Open Collections

Randall, Ellen C.

University of British Columbia

Total knee arthroplasty (TKA) is the most common joint replacement surgery in Canada. Despite longstanding high volumes, there is persistent evidence that TKA patient satisfaction is not as high as desired, with studies reporting that 10%–20% of patients are not satisfied. Reducing this percentage is a priority. While research exploring drivers of TKA satisfaction exists, new actionable insights into the high numbers of unsatisfied patients is needed. This mixed methods study brought three lenses (quantitative, qualitative, mixed methods integration) to bear on the question: What factors explain variation in long-term satisfaction following primary TKA surgery? The quantitative component used bivariate analyses to analyze responses (n=314) to a patient questionnaire completed three years post-surgery, assessing associations between predictors and a binary satisfaction measure (satisfied/not satisfied). Variation in satisfaction was associated with symptoms such as pain or mental health conditions such as anxiety. The qualitative component was a grounded theory study in which 27 purposefully sampled members of the quantitative sample were interviewed about TKA satisfaction. Interviewees tended not to reflect on satisfaction, instead describing their knee’s “adequacy”: how it felt, functioned, and met their expectations. Central to their stories was the process of adapting to the TKA knee; experiences adapting shaped perceptions of adequacy. In the integration component, key concepts from the quantitative and qualitative components were compared using an analytic framework to evaluate how these concepts aligned. Quantitative and qualitative components were confirmatory in finding a relationship between current physical symptoms and lower assessments of satisfaction or adequacy, signalling a need for enhanced clinical support for patients whose symptoms don’t abate. Differences in representations of patient expectations in the two components highlights a need for a standard approach to this concept, with a focus on expectation fulfilment. Instances of non-alignment, where a concept was present in only one component, point to opportunities for future research. The integration analysis found complementarity in the concepts of “satisfaction” and “adequacy.” This suggests potential to reconceptualize satisfaction in ways more resonant with the patient perspective, bringing us closer to measuring—and improving—what matters to patients when assessing the success of TKA surgery.

Text

2024-04-12

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/87778

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/