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Osteoarthritis patients' perceptions of ' appropriateness' for total joint replacement surgery

机译：骨关节炎患者对全关节置换手术的“适当性”看法

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Objective: To understand patients' perspectives on 'appropriateness' for hip and knee total joint arthroplasty (TJA). Methods: Focus groups were conducted, stratified by history of a previous TJA, in English-speaking men and women aged 40+ years with moderate to severe hip and knee osteoarthritis. Participants discussed: their appropriateness for TJA; the ideal candidate; patients' role in TJA decision making; and the relationship between appropriateness and willingness to consider TJA. Participants self-completed a questionnaire assessing demographics, arthritis severity (Western Ontario McMaster University Osteoarthritis index - WOMAC), perceived TJA candidacy and willingness to consider TJA. Focus groups were audio-taped and transcribed verbatim. Content analysis was performed. Results: Eleven focus groups were conducted with 58 participants in total: mean age 72 years; 79% female; 25 (43%) with prior TJA; mean WOMAC summary score 43.1. Half reported willingness to consider TJA and 43% felt they were appropriate for TJA. Appropriateness was equated with candidacy for the procedure. Pain intensity and the ability to cope with pain were identified as the most important factors determining surgical candidacy, but felt to be inadequately evaluated by physicians. TJA appropriateness and willingness were felt to be distinct, yet related, concepts; those unwilling had stricter criteria about candidacy than those who were willing. Conclusions: Participants equated appropriateness for TJA with surgical candidacy. Patients' pain experience (intensity, impact on quality of life, ability to cope) was seen as most important in determining appropriateness, but felt to be inadequately evaluated currently. Enhanced patient-physician communication, possibly through use of patient decision aids, has potential to improve patient selection for TJA.
机译：目的：了解患者对髋和膝关节全关节置换术（TJA）“适当性”的看法。方法：根据先前TJA的病史，对年龄在40岁以上，患有中度到重度髋关节和膝关节骨关节炎的英语男女进行焦点小组研究。参加者讨论了：他们对TJA的适用性;理想的候选人;患者在TJA决策中的作用;以及考虑TJA的适当性和意愿之间的关系。参与者自行完成了一份问卷调查表，以评估人口统计学，关节炎严重程度（西安大略麦克马斯特大学骨关节炎指数-WOMAC），TJA候选资格和考虑TJA的意愿。焦点小组被录音并逐字记录。进行了内容分析。结果：共进行了11个焦点小组的研究，共有58名参与者：平均年龄72岁;平均年龄72岁。女性占79％; 25（43％）曾接受过TJA;平均WOMAC摘要分数为43.1。一半的人表示愿意考虑TJA，而43％的人认为他们适合TJA。适当性等同于该程序的候选资格。疼痛强度和应对疼痛的能力被确定为决定手术候选人资格的最重要因素，但医生认为评估不足。 TJA的适当性和意愿被认为是截然不同但又相关的概念。那些不愿意的人比那些愿意的人拥有更严格的候选人资格标准。结论：参加者将TJA的适当性等同于外科手术的候选资格。患者的疼痛经历（强度，对生活质量的影响，应对能力）被认为是确定适当性的最重要方法，但目前尚未得到充分评估。可能通过使用患者决策辅助工具来增强患者与医生的沟通，可能会改善TJA的患者选择。

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