Improving patient engagement through a Clinical Decision-Making Tool: factors associated with readiness for knee arthroplasty

Purpose The study goals were (1) to assess patient readiness to have knee arthroplasty surgery using a Clinical Decision-Making Tool, (2) to explore the relationship between recovery expectations and patient characteristics and (3) to explore the relationship between final decision to have surgery and pre-operative discussion with clinician.Methods Candidates for knee arthroplasty seen at a Rapid Access Clinic were included. Readiness to have surgery, pre-operative lower extremity functional measure score (LEFS), pain score, expectations and satisfaction with original decision to have surgery were documented.Results Sixty patients, 37 (62%) women, mean age 69, SD = 8, participated in the study. Forty-six patients; 26 (58%) women and 20 (42%) men had surgery and completed the satisfaction survey. Patients who reported higher levels of readiness for TKA surgery reported worse symptoms and functional difficulties (p = 0.0005), had more achievable expectations for recovery (p < 0.0001), and better understanding of surgical risks/benefits (p = 0.0003). Higher pre-operative expectations for recovery were associated with higher pre-operative disability as defined by LEFS (p = 0.004), more pain (p = 0.0005) and higher osteoarthritis (OA) severity score (p = 0.002). Post-operatively, 38 (83%) patients reported that they would ‘definitely’ have chosen surgery. Eight (17%) patients who questioned their original judgement felt that they were not given as much information on alternative options (p < 0.0001), recovery timeline (p = 0.01) or surgical benefits/risks (p < 0.0009).Conclusions Severity of symptoms, functional difficulties and achievable expectations for recovery are associated with readiness for knee arthroplasty. Understanding alternative treatments, recovery trajectory and benefits and surgical risks affect satisfaction with the decision to have undergone surgery.