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Open Access 01-12-2022 | Knee-TEP | Research

The impact of a digital joint school educational programme on post-operative outcomes following lower limb arthroplasty: a retrospective comparative cohort study

Authors: Joanne Gray, Stephen McCarthy, Esther Carr, Gerard Danjoux, Rhiannon Hackett, Andrew McCarthy, Peter McMeekin, Natalie Clark, Paul Baker

Published in: BMC Health Services Research | Issue 1/2022

Abstract

Background

As part of an ongoing service improvement project, a digital ‘joint school’ (DJS) was developed to provide education and support to patients undergoing total hip (THR) and total knee (TKR) replacement surgery. The DJS allowed patients to access personalised care plans and educational resources using web-enabled devices, from being listed for surgery until 12 months post-operation. The aim of this study was to compare a cohort of patients enrolled into the DJS with a cohort of patients from the same NHS trust who received a standard ‘non-digital’ package of education and support in terms of Health-Related Quality of Life (HRQoL), functional outcomes and hospital length of stay (LoS).

Methods

A retrospective comparative cohort study of all patients undergoing primary TKR/THR at a single NHS trust between 1st Jan 2018 and 31st Dec 2019 (n = 2406) was undertaken. The DJS was offered to all patients attending the clinics of early adopting surgeons and the remaining surgeons offered their patient’s standard written and verbal information. This allowed comparison between patients that received the DJS (n = 595) and those that received standard care (n = 1811). For each patient, demographic data, LoS and patient reported outcome measures (EQ-5D-3L, Oxford hip/knee scores (OKS/OHS)) were obtained. Polynomial regressions, adjusting for age, sex, Charlson Comorbidity Index (CCI) and pre-operative OKS/OHS or EQ-5D, were used to compare the outcomes for patients receiving DJS and those receiving standard care.

Findings

Patients that used the DJS had greater improvements in their EQ-5D, and OKS/OHS compared to patients receiving standard care for both TKR and THR (EQ-5D difference: TKR coefficient estimate (est) = 0.070 (95%CI 0.004 to 0.135); THR est = 0.114 (95%CI 0.061 to 0.166)) and OKS/OHS difference: TKR est = 5.016 (95%CI 2.211 to 7.820); THR est = 4.106 (95%CI 2.257 to 5.955)). The DJS had a statistically significant reduction on LoS for patients who underwent THR but not TKR.

Conclusion

The use of a DJS was associated with improved functional outcomes when compared to a standard ‘non-digital’ method. The improvements between pre-operative and post-operative outcomes in EQ-5D and OKS/OHS were higher for patients using the DJS. Furthermore, THR patients also had a shorter LoS.

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Soever LJ, MacKay C, Saryeddine T, Davis AM, Flannery JF, Jaglal SB, et al. Educational needs of patients undergoing total joint arthroplasty. Physiother Can. 2010;62(3):206–14. https://doi.org/10.3138/physio.62.3.206.

National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder (NICE guideline 157). 2020. Available from: https://www.nice.org.uk/guidance/ng157. Accessed 23 Mar 2022.

Centre for Peri-Operative Care. Case Studies: Preoperative Optimisation. Development and Impact of a ‘digital joint school’ within an elective orthopaedic surgery pathway (South Tees Hospital NHS Foundation Trust). Available from: https://cpoc.org.uk/case-studies-preoperative-optimisation.

Aydin D, Klit J, Jacobsen S, Troelsen A, Husted H. No major effects of preoperative education in patients undergoing hip or knee replacement – a systematic review. Danish Med J. 2015;62(7):1–5.

Go Well Health. SHI Global Ltd 2021. Available from: https://gowellhealth.co.uk/ Accessed 23 Mar 2022.

Rabin R, Gudex C, Selai C, Herdman M. From translation to version management: a history and review of methods for the cultural adaptation of the EuroQol five-dimensional questionnaire. Value Health. 2014;17(1):70–6. https://doi.org/10.1016/j.jval.2013.10.006 PMID: 24438719.CrossRefPubMed

The EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef

Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg (Br). 2007;89(8):1010–4. https://doi.org/10.1302/0301-620X.89B8.19424.

