Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Bryant, Dianne

2nd Supervisor

Giffin, J Robert.



Purpose: The non-operative management of patients with knee osteoarthritis (OA) is often considered suboptimal. Sub-optimal management includes inadequate use of non-surgical treatments, misuse of diagnostic imaging, and non-operative referrals to surgeons in consideration of total knee replacement (TKR). These inefficiencies result from an interplay of factors involving primary care physicians, patients, and the systems in which they function. The overall purpose of this thesis is to develop a means to optimize the management of patients with knee OA, and the timing and quality of referrals to TKR.

Methods: This thesis includes three studies. In study 1, we identified and cross-validated patient self-reported predictors of being scheduled for TKR using multivariate logistic regression (Chapter two). We followed this work by creating five educational whiteboard videos for patients with knee OA to encourage responsible use of health care resources and guide decision making regarding primary care and operative management. In study 2, we conducted a mixed methods evaluation of our videos using a qualitative descriptive approach. We conducted in-depth semi-structured interviews with patients to garner patients' experiences and perspectives regarding interacting with the videos (Chapter three). In study 3, we conducted a qualitative descriptive investigation of physicians’ perspectives regarding our education videos (Chapter four).

Results: In study 1 (n=406), patients’ willingness to undergo surgery, having greater pain, worse physical function, having tried injections, and older age were predictive of being offered and electing to undergo TKR. At its optimal efficiency, this model can reduce the proportion of non-operative referrals made to a surgeon from 45% to 25%, while identifying the vast majority of surgical candidates (>90%). In study 2, participants (n=13) felt that the videos enhanced their confidence and clarity about their decision to undergo TKR and addressed knowledge gaps in their understanding. Our findings suggest that educating patients regarding best practice may improve the quality of OA management. In study 3, physicians (n=10) indicated interest in using our education videos to support patient buy-in regarding appropriate management, enhance patient understanding, and felt that the videos would improve their own practice.

Conclusion: A web-based platform including resources informed by our predictive model and our educational videos will educate and guide referring clinicians and patients to understand appropriate management of knee OA including when specialist consultation is the appropriate next step. A consorted effort between primary care physicians, the patient and surgeons will create huge efficiencies toward the management of this growing population.

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