Shared Decision-Making Is Associated with Better Outcomes in Patients with Knee But Not Hip Osteoarthritis

医学 骨关节炎 后悔 置信区间 物理疗法 逻辑回归 生活质量(医疗保健) 决策质量 患者满意度 外科 内科学 替代医学 计算机科学 机器学习 病理 护理部
作者
Karen Sepucha,Ha Vo,Yuchiao Chang,Janet M. Dorrwachter,Maureen K. Dwyer,Andrew A. Freiberg,Carl T. Talmo,Hany Bedair
出处
期刊:Journal of Bone and Joint Surgery, American Volume [Wolters Kluwer]
卷期号:104 (1): 62-69 被引量:11
标识
DOI:10.2106/jbjs.21.00064
摘要

Current guidelines recommend shared surgical decision-making, yet it is unclear whether shared decision-making improves health outcomes in patients who are considering knee and hip replacement. The purpose of the present study was to examine whether patients who made high-quality, informed, patient-centered (IPC) decisions had better health outcomes, higher satisfaction, and less decision regret compared with those who made lower-quality decisions.A multisite, randomized study of 2 decision aids for patients with hip and knee osteoarthritis was utilized to collect data on decision-making and health outcomes at 2 time points: shortly after the initial surgical evaluation and about 6 months after treatment. We calculated the percentage of patients who made an IPC decision and examined the a priori hypotheses that IPC decisions would be associated with better health outcomes, satisfaction, and less regret at 6 months. Linear and logistic regression models were utilized to examine the relationships.The analytic sample included 854 patients with a mean age of 65 years (standard deviation, 9 years), of whom 58% were female, 93% were White non-Hispanic, 67% had knee (compared with hip) osteoarthritis, and 62% underwent operative treatment within 6 months of the initial evaluation. The majority of patients (68%) made IPC decisions. The IPC group had significantly larger gains in quality of life (mean difference in EuroQol-5 Dimension, 0.04; 95% confidence interval [CI], 0.02 to 0.07; p < 0.001) compared with the non-IPC group. For knee patients, the IPC group also had significantly better Knee injury and Osteoarthritis Outcome Scores (mean difference, 4.9; 95% CI, 1.5 to 8.3; p = 0.004), higher satisfaction (adjusted odds ratio [aOR], 1.7; 95% CI, 1.2 to 2.3; p = 0.003), much better pain relief (aOR, 2.1; 95% CI, 1.3 to 3.5; p = 0.002), and were more likely to have no decision regret (aOR, 2.3; 95% CI, 1.3 to 4.1; p = 0.003). For hip patients, IPC decisions were not associated with better Harris hip scores or satisfaction and were associated with more regret.Higher-quality decisions predicted small improvements in health outcomes, as well as greater satisfaction and less regret for patients with knee osteoarthritis, but not for patients with hip osteoarthritis.Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
英姑应助聪慧的正豪采纳,获得10
刚刚
1秒前
整齐荟完成签到,获得积分10
1秒前
领导范儿应助威武的元冬采纳,获得30
5秒前
5秒前
junjun2011完成签到,获得积分10
7秒前
Dasha完成签到,获得积分10
7秒前
充电宝应助puzi采纳,获得10
9秒前
LiuLiu发布了新的文献求助10
10秒前
深情安青应助昏睡的绿海采纳,获得10
10秒前
11秒前
大大的西瓜完成签到 ,获得积分10
15秒前
华仔应助XYN1采纳,获得10
16秒前
16秒前
A阿澍发布了新的文献求助30
16秒前
丘比特应助TMX采纳,获得10
18秒前
20秒前
量子星尘发布了新的文献求助10
21秒前
23秒前
无奈满天发布了新的文献求助10
26秒前
26秒前
26秒前
27秒前
28秒前
29秒前
zhou269完成签到,获得积分10
31秒前
在逃公主许翠花完成签到,获得积分10
31秒前
littleblack发布了新的文献求助10
32秒前
TMX发布了新的文献求助10
32秒前
32秒前
DaiTing发布了新的文献求助10
32秒前
33秒前
简单点发布了新的文献求助10
33秒前
华仔应助无奈满天采纳,获得10
33秒前
fjejj发布了新的文献求助10
34秒前
sisi发布了新的文献求助10
35秒前
华仔完成签到,获得积分10
37秒前
华仔应助特梅头采纳,获得10
39秒前
40秒前
无奈满天完成签到,获得积分10
41秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3988920
求助须知:如何正确求助?哪些是违规求助? 3531290
关于积分的说明 11253247
捐赠科研通 3269903
什么是DOI,文献DOI怎么找? 1804830
邀请新用户注册赠送积分活动 882027
科研通“疑难数据库(出版商)”最低求助积分说明 809052