Use of a decision aid likely increases TKR rate among black patients with knee OA
Among black patients with knee osteoarthritis, investigators found an increased rate of total knee replacement for patients who were given a decision aid.
“[There] is now evidence that patient-centered educational intervention using evidence-based, validated, decision aids can significantly increase access to knee replacement for minority patients, most specifically African-American patients,” study investigator Said A. Ibrahim, MD, MPH, MBA, told Orthopedics Today.
He added, “It is important for orthopedic surgeons to know that minority patients are open to surgery provided they are educated about the risks/benefits of joint replacement. Decision aids are a reasonable alternative to extensive orthopedic doctor-patient discussions about surgery, but we have to make sure that the right decision aids are used and the right setting for patient education is chosen.”
Ibrahim and colleagues performed a randomized controlled trial at three medical centers that included 336 self-identified black patients with knee osteoarthritis. Investigators randomized patients into either an intervention group, where they viewed a 40-minute video that discussed the risks and benefits of total knee replacement (TKR), or a control group. Each group included 168 patients.
The primary outcome was how patients responded to TKR 12 months after viewing the decision aid and how patients responded to an orthopedic surgeon’s recommendation for surgery 6 months after patients viewed the video. Investigators analyzed patients with a per-protocol basis and intention-to-treat (ITT) basis.
There were 25 intervention patients and 13 control patients who underwent TKR 12 months after viewing the decision aid, leading to a 70% increase in the rate of TKR. Within 6 months, 34 intervention patients vs. 26 control patients in the ITT analysis were recommended for surgery. The groups were not statistically significantly different with regard to the surgery recommendation rate. The adjusted odds ratios for ITT and per-protocol analyses for recommendation of TKR within 12 months were 2.10 and 2.39, respectively. ‒ by Monica Jaramillo
Disclosure: Ibrahim reports no relevant financial disclosures.