![]() ![]() Joint-replacement surgery is a common treatment for OA, and >1 000 000 hip and knee replacements are performed annually in the United States. A significant percentage of patients with OA (40%) report that their overall health is only “fair” or “poor.” 2 Studies have also found that adults with OA have higher age- and sex-adjusted rates of death from all causes, cardiovascular deaths, and dementia deaths (1.6, 1.7, and 2.0 times higher, respectively) compared with the general population. More than 30 million US adults aged ≥65 years have OA, 1 and the majority report at least some degree of limitation. Osteoarthritis (OA) is a leading cause of disability in the United States and a growing public health problem. Osteoarthritis: a Common and Debilitating Disease The IPC decision was not associated with a difference for hip symptoms (mean diff = 1.2 points P =. 004) than did those who did not make an IPC decision. 001) and knee symptoms (mean diff = 4.9 points P =. Patients who made an IPC decision had a significantly greater improvement in overall health (mean difference = 0.04 points P <. Surgeons were highly satisfied and reported that the majority (88.7%) of visits were normal or shorter than normal. More than half of the sample (60.1%) had surgery within 6 months of the visit, and rates did not differ significantly by PDA (62.5% long vs 57.6% short mean diff = 5.0% 95% CI, −0.4% to 10.4%]) or surgeon (59.7% usual care vs 60.5% intervention mean diff = −0.8% 95% CI, −13.7% to 8.0%) groups. ![]() Knowledge scores were higher for the short PDA (mean = 73.1% long PDA vs 81.9% short PDA mean diff = 8.8% 95% CI, 6.0%-11.6%). The majority made IPC decisions (67.4%), and these rates did not vary significantly across PDAs (67.1% long vs 67.3% short mean difference = −0.2% 95% CI, −6.6% to 6.4%) or surgeon groups (67.0% usual care vs 67.3% intervention mean diff = −0.3% 95% CI, −6.9% to 6.4%). On average, the patient sample was aged 65 years (SD, 10 years), female (57%), and White, non-Hispanic (91%), with knee OA (67%). We received 967 of 1124 postvisit surveys and 924 of 1119 follow-up surveys (86% and 83% response rate, respectively). In total, 1124 patients were eligible for the study and consented to join. Planned subgroup analyses examined patient-, surgeon-, and intervention-level (eg, usage) factors on outcomes. No interaction effect was detected between the patient and surgeon interventions thus, groups were collapsed for analyses. Linear or logistic regression models were used with the generalized estimating equations approach to account for the clustering of patients within surgeons, as appropriate. ![]() Patient-reported outcomes included overall quality of life (assessed using the EuroQol-5D), knee symptoms (assessed using the Knee Injury and Osteoarthritis Outcome Score), and hip symptoms (assessed using the Harris Hip Score). ![]() Key secondary outcomes included knowledge, concordance of patients' preferred treatment and treatment received, and SDM. The primary outcome was the proportion of IPC decisions. Surgeons completed a short survey on 30% of their study patients after the visit. Patients received the assigned PDA to review at home before their visit with the surgeon and completed 3 surveys: previsit (before their surgeon visit), postvisit (about 1 week after the visit), and follow-up (about 6 months after treatment). We used a 2 × 2 factorial randomized trial at 3 sites to randomly assign surgeons to receive the patient preference report or usual care, and then randomly assigned patients to receive the short PDA or long PDA. ![]()
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