School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada.
BMC Musculoskelet Disord. 2022 Sep 6;23(1):845. doi: 10.1186/s12891-022-05695-x.
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.
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.
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.
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.
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.
全球范围内，全膝关节置换术（TKA）的数量呈上升趋势，这反映了人口老龄化、骨关节炎治疗的增加以及提高生活质量的愿望。有证据表明，高达 15%至 20%的患者对 TKA 结果不满意，因此需要努力提高这些比例。本研究旨在确定患者在反思 TKA 满意度时认为重要的因素，为确定服务转型机会铺平道路，这些机会将增强以患者为中心的护理和对该手术的满意度。
在加拿大不列颠哥伦比亚省招募了 27 名 TKA 接受者。对参与者在手术后三到四年内对 TKA 体验和满意度的半结构化访谈进行了分析。采用扎根理论分析参与者对新膝关节满意度的思考中浮现的内容。
参与者用其术后膝关节的适宜性来描述新膝关节：感觉和功能如何，以及如何与他们术前的期望相匹配。他们的故事的核心要素是适应过程，这导致了他们对适宜性的认知。适应包括患者身体融入和认知接受新膝关节的过程。适应模式反映了新膝关节达到的适宜性水平和适应过程的简单程度。
适宜性的概念化和适应过程使人们能够从以患者为中心的角度理解患者在接受 TKA 后的体验。对于那些没有轻易达到预期适宜性的参与者，他们在适应过程中遇到的挑战主导了他们的故事。参与者的适应故事提供了关键的见解，了解医疗保健系统如何进行调整以更好地支持 TKA 患者，并提高对该手术的满意度。
适应过程本身就可以进行系统干预，以支持增强 TKA 术后的结果和满意度。这些干预措施可能包括制定一种护理模式，包括为那些膝关节未按计划达到预期结果的患者提供长期临床支持，以及与患者合作，设定和管理他们对术后膝关节的感觉和功能的合理期望。
