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Time for Surgery? Using Patient-Reported Outcomes for Shared Decision Making for Osteoarthritis Patients

Time for Surgery? Using Patient-Reported Outcomes for Shared Decision Making for Osteoarthritis Patients

Successful validation of a patient-reported outcomes-guided shared decision making tool for patients with osteoarthritis of the knee may lead to widespread scaling and use by musculoskeletal providers and their patients.

Knee pain prevalence

Osteoarthritis (OA) of the knee is prevalent among millions of Americans. While it is not a life-threatening condition, it impacts a person’s quality of life. OA impairs a person’s mobility and comes with an economic impact by affecting people’s ability to work and take care of themselves and their families. Total knee replacement (TKR) for severe knee OA is an increasingly popular treatment to alleviate pain and improve function, but about 15-20 percent of patients who have TKR are dissatisfied with the outcome. This adds to the growing concerns around the appropriateness of TKR in some patients. Drs. Kevin Bozic and Joel Tsevat want to better identify patients who are most likely to experience improved health outcomes with this treatment.

A holistic approach to treating osteoarthritis

Researchers, led by Dr. Bozic at the University of Texas-Austin (UT-Austin), developed a tool to support shared decision making comparing TKR versus non-operative treatment for patients with knee OA by using the patient’s information, including pain status, quality of life, mental and physical health, comorbidities, and other characteristics, such as age. The tool is designed to use data from patient-reported outcome (PRO) scores as well as the patient’s preferences and values to inform their decision on whether to choose surgery or not. The research team will conduct a randomized controlled trial of use of the tool at UT Austin, and then integrate and test it in two electronic health record systems and two patient populations at UT Austin and the University of Texas Health Science Center at San Antonio.

When talking about "preference-sensitive" conditions, where preferences matter, I think having tools to inform patients about the pathophysiology of disease and the potential treatment options and possible outcomes, as well as inform the clinical team of the patient’s preferences and values, is really what shared decision making is all about.”
- Dr. Bozic

Putting patients in the center of the decision making

This model puts patients at the center of their care and enables them to participate in informed medical decision making. This tool provides a specific use case that could potentially increase adoption and use of PROs in routine clinical practice. Drs. Bozic and Tsevat hope the knowledge gained will support scaling and implementing this tool to other musculoskeletal care providers and ensuring this is a feasible and pragmatic tool to implement across the country.