Doctor of Philosophy
Health and Rehabilitation Sciences
Dr. Bert Chesworth
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.
Culliton, Sharon E., "A Randomized Controlled Trial to Establish Realistic Patient Expectations Following Total Knee Replacement Surgery" (2016). Electronic Thesis and Dissertation Repository. 4268.