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What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement

BACKGROUND: Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA re...

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Autores principales: Randall, Ellen, Bryan, Stirling, Black, Charlyn, Goldsmith, Laurie J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9446772/
https://www.ncbi.nlm.nih.gov/pubmed/36068507
http://dx.doi.org/10.1186/s12891-022-05695-x
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author Randall, Ellen
Bryan, Stirling
Black, Charlyn
Goldsmith, Laurie J.
author_facet Randall, Ellen
Bryan, Stirling
Black, Charlyn
Goldsmith, Laurie J.
author_sort Randall, Ellen
collection PubMed
description BACKGROUND: Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure. METHODS: Twenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants’ experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants’ stories about what was front of mind when they reflected on satisfaction with their new knee. RESULTS: Participants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee’s achieved adequacy and the straightforwardness of the adapting process. DISCUSSION: The conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants’ adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure. CONCLUSIONS: The process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function.
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spelling pubmed-94467722022-09-07 What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement Randall, Ellen Bryan, Stirling Black, Charlyn Goldsmith, Laurie J. BMC Musculoskelet Disord Research BACKGROUND: Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure. METHODS: Twenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants’ experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants’ stories about what was front of mind when they reflected on satisfaction with their new knee. RESULTS: Participants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee’s achieved adequacy and the straightforwardness of the adapting process. DISCUSSION: The conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants’ adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure. CONCLUSIONS: The process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function. BioMed Central 2022-09-06 /pmc/articles/PMC9446772/ /pubmed/36068507 http://dx.doi.org/10.1186/s12891-022-05695-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Randall, Ellen
Bryan, Stirling
Black, Charlyn
Goldsmith, Laurie J.
What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement
title What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement
title_full What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement
title_fullStr What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement
title_full_unstemmed What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement
title_short What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement
title_sort what matters to patients following total knee arthroplasty? a grounded theory of adapting to a knee replacement
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9446772/
https://www.ncbi.nlm.nih.gov/pubmed/36068507
http://dx.doi.org/10.1186/s12891-022-05695-x
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