective decision-making factors [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Decision-making factors and their thresholds for total knee arthroplasty in lateral tibiofemoral osteoarthritis patients: a retrospective cohort study

Choi

Kim

Han

2022

Knee Surg & Relat Res

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Background There has been no study examining lateral tibiofemoral (TF) osteoarthritis (OA) and objective decision-making factors affecting when patients decide to have total knee arthroplasty (TKA). The purpose of this study was to assess which factors and their thresholds cause patients with lateral TF OA to decide on TKA. Methods We conducted a retrospective cohort study and identified patients who had initially been diagnosed with isolated lateral TF OA from October 2004 to February 2021. We finally included 56 patients; patients who had chosen conservative treatment followed by in-depth interviews for the deliberation stage (n = 32), and the other patients who decided to undergo TKA for the decision-making stage (n = 24). Demographic, clinical, and radiographic characteristics were considered candidate predictive factors. Radiographic variables included the Ahlbäck grade, hip–knee–ankle (HKA) angle, joint line convergence angle (JLCA), and TF subluxation. Univariate and multivariate logistic regression analyses were performed. Results Clinically, the pain visual analog scale (VAS) score was significantly higher and the knee flexion angle was lower at the decision-making stage. Radiographic measurements showed that the Ahlbäck grade, HKA angle, JLCA, and TF subluxation measured at the center, in addition to the tibiotalar angle, differed statistically between the two stages. According to univariate analyses, two clinical characteristics and six radiographic variables on the ipsilateral side of the leg, and one radiographic variable on the contralateral side of the leg were included as factors influencing the patients’ decision to undergo TKA. After making adjustments based on multivariate analysis, the ipsilateral knee pain VAS (OR = 1.61; 95% CI = 1.14–2.28, p = 0.007) and medial TF subluxation measured at the center (OR = 1.14, 95% CI = 1.01–1.32, p = 0.072) were found to be significant factors for choosing TKA. The area under the curve (AUC) for pain VAS was 0.757 and the cutoff value was 4.5. The AUC for TF subluxation measured at the center was 0.697 and the cutoff value was −4.10% of medial TF subluxation. Conclusion Higher ipsilateral knee pain VAS and more severe medial TF subluxation measured at the center were independent factors affecting patient decisions to undergo TKA with lateral TF OA. Understanding the determining factors that may affect patient decision-making when considering TKA may be an essential aspect of evaluating the prognosis of patients with lateral TF OA. Level of evidence III.

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Triggers and decision‐making patterns for receiving total knee arthroplasty among older adults with knee osteoarthritis: A qualitative descriptive study

Abstract: Our findings provide evidence for healthcare providers to offer information and support to their older adult patients with knee-osteoarthritis pain who are deciding whether to undergo total knee arthroplasty.

Cited by 12 publications

References 28 publications

Patient Perspectives Surrounding Intraarticular Injections for Knee Osteoarthritis: A Qualitative Study

Patient Perspectives Surrounding Intraarticular Injections for Knee Osteoarthritis: A Qualitative Study

Qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain

Decision-making factors and their thresholds for total knee arthroplasty in lateral tibiofemoral osteoarthritis patients: a retrospective cohort study

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