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Willingness for surgery and health-related quality of life after six months in a digital osteoarthritis self-management program

      Purpose: To investigate the change in willingness to undergo surgery and in health-related quality of life in those participating in a digital first-line osteoarthritis self-management program during six months.
      Methods: Data on people with hip- or knee osteoarthritis, having participated in a digital self-management program for 6 months and reporting whether they experienced symptoms so severe they wanted to undergo joint surgery (dichotomous reply, yes/no), was extracted from the Joint Academy® patient registry. Reported willingness and the change over time was analyzed together with EQ5D-5L data. Individuals were separated into two groups, those willing to undergo surgery at baseline and then changing their mind (YES-NO), and those willing at baseline and still willing to undergo surgery at 6 months (YES-YES). Demographic data and frequency of response for each level of dimension from the EQ5D-5L per group was calculated. The Mann-Whitney U test was performed to investigate whether the distributions of levels in each dimension of EQ5D-5L were the same between groups, at baseline and at 6 months. Ethical approval was received from the regional ethics committee of Lund University and the Swedish Ethical Review Authority (Dnr: 2018/650 and 2019-02232).
      Results: A total of 1073 individuals answered the question on willingness for surgery at baseline and at 6 months. Of these, 200 individuals reported willingness for surgery at baseline. At 6 months, 94 individuals (47%) reported they did no longer have a need for surgery, whilst 106 (53%) individuals were still willing to undergo surgery (Table 1). Of those unwilling at baseline, 8% reported willingness for surgery after 6 months. The Mann Whitney U-test indicated that at baseline the distribution of frequencies was similar for the two groups (YES-YES and YES-no) for the EQ5D-5L dimensions Pain/Discomfort, Usual Activities and Anxiety/Depression, whilst showing statistically significant worse responses for Mobility (p=0.04) and Self Care (p=0.03) for those still willing to have surgery after 6 months (YES-YES). At 6 months, there were differences in all dimensions between the two groups, and the distribution of frequencies indicated greater health-related quality of life in the YES-NO group.For the YES-YES group, there was a statistically significant difference in Self Care at baseline and at 6 months, and Pain / Discomfort at 6 months, between participants with knee- and hip OA. For the YES-NO group, there was a statistically significant difference in Self Care at baseline only, between knee- and hip OA participants. Conclusions: Previous research has shown that the percentage of patients with hip- and knee osteoarthritis willing to undergo surgery decreased by 31% after 6 weeks of participation in a digital osteoarthritis self-management program. In this unique study, where individuals with knee or hip osteoarthritis have adhered to a digital treatment program for 6 months, results suggest that with increased treatment adherence time the proportion of ‘no longer willing’ increases. Thus, the potential to avoid or delay total joint replacement may increase with increased participation time, and patient selection for total joint replacement may be facilitated. In addition, change in willingness from yes to no was associated with improvement in health-related quality of life during participation in the digital self-management program.
      Table 1. Demographic data in means, frequency or percentage, per willingness-group.
      CharacteristicYES-NO (n=94)YES-YES (n=106)
      Age (SD)62.4 (9.5)62.2 (7.3)
      Female, n (%)70 (75)82 (77)
      Knee OA, n (%)64 (68)54 (51)
      Adherence, % (SD)72 (23)71 (23)
      BMI (SD)28 (6)29 (6)
      Baseline pain (SD)6.3 (1.7)6.7 (1.4)
      6 month pain (SD)3.3 (2.0)5.3 (2.1)