Factors Associated With Patients' Willingness to Consider Joint Surgery After Completion of a Digital Osteoarthritis Treatment Program: A Prospective Cohort Study

Arthritis Care Res (Hoboken). 2019 Sep;71(9):1194-1201. doi: 10.1002/acr.23772. Epub 2019 Jul 17.


Objective: To examine patient willingness and a possible shift in willingness for surgery and to investigate factors associated with this shift, following participation in the digital nonsurgical osteoarthritis (OA) treatment program Joint Academy.

Methods: A total of 458 individuals (mean ± SD age 62 ± 5.6 years, 67% women) with diagnosed hip or knee OA were evaluated after 6 weeks in the Joint Academy program, comprising education and exercise as well as asynchronous chat with a physical therapist. Data describing joint pain, health-related quality of life (the EuroQol 5-domain [EQ-5D] questionnaire in 3 levels), walking difficulties, the 30-second chair stand test, and willingness to consider surgery were collected at baseline and at 6 weeks.

Results: At follow-up, 31% of those participants willing to consider surgery at baseline no longer considered surgery. Of those participants who were unwilling to consider surgery at baseline, 6% reconsidered and decided in favor of surgery at follow-up. Less pain and a higher EQ-5D score at 6 weeks were associated with the change from being willing to unwilling to consider surgery at follow-up (odds ratio [OR] 0.67-1.64; P < 0.05). Worse pain, a lower EQ-5D score, and having walking difficulties at 6 weeks, and a lower pain and EQ-5D score improvement were associated with the change from being unwilling to willing to consider surgery at 6 weeks (OR 0.51-4.30; P < 0.005).

Conclusion: Evidence-based nonsurgical OA treatment, at least delivered in a digital format, may reduce the need for surgery and should therefore be offered as the first-line treatment option to patients with hip and knee OA. The results also support the idea that such treatment programs have the potential to improve selection of patients for total joint replacement.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Cohort Studies
  • Computer-Assisted Instruction / methods*
  • Decision Making, Shared
  • Female
  • Follow-Up Studies
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / rehabilitation*
  • Osteoarthritis, Hip / surgery
  • Osteoarthritis, Knee / rehabilitation*
  • Osteoarthritis, Knee / surgery
  • Patient Compliance / statistics & numerical data*
  • Patient Education as Topic / organization & administration
  • Preoperative Care / methods
  • Program Evaluation
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Surveys and Questionnaires*
  • Treatment Outcome