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Bryan S, Goldsmith LJ, Suryaprakash N, Sawatzky R, Mulldoon M, Le Mercier M, Moorthy D, Gandhi R, Bains SK, Li LC, Doyle-Waters M, Brown S. A research agenda to improve patients' experience of knee replacement surgery: a patient-oriented modified Delphi study of patients of South Asian origin in British Columbia. CMAJ Open 2020; 8:E226-E233. [PMID: 32220875 PMCID: PMC7124165 DOI: 10.9778/cmajo.20190128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Up to 1 in 5 patients who undergo total knee arthroplasty (TKA) express dissatisfaction with their surgery. Our goal was to understand the experiences of patients of South Asian origin who undergo TKA and to identify a research agenda for this patient population. METHODS We undertook a modified Delphi study in British Columbia to generate and prioritize potential research topics. An initial list of topics was generated using 3 focus groups with patients of South Asian origin who underwent TKA and their caregivers. Focus group sessions were audiotaped and transcribed, and the data were analyzed using thematic analysis. The resulting Delphi question-naire was administered over 2 rounds to patients, caregivers and health professionals. The second-round questionnaire included only topics that were strongly supported in the first round. A patient-oriented approach was adopted, with 3 patient partners as full research team members, who contributed to scoping, design, data collection, analysis and interpretation. RESULTS Twenty-one patients who had undergone TKA and 6 caregivers attended the focus groups. Our analyses resulted in 6 broad themes and 25 research topics, all of which were presented in the first round of the Delphi survey. The survey was completed by 27 patients and 5 caregivers (54% combined response rate) and by 25 clinicians (76% response rate). Top priorities both for patients and caregivers and for clinicians were promoting exercise following surgery and self-management after hospital discharge. One of the highest ranked topics for patients and caregivers was improving knee implants; this was supported by only 60% of clinicians. INTERPRETATION The patients and caregivers in our study prioritized research on promotion of exercise and self-management following surgery and improvement in knee implants. Future patient-oriented research efforts in Canada should emphasize these topics for this patient population.
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Affiliation(s)
- Stirling Bryan
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Laurie J Goldsmith
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Nitya Suryaprakash
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Richard Sawatzky
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Marilyn Mulldoon
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Moira Le Mercier
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - David Moorthy
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Rajiv Gandhi
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Satwinder Kaur Bains
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Linda C Li
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Mary Doyle-Waters
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Sean Brown
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
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