JMIR Publications

ABSTRACT

Background:

Following total knee arthroplasty (TKA), 10-20% of patients report being dissatisfied with procedure outcomes. There is growing recognition that post-surgical satisfaction is shaped not only by the quality of surgery, but also by psychological and social factors. Surprisingly, information on psychological and social determinants of surgical outcome is rarely collected pre-surgery. Comprehensive collection of biopsychosocial information could assist clinicians when making recommendations in relation to rehabilitation, particularly if there was robust evidence to support the ability of pre-surgical constructs to predict post-surgical outcomes. Clinical decision support tools can help to identify factors influencing patient outcomes and support the provision of interventions or services which can be tailored to meet individuals’ needs. However, despite their potential clinical benefit, the application of such tools remains limited.

Objective:

This project is designed to develop a clinical decision tool that will assist with patient stratification and more precisely targeted clinical decision-making regarding pre-habilitation and rehabilitation for TKA, based on identified individual biopsychosocial needs.

Methods:

In this prospective, observational study, all participants provided written or electronic consent prior to study commencement. Patient-completed questionnaires captured information relating to a broad range of biopsychosocial parameters during the month preceding TKA. This included demographic factors (sex, age, rurality) psychological factors (mood status, pain catastrophizing, resilience and committed action), quality of life, social supports, lifestyle factors and knee symptoms. Physical measures assessing mobility, balance, and functional lower body strength were undertaken via videocalls with patients in their home. Information relating to pre-existing health issues and concomitant medications was derived from hospital medical records. Patient recovery outcomes were assessed three months following the surgical procedure and included quality of life, patient-reported knee symptoms, satisfaction with the surgical procedure and mood status.

Results:

This study was funded in September 2018 by the Ramsay Hospital Research Foundation. Patient recruitment and data collection commenced in November 2019 and completed in June 2022. A total of 1050 TKA patients were enrolled to take part in this study. Machine learning data analysis techniques will be applied to determine which pre-surgery parameters have the strongest power for predicting patient recovery following total knee replacement. From these analyses a predictive model will be developed. Predictive models will undergo internal validation, and Bayesian analysis will be applied to provide additional metrics regarding prediction accuracy.

Conclusions:

Our findings will facilitate the development of the first comprehensive biopsychosocial prediction tool, which has the potential to objectively predict a patient’s individual recovery outcomes following TKA once selected by an orthopaedic surgeon to undergo TKA. If successful, the tool could also inform the evolution rehabilitation services, such that factors in addition to physical performance can be addressed and have the potential to further enhance patient recovery and satisfaction. Clinical Trial: Australian New Zealand Clinical Trials Registry ANZCTR 12619001000190; https://www.anzctr.org.au/ACTRN12619001000190.spx Universal Trials Number (UTN) U1111-1235-7747.