title: Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial.
abstract: Undiagnosed, or diagnosed and untreated osteoporosis (OP) increases the likelihood that falls result in hip fractures, decreased quality of life (QOL), and significant medical expenditures among older adults. We tested whether a tailored dual energy x-ray absorptiometry (DXA) test result letter and an accompanying educational bone-health brochure affected patient satisfaction, QOL, or OP knowledge.
  
  
  
  The Patient Activation after DXA Result Notification (PAADRN) study was a double-blinded, pragmatic, randomized trial which enrolled patients from 2012 to 2014. We randomized 7,749 patients presenting for DXA at three health care institutions in the United States who were ≥ 50 years old and able to understand English. Intervention patients received a tailored letter four weeks after DXA containing their results, 10-year fracture risk, and a bone-health educational brochure. Control patients received the results of their DXA per the usual practices of their providers and institutions. Satisfaction with bone health care, QOL, and OP knowledge were assessed at baseline and 12- and 52-weeks after DXA. Intention-to-treat analyses used multiple imputation for missing data and random effects regression models to adjust for clustering within providers and covariates.
  
  
  
  At 12-weeks 6,728 (86.8 %) and at 52-weeks 6,103 participants (78.8 %) completed their follow-up interviews. The intervention group was more satisfied with their bone health care compared to the usual care group at both their 12- and 52-week follow-ups (standardized effect size = 0.28 at 12-weeks and 0.17 at 52-weeks, p < 0.001). There were no differences between the intervention and usual care groups in QOL or OP knowledge at either time point.
  
  
  
  A tailored DXA result letter and bone-health educational brochure sent to patients improved patient satisfaction with bone-related health care.
  
  
  
  Clinical Trials.gov Identifier: NCT01507662 First received: December 8, 2011.
authors: Carver College of Medicine, Department of Internal Medicine, University of Iowa, 5231 Westlawn, IA 52242, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.|College of Nursing, University of Iowa, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.
authors: Stephanie W
authors: SW
authors: Edmonds
authors: Department of Medicine, University of Toronto Division of General Internal Medicine, Toronto, ON, Canada.|University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
authors: Peter
authors: P
authors: Cram
authors: College of Public Health, Department of Biostatistics, University of Iowa, Iowa City, IA, USA.
authors: Yiyue
authors: Y
authors: Lou
authors: College of Public Health, Department of Biostatistics, University of Iowa, Iowa City, IA, USA.|Iowa City Veterans Affairs Health System, Iowa City, IA, USA.
authors: Michael P
authors: MP
authors: Jones
authors: Kaiser Permanente, Atlanta, GA, USA.|School of Public Health, Department of Health Management and Policy, Georgia State University, Atlanta, GA, USA.
authors: Douglas W
authors: DW
authors: Roblin
authors: Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Kenneth G
authors: KG
authors: Saag
authors: School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Nicole C
authors: NC
authors: Wright
authors: Carver College of Medicine, Department of Internal Medicine, University of Iowa, 5231 Westlawn, IA 52242, Iowa City, IA, USA.|College of Nursing, University of Iowa, Iowa City, IA, USA.|College of Public Health, Department of Health Management and Policy, University of Iowa, Iowa, IA, USA.
authors: Fredric D
authors: FD
authors: Wolinsky
mesh_terms: D015502:Absorptiometry, Photon; D000058:Accidental Falls / Q000517:prevention & control; D000367:Age Factors; D000368:Aged; D015519:Bone Density; D004311:Double-Blind Method; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D010174:Pamphlets; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011788:Quality of Life; D012307:Risk Factors; D057566:Self Report; D013689:Telephone; D014481:United States
keywords: Dual-energy x-ray absorptiometry; Health education; Osteoporosis; Quality of health care; Quality of life