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How an Individualized Decision Aid for Patients Considering Total Knee Replacement Surgery Can Help Them to Make Better Decisions
Knee-Replacement_PLS-image
Scientific Study Title:
Effectiveness of an individualized decision aid for total knee arthroplasty implemented in routine clinical practice
Start Date:
  • September 2022
End Date:
  • May 2025
Research Category
Tags
Deborah A. Marshall, Research Team Member, Arthritis Research Canada
Deborah A. Marshall
Senior Scientist, Health Services Research and Health Economics, PhD

Why did we do this research?

Reason For Research

We led this project to provide patients with a tool to support shared decision making, improve the quality of patients’ decisions and enhance quality of care for patients considering total knee replacement surgery.

 

What did we do?

Execution of Research

In a previous EuroQoL-funded research study, we developed and tested the effectiveness of an online individualized decision aid for patients considering total knee replacement surgery. We found that patients completing the decision aid were more likely to make a quality decision about surgery compared to those who did not complete the decision aid. Building on this proof of concept, we refined the pilot version with updates to information contained, questions posed to the patient, and visual representation of data for patients to use in their decision making. Finally, we implemented this updated version of the decision aid in routine care in Alberta in the fall of 2024.

 

What did we find?

Patients helped us refine and choose between the two versions tested in the clinic showing different visual representations of the EQ5D and patient outcomes 12 months after either surgery or the GLA:D physiotherapy program. Patient feedback helped us make changes to improve font sizes and colour, layout of the graphs, and enhance comprehension and usefulness of the tool when using it.

We validated these written opinions using the Preparation for Decisions Making Scale (PDMS) and the System Usability Scale (SUS). Patients had an average PRMS score of 66.4, meaning above average preparedness for decision making, and an SUS score of 63.4, indicating that the tool has sufficient usability. With this feedback we were able to create a version that has been integrated into routine clinical practice in Alberta.

Our preliminary results show patients spent an average of 35 minutes using the tool and the majority of patients (56%) found the tool helpful and would consider it when making a treatment decision about their knee OA. Most patients (90%) had made up their mind about their preferred treatment and most (67%) wanted to have surgery. Most patients (90%) had tried at least two non-surgical treatments before seeing a surgeon and were willing to wait more than 18 months to have surgery (65%).

What are the next steps?

We will complete the preliminary analysis of the data collected from routine practice. Currently we have not completed our full analysis of the data captured by the tool in terms of decisional concordance, and patients expressed desire for treatment and the option they ultimately select, or our analysis of patient willingness to consider outcomes versus time spent on a waitlist. These two key questions, as well as some secondary questions will be answered once we complete our full analysis of the data collected thus far.

As we interact with more patients and improve access to the tool there will be further integration into rural clinics in Alberta and more outreach to connect with more patients. We are working with clinics to raise awareness of this tool and to increase the accessibility and impact it has for patients who are unsure of their treatment decision or what questions to discuss with their care team.

How are equity, diversity and inclusion addressed?

The online individualized decision aid ensures information provided to patients is specific to each patient (individualized) and uses non-gendered images/icons. Development and testing of the decision aid involved patients from diverse background and did not restrict based on age, gender, or race/ethnicity. The data used within the decision aid is based on all Albertans.

 

The Research Team

Principal Investigators:

Jeffrey A Johnson, PhD, Professor, School of Public Health (University of Alberta)

Deborah A. Marshall, PhD, Senior Scientist, Health Services Research and Health Economics, Arthritis Research Canada (University of Calgary)

Co-Investigators:

Shakib Rahman, MSc (University of Calgary)

Allison Soprovich, MPH, BScN, APERSU (University of Alberta)

Lisa Wozniak, MA (University of Alberta)

Ademola Itiola, MSc (University of Alberta)

Christopher Smith, MBA (Institute for Improved Health Outcomes)

Who Funded This Research?

EuroQol Research Foundation

How Can People Get Involved?

Involvement

  • Albertans with osteoarthritis considering total knee replacement surgery
  • Orthopedic clinics across Alberta
  • Alberta Bone and Joint Health Institute/Institute for Improved Health Outcomes
  • Researchers at the University of Alberta and the University of Calgary
  • APERSU (Alberta PROMS and EQ-5D Research and Support Unit)

 

 

Related Publications

  • Johnson JA, Itiola A, Rahman S, Smith C, Sporovich A, Wozniak LA, Marshall DA. Exploring patient perspectives on EQ-5D-5L data visualization within an individualized decision aid for total knee arthroplasty (TKA) in Alberta, Canada. BMC Musculoskeletal Disorders, March 2024;25(1):183
  • Johnson JA, Itiola A, Rahman S, Smith C, Soprovich A, Wozniak LA, Marshall DA. Usability Testing of an Individualized Decision Aid for Total Knee Arthroplasty (TKA). PEC Innovation 2025;7:100421
  • Bansback N, Trenaman L, MacDonald KV, Durand D, Hawker G, Johnson JA, Smith C, Stacey D, Marshall DA. An online individualised patient decision aid improves the quality of decisions in patients considering total knee arthroplasty in routine care: A randomized controlled trial. Osteoarthr Cartil Open. 2022 Jun 25;4(3):100286
  • Marshall DA, Trenaman L, MacDonald KV, Johnson JA, Stacey D, Hawker G, Smith C, Durand D, Bansback N. Impact of an online, individualised, patient reported outcome measures based patient decision aid on patient expectations, decisional regret, satisfaction, and health-related quality-of-life for patients considering total knee arthroplasty: Results from a randomised controlled trial. J Eval Clin Pract. 2023 Apr;29(3):513-524
  • Bansback N, Trenaman L, MacDonald KV, Hawker G, Johnson JA, Stacey D, Marshall DA. An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord. 2019 Feb 23;20(1):89

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