University of Western Ontario - Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Dr. Dianne Bryant


Objectives: To determine the feasibility, effectiveness, costs and satisfaction involved with a web-based assessment following total joint arthroplasty compared to the usual method of in-person assessment.

Methods: We determined agreement between electronic and paper versions of the WOMAC and SF-12 questionnaires (Chapter 2). We randomized patients who were at least 12 months post-operative to complete a web-based follow-up or to have their appointment at the clinic. We recorded travel distances, costs, and time involved with each appointment. We report the frequency of web-based patients who: 1) indicated they were having problems, 2) had an identified radiographic issue, 3) the surgeon felt actually had a significant issue, and 4) the surgeon felt an issue was missed by using the web-based follow-up (Chapter 3). All patients completed a satisfaction questionnaire, and patients in the web-based group were invited to take part in a focus group session (Chapter 4).

Results: The intraclass correlation coefficient (ICC) values for the WOMAC and the SF-12 were high, indicating excellent agreement (WOMAC ICC=0.96, 95% CI 0.94 to 0.98), SF-12(PCS) ICC=0.95, 95% CI 0.92 to 0.97; SF-12(MCS) ICC=0.92, 95%CI 0.86 to 0.95) (Chapter 2). A total of 229 patients (118 Web, 111 Usual) completed the web-based study. Patients in the web-based group travelled less (28.2 vs 103.7 km, (p

Twenty-five patients reported that they were having problems, of which eight (32%) were considered to actually have a significant issue. There were no patients who the surgeon felt had issues that were missed by the web-based follow-up (Chapter 3). Patients were satisfied with the web-based follow-up (29% extremely satisfied, 36.6% very satisfied, 20.4% somewhat satisfied). Forty-four percent of patients preferred the web-based method, 36% preferred the usual follow-up in person at the clinic, and 16% had no preference (Chapter 4).

Conclusions: Web-based follow-up assessment is a feasible, clinically effective and cost saving means of tracking patient outcomes following total joint arthroplasy.

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