5 Minute Poster Presentation ARA-NSW 2020 - 42nd Annual NSW Branch Meeting

Establishing the hierarchy of goals for patients undergoing total knee arthroplasty: Can health professionals identify their patients' goals? (#27)

Sascha Karunaratne 1 2 3 , Mark Horsley 3 , Lyndal Trevena 4 , Ian Harris 1 2 3 5 , Michael Solomon 1 2
  1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  3. Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  4. School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
  5. Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia

Background: Patients suffering from end-stage osteoarthritis are often encouraged to consider total knee replacement (TKA). However, the most important goals to patients may not be taken into consideration by health professionals, leading to unrealistic expectations. The purpose of this study was to formulate a hierarchy of primary goals patients have prior to TKA and evaluate the agreement between patients and health professionals regarding this hierarchy of patient goals.

Methods: The five most important goals for 107 consecutive patients booked for TKA between June to October 2019 were identified. Identified goals were grouped into themes and a hierarchy was formulated based on mean importance to the patient. This hierarchy was randomised and provided to 94 health professionals, including orthopaedic surgeons (n=49), rheumatologists (n=16), physiotherapists (n=16) and general practitioners (n=13). These health professionals ranked the provided goals based on their belief of what was most important to patients.

Results: Ten overarching goals were identified, with the five most important goals to patients being mobility, reducing knee pain, improving daily tasks and participating in social & hobby activities. Health professionals ranked these goals highly similar to patients. However in contrast to patients, health professionals ranked quality of life near the top of the hierarchy, while ranking mobility in the bottom half. Ranking of these goals was similar between each health professional group. However there was minor disagreement with rheumatologists pertaining to range of motion and returning to work, which rheumatologists ranked higher and lower respectively.

Conclusion: Pain and mobility are the most important goals to patients, with health professionals recognising what goals are most important to patients. However in contrast to patients, health professionals ranked quality of life and mobility in opposite positions on the hierarchy. This incongruity should be considered by health professionals when educating patients and communicating realistic treatment outcomes.