NHS. Patient Reported Outcome Measures (PROMs). Available from: https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/patient-reported-outcome-measures-proms. Accessed 23 Mar 2022.

10.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/10.1016/0021-9681(87)90171-8.CrossRefPubMed

11.

Faria R, Gomes M, Epstein D, White IR. A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. PharmacoEconomics. 2014;32(12):1157–70. https://doi.org/10.1007/s40273-014-0193-3.CrossRefPubMedPubMedCentral

12.

Madley-Dowd P, Hughes R, Tilling K, Heron J. The proportion of missing data should not be used to guide decisions on multiple imputation. J Clin Epidemiol. 2019;110:63–73. https://doi.org/10.1016/j.jclinepi.2019.02.016.CrossRefPubMedPubMedCentral

13.

Sauerbrei W, Royston P. Building multivariable prognostic and diagnostic models: transformation of the predictors by using fractional polynomials. J Roy Stat Soc. 1999;162(1):71–94. https://doi.org/10.1111/1467-985X.00122.CrossRef

14.

Coxe S, West SG, Aiken LS. The analysis of count data: a gentle introduction to Poisson regression and its alternatives. J Pers Assess. 2009;91(2):121–36. https://doi.org/10.1080/00223890802634175.CrossRefPubMed

15.

StataCorp. Stata statistical software: release 14. College Station, TX: StataCorp LP; 2015.

16.

NHS Digital. Finalised Patient Reported Outcome Measures (PROMs) in England for Hip and Knee Replacement Procedures (April 2019 to March 2020). 2021. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/patient-reported-outcome-measures-proms/finalised-hip-and-knee-replacement-april-2019%2D%2D-march-2020.

17.

Clement ND, MacDonald D, Simpson AHRW. The minimal clinically important difference in the Oxford knee score and short form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22(8):1933–9. https://doi.org/10.1007/s00167-013-2776-5.CrossRefPubMed

18.

Beard DJ, Harris K, Dawson J, Doll H, Murray DW, Carr AJ, et al. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2015;68(1):73–39. https://doi.org/10.1016/j.jclinepi.2014.08.009.

19.

Bilbao A, Garcia-Perez L, Arenaza JC, Garcia I, Arizaa-Cardiel G, Trujillo-Martin E, et al. Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness. Qual Life Res. 2018;27(11):2897–908. https://doi.org/10.1007/s11136-018-1929-x.

20.

Murray DW, MacLennan GS, Breeman S, Dakin HA, Johnston L, Campbell MK, et al. A randomised controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses: the knee Arthroplasty trial (KAT). Health Technol Assess (Winchester, England). 2014;18(19):1. https://doi.org/10.3310/hta18190.

21.

Beard DJ, Davies LJ, Cook JA, MacLennan G, Price A, Kent S, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medical compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet. 2019;394(10200):746–56. https://doi.org/10.1016/S0140-6736(19)31281-4.

22.

Jameson SS, Mason J, Baker P, Gregg PJ, McMurtry IA, Deehan DJ, et al. A comparison of surgical approaches for primary hip arthroplasty: a cohort study of patient reported outcome measure (PROMs) and early revision using linked national databases. J Arthroplast. 2014;29(6):1248–55. https://doi.org/10.1016/j.arth.2013.11.027.

23.

Jameson SS, Mason J, Baker PN, Gregg PJ, Deehan DJ, Reed M, et al. Implant optimisation for primary hip replacement in patients over 60 years with osteoarthritis: a cohort study of clinical outcomes and implant costs using data from England and Wales. PLoS One. 2015;10(11):e0140309. https://doi.org/10.1371/journal.pone.0140309.

24.

NHS England. Reducing length of stay. Available from: https://www.england.nhs.uk/urgent-emergency-care/reducing-length-of-stay/. Accessed 23 Mar 2022.

25.

Yoon RS, Nellans KW, Geller JA, Kim AD, Jacobs MR, Macaulay W. Patient education before hip or knee arthroplasty lowers length of stay. J Arthroplast. 2010;25(4):547–51. https://doi.org/10.1016/j.arth.2009.03.012.CrossRef

26.

