A Randomized Controlled Trial to Establish Realistic Patient Expectations Following Total Knee Replacement Surgery

Objectives: To evaluate whether e-learning videos can affect whether patients felt their expectations were met and were satisfied with surgery 1 year following primary total knee replacement (TKR) (Chapter 3). In Chapter 4, we described characteristics of users and utilization patterns of the e-learning tool. In Chapter 5, we evaluated the internal consistency and construct validity of the new Knee Society Knee Scoring System (KSS) in a sample of TKR patients. Methods: We recruited consecutive patients with osteoarthritis from the London Health Sciences Centre, Ontario, Canada (Chapter 3). We randomized patients with osteoarthritis to either control (n=207) they received our standard patient education, or intervention (n=209) they had access to the e-learning tool in addition to our standard patient education (Chapter 4). In Chapter 5 we pooled the RCT data to evaluate the measurement properties of the new KSS. We calculated the associations between KSS and Knee Injury and Osteoarthritis Outcome Score subscales to evaluate cross-sectional and longitudinal validity and divided patients into tertiles according to their Physical Component Score on the SF-12 and compared those scores to the scores on the KSS to determine known-groups validity. We also divided patients by their rating of pre- and post-operative expectations and compared their responses to those on the pre- and post-operative expectations scores of the KSS. Results: There was no statistically significant difference between groups for expectations, RD=1.3% (95% CI -7.8% to 10.4%, p=0.78) or satisfaction, RD=0.6% (95% CI -8.4% to 9.6%, p=0.78) (Chapter 3). In Chapter 4 we found baseline characteristics of e-learning users were no different than nonusers and use of the tool was highest pre-operatively. Finally, surgeon videos that included content about expectations of surgery were most frequently viewed videos, pre- and post-operatively. In Chapter 5 we demonstrated the internal reliability, cross-sectional, longitudinal and known-groups validity of the KSS. Conclusions: In Chapter 3, we failed to demonstrate the effectiveness of an e-learning tool and showed, in Chapter 4, a reduction in use of the tool over time. In Chapter 5 we provided evidence of the measurement properties of the new KSS, which was used throughout this thesis