The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation.
Total knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature.



We report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals' knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders.



Participants' descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves.



Patient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients' TKA experience.
Faculty of Health Sciences, Simon Fraser University, Blusson Hall 10506, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. laurie_goldsmith@sfu.ca.
Laurie J
LJ
Goldsmith
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
Nitya
N
Suryaprakash
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.|School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
Ellen
E
Randall
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.|Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, 10th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
Jessica
J
Shum
Burnaby Hospital & Surgical Network, Fraser Health, 3935 Kincaid Street, Burnaby, BC, V5K 2X6, Canada.
Valerie
V
MacDonald
School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.|Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Richard
R
Sawatzky
Department of Evaluation and Research Service, Fraser Health, Suite 400, Central City Tower, 13450 102 Avenue, Surrey, BC, V3T 0H1, Canada.
Samar
S
Hejazi
Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.|Aging, Mobility, and Cognitive Neurosciences Lab, University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
Jennifer C
JC
Davis
Rebalance MD, 104-3551 Blanshard Street, Victoria, BC, V8Z 0B9, Canada.
Patrick
P
McAllister
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.|School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
Stirling
S
Bryan
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D012944:Social Support
Patient experience; Patient-centred care; Qualitative research; Support; Total knee arthroplasty