改善膝关节置换手术患者体验的研究议程：一项针对不列颠哥伦比亚省南亚裔患者的以患者为导向的改良德尔菲研究。
A research agenda to improve patients' experience of knee replacement surgery: a patient-oriented modified Delphi study of patients of South Asian origin in British Columbia.
作者信息
Bryan Stirling, Goldsmith Laurie J, Suryaprakash Nitya, Sawatzky Richard, Mulldoon Marilyn, Le Mercier Moira, Moorthy David, Gandhi Rajiv, Bains Satwinder Kaur, Li Linda C, Doyle-Waters Mary, Brown Sean
机构信息
School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC.
出版信息
CMAJ Open. 2020 Mar 27;8(1):E226-E233. doi: 10.9778/cmajo.20190128. Print 2020 Jan-Mar.
BACKGROUND
Up to 1 in 5 patients who undergo total knee arthroplasty (TKA) express dissatisfaction with their surgery. Our goal was to understand the experiences of patients of South Asian origin who undergo TKA and to identify a research agenda for this patient population.
METHODS
We undertook a modified Delphi study in British Columbia to generate and prioritize potential research topics. An initial list of topics was generated using 3 focus groups with patients of South Asian origin who underwent TKA and their caregivers. Focus group sessions were audiotaped and transcribed, and the data were analyzed using thematic analysis. The resulting Delphi question-naire was administered over 2 rounds to patients, caregivers and health professionals. The second-round questionnaire included only topics that were strongly supported in the first round. A patient-oriented approach was adopted, with 3 patient partners as full research team members, who contributed to scoping, design, data collection, analysis and interpretation.
RESULTS
Twenty-one patients who had undergone TKA and 6 caregivers attended the focus groups. Our analyses resulted in 6 broad themes and 25 research topics, all of which were presented in the first round of the Delphi survey. The survey was completed by 27 patients and 5 caregivers (54% combined response rate) and by 25 clinicians (76% response rate). Top priorities both for patients and caregivers and for clinicians were promoting exercise following surgery and self-management after hospital discharge. One of the highest ranked topics for patients and caregivers was improving knee implants; this was supported by only 60% of clinicians.
INTERPRETATION
The patients and caregivers in our study prioritized research on promotion of exercise and self-management following surgery and improvement in knee implants. Future patient-oriented research efforts in Canada should emphasize these topics for this patient population.
背景
接受全膝关节置换术（TKA）的患者中，多达五分之一对手术表示不满。我们的目标是了解接受TKA的南亚裔患者的经历，并确定针对这一患者群体的研究议程。
方法
我们在不列颠哥伦比亚省进行了一项改良的德尔菲研究，以生成潜在研究主题并确定其优先级。通过与接受TKA的南亚裔患者及其护理人员进行3次焦点小组讨论，生成了初始主题列表。焦点小组会议进行了录音和转录，并使用主题分析对数据进行了分析。由此产生的德尔菲问卷分两轮发给患者、护理人员和卫生专业人员。第二轮问卷仅包括在第一轮中得到大力支持的主题。采用了以患者为导向的方法，有3名患者合作伙伴作为完整的研究团队成员，他们参与了范围界定、设计、数据收集、分析和解释工作。
结果
21名接受过TKA的患者和6名护理人员参加了焦点小组讨论。我们的分析得出了6个广泛的主题和25个研究课题，所有这些都在德尔菲调查的第一轮中呈现。该调查由27名患者和5名护理人员（综合回复率54%）以及25名临床医生（回复率76%）完成。患者和护理人员以及临床医生的首要任务都是促进术后锻炼和出院后的自我管理。患者和护理人员排名最高的主题之一是改进膝关节植入物；只有60%的临床医生支持这一点。
解读
我们研究中的患者和护理人员将术后锻炼促进、自我管理以及膝关节植入物改进方面的研究列为优先事项。加拿大未来以患者为导向的研究工作应针对这一患者群体强调这些主题。
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