Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 5 (2), e17

A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design


A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design

Hua Zheng et al. JMIR Hum Factors.


Background: Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery.

Objective: The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults.

Methods: User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants' responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods.

Results: Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra "next page" click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status.

Conclusions: We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients' use.

Keywords: knee osteoarthritis; outcome prediction; patient decision support; total knee replacement; usability evaluation.

Conflict of interest statement

Conflicts of Interest: None declared.


Figure 1
Figure 1
Questionnaire recording patients’ buttons preferences.
Figure 2
Figure 2
Distribution of the time spent on each page of the tool.
Figure 3
Figure 3
Computer System Usability Questionnaire item scores.

Similar articles

See all similar articles

Cited by 4 PubMed Central articles


    1. United States Bone and Joint Initiative . The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Cost. 3rd edition. Rosemont, IL: United States Bone and Joint Initiative; 2015.
    1. Williams SN, Wolford ML, Bercovitz A. National Center for Health Statistics, Centers for Disease Control and Prevention. 2015. Aug, [2018-04-11]. NCHS Data Brief, no 210: Hospitalization for total knee replacement among inpatients aged 45 and over: United States, 2000-2010 .
    1. Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Bélisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, Tanzer M, Sledge C, Fossel AH, Katz JN. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002 Dec;46(12):3327–3330. doi: 10.1002/art.10631. doi: 10.1002/art.10631. - DOI - DOI - PubMed
    1. Hudak PL, Clark JP, Hawker GA, Coyte PC, Mahomed NN, Kreder HJ, Wright JG. “You're perfect for the procedure! Why don't you want it?” Elderly arthritis patients' unwillingness to consider total joint arthroplasty surgery: a qualitative study. Med Decis Making. 2002;22(3):272–278. doi: 10.1177/0272989X0202200315. - DOI - PubMed
    1. Adam JA, Khaw F, Thomson RG, Gregg PJ, Llewellyn-Thomas HA. Patient decision aids in joint replacement surgery: a literature review and an opinion survey of consultant orthopaedic surgeons. Ann R Coll Surg Engl. 2008 Apr;90(3):198–207. doi: 10.1308/003588408X285748. - DOI - PMC - PubMed

LinkOut - more resources