NHS. NHS Long Term Plan. Available from: https://www.longtermplan.nhs.uk/. Accessed 23 March 2022.

27.

National Institute for Health and Care Excellence. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services (Clinical guideline 138). 2012. Available at: https://www.nice.org.uk/guidance/cg138. Accessed 23 Mar 2022.

28.

National Institute for Health and Care Excellence. Shared decision making. Available from https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making. Accessed 23 Mar 2022.

29.

Ponder M, Ansah-Yeboah A, Charalambous L, Adil S, Venkatraman V, Abd-El-Barr M, et al. A smartphone app with a digital care pathway for patients undergoing spine surgery: development and feasibility study. JMIR Perioper Med. 2020;3(2):e21138. https://doi.org/10.2196/21138.

30.

Baker PN, Clark NL. Delivery of patient education and support using an online digital platform for patients undergoing primary hip and knee replacement: the patient’s perspectives. Patient Exp J. 2021;8(1):99–107. https://doi.org/10.35680/2372-0247.1537.CrossRef

31.

Fraval A, Chandrananth J, Chong YM, Tran P, Coventry LS. Internet based patient education improves informed consent for elective orthopaedic surgery: a randomised control trial. BMC Musculoskelet Disord. 2015;16(1):1–6. https://doi.org/10.1186/s12891-015-0466-9.CrossRef

32.

De Achaval S, Fraenkel L, Volk RJ, Cox V, Suarez-Almazor ME. Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty. Arthritis Care Res. 2012;64(2):229–37. https://doi.org/10.1002/acr.20646.CrossRef

33.

NHS England. Hip replacement. 2021. Available from: https://www.nhs.uk/conditions/hip-replacement/. Accessed 23 Mar 2022..

34.

National Institute for Health and Care Excellence. Perioperative care in adults. 2019. Available at: https://www.nice.org.uk/guidance/GID-NG10072/documents/evidence-review-12. Accessed 23 Mar 2022.

35.

Curtis L, Burns A. Unit costs of health and social care 2019. Canterbury: Personal Social Services Research Unit, University of Kent; 2019.

36.

Kuss O, Blettner M, Börgermann J. Propensity score: an alternative method of analyzing treatment effects. Dtsch Arztebl Int. 2016;113(35–36):597–603. https://doi.org/10.3238/arztebl.2016.0597.CrossRefPubMedPubMedCentral

37.

Freemantle N, Marston L, Walters K, Wood J, Reynolds MR, Petersen I. Making inferences on treatment effects from real world data: propensity scores, confounding by indication, and other perils for the unwary in observational research. BMJ. 2013;347:f6409. https://doi.org/10.1136/bmj.f6409Place.CrossRefPubMed

38.

Stürmer T, Schneeweiss S, Brookhart MA, Rothman KJ, Avorn J, Glynn RJ. Analytic strategies to adjust confounding using exposure propensity scores and disease risk scores: nonsteroidal antiinflammatory drugs and short-term mortality in the elderly. Am J Epidemiol. 2005;161(9):891–8. https://doi.org/10.1093/aje/kwi106.CrossRefPubMed

39.

Kurth T, Walker AM, Glynn RJ, Arnold Chan K, Michael Gaziano J, Berger K, et al. Results of multivariable logistic regression, propensity matching, propensity adjustment, and propensity-based weighting under conditions of nonuniform effect. Am J Epidemiol. 2006;163(3):262–70. https://doi.org/10.1093/aje/kwj047.

Title: The impact of a digital joint school educational programme on post-operative outcomes following lower limb arthroplasty: a retrospective comparative cohort study
Authors: Joanne Gray
Stephen McCarthy
Esther Carr
Gerard Danjoux
Rhiannon Hackett
Andrew McCarthy
Peter McMeekin
Natalie Clark
Paul Baker
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Knee-TEP
Hip-TEP
Hip-TEP
Knee-TEP
Published in: BMC Health Services Research / Issue 1/2022
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-022-07989-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of a digital joint school educational programme on post-operative outcomes following lower limb arthroplasty: a retrospective comparative cohort study

Abstract

Background

Methods

Findings

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Findings

Conclusion

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