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Shared Decision Making in Patients withOsteoarthritis of the Hip and Knee
Results of a Randomized Controlled Trial
Kevin J. Bozic, MD, MBA, Jeffrey Belkora, PhD, Vanessa Chan,MPH, Jiwon You, MD, M!, "ianzan #hou, B!,
John Du$ai%, MD, An&ela 'ava Bye, MA, A"C, Clarence H.Bra((ock ))), MD, MPH, Ka*e +resian Chenok, MBA,
an( Jaes ). Hu((les*on ))), MD
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s*eoar*hri*is of *he hi$ an( knee affec*sillions of Aericans.
"he clinical anifes*a*ions ran&e froil( $ain causin& inial i$airen* *o
severe $ain an( (isa-ili*y, resul*in& inlii*e( o-ili*y an( $oor uali*y of life.
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"rea*en* al*erna*ives /0 Ac*ivi*y o(ifica*ion,
0 1ei&h* loss,0 Physical *hera$y, an(
0 'ons*eroi(al an*i2inflaa*ory e(ica*ions
0 More invasive *hera$ies, such as in3ec*ions,
os*eo*oy, an( *o*al 3oin* ar*hro$las*y.
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"hese *rea*en*s e%$ose $a*ien*s *o$o*en*ial risks as well as $ossi-le -enefi*s.Physicians shoul( incor$ora*e $a*ien*
$references a-ou* *he value, *iin&, an(likelihoo( of *hese risks an( -enefi*s when
(evelo$in& a *rea*en* $lan wi*h *heir$a*ien*s.
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ackground
Des$i*e evi(ence *ha* share( (ecision2
akin& *ools for *rea*en* (ecisionsi$rove (ecision uali*y an( $a*ien*en&a&een*, the! are not commonl!
emplo!ed in orthopaedic practice.
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The purpose of this stud! "0 *o evalua*e *he i$ac* of (ecision an(
counica*ion ai(s on $a*ien* knowle(&e,0 efficiency of (ecision akin&,
0 *rea*en* choice, an(
0 $a*ien* an( sur&eon e%$erience in $a*ien*s
wi*h os*eoar*hri*is of *he hi$ or knee.
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Materials and Methods
#$% $a*ien*s referre( *o *wo aca(eice(ical cen*ers 4*he 5niversi*y of California,
!an 6rancisco an( !*anfor(5niversi*y78ecrui*e( -e*ween !e$*e-er 9:;; an(
May 9:;9Consi(ere( e(ically a$$ro$ria*e for hi$ or
knee re$laceen*.8an(oize( *o ei*her a shared decision&
making inter'entionor usual care.
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(nter'ention group
8eceive( a (i&i*al vi(eo(isc an( -ookle*(escri-in& *he na*ural
his*ory an( *rea*en*al*erna*ives for hi$ an(knee os*eoar*hri*is.An( (evelo$e( a
s*ruc*ure( lis* of
ues*ions for *heirsur&eon in consul*a*ionwi*h a heal*h coach.
Control group
8eceive( infora*iona-ou* *he sur&eon
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Bo*h &rou$s re$or*e( *heir knowle(&e an(s*a&e in (ecision akin& an( *heir
*rea*en* choice, sa*isfac*ion, an(counica*ion wi*h *heir sur&eon.!ur&eons re$or*e( *he a$$ro$ria*eness of
$a*ien* ues*ions an( *heir sa*isfac*ionwi*h *he visi*.
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Po*en*ial su-3ec*s were i(en*ifie( froclinic sche(ules an( were calle( *o assess
*heir neli&i-ili*y an( *o o-*ain ver-alconsen*.1hen $a*ien*s cae for *heir clinic visi*,
wri**en consen* was o-*aine(.
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Pa*ien*s were eli&i-le for *he s*u(y if /0 *hey ha( a $riary (ia&nosis of os*eoar*hri*is
of *he hi$ or knee,0 firs* *ie seein& an or*ho$ae(ic sur&eon for*his $ro-le, an(
0 *hey ha( no his*ory of a lower2e%*rei*y 3oin*
ar*hro$las*y.
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Pa*ien*s were ineli&i-le if /0 *hey coul( no* rea( or s$eak +n&lish or
0 ha( a $revious a$$oin*en* wi*h ano*heror*ho$ae(ic sur&eon for evalua*ion of *hear*hri*ic hi$ or knee.
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Results
!i&nifican*ly ore $a*ien*s in *hein*erven*ion &rou$ 4=>?7 reache( an
infore( (ecision (urin& *he firs* visi*co$are( wi*h *he con*rol &rou$ 4@@?7 4$ :.::=7.
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"he in*erven*ion &rou$ re$or*e( hi&herconfi(ence in knowin& wha* ues*ions *o
ask *heir (oc*or 4$ :.::@7.Af*er *he a$$oin*en*, *here was no
si&nifican* (ifference -e*ween &rou$s in*he $ercen*a&e of $a*ien*s choosin&sur&ery
4$ :.>7.
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!ur&eons ra*e( *he nu-er an(a$$ro$ria*eness of $a*ien* ues*ions
hi&her in *he in*erven*ion &rou$ 4$ :.:::;7, re$or*e( hi&her sa*isfac*ion wi*h*he efficiency of *he in*erven*ion &rou$visi*s 4$ :.:::;7, an( were oresa*isfie( overall wi*h *he in*erven*ion&rou$ visi*s 4$ :.:::;7.
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Conclusions
Decision an( counica*ion ai(s use( inor*ho$ae(ic $rac*ice ha( -enefi*s for -o*h
$a*ien*s an( sur&eons."hese fin(in&s coul( -e i$or*an* in
facili*a*in& a(o$*ion of share( (ecision2akin& *ools in*o rou*ine or*ho$ae(ic$rac*ice.
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)e'el of *'idence
"hera$eu*ic evel ). !ee )ns*ruc*ions forAu*hors for a co$le*e (escri$*ion of
levels of evi(ence.
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TH+,K-O.
