Patient and Clinician Perceptions of a Clinical Decision Support Tool for Personalized Rehabilitation after Total Knee Arthroplasty: A Qualitative Interview Study

Abstract

AbstractObjectiveWe developed a clinical decision support tool to help physical therapists (PTs) address the varied expectations and recoveries of the total knee arthroplasty (TKA) population. The tool uses a “people-like-me” algorithm to predict recovery after TKA. The purpose of this study was to explore patients’ and clinicians’ perceptions and experiences with the tool during rehabilitation after TKA.MethodsWe piloted the tool in 2 outpatient physical therapy clinics. We conducted in-depth semi-structured interviews with 1) patients who underwent TKA and were exposed to the tool during rehabilitation and 2) clinicians who used the tool with patients after TKA. Two members of the research team coded the interview data using a descriptive content analysis.Results16 patients and 10 clinicians were interviewed.We identified 4 common themes: 1) Expectations: most patients and clinicians felt the tool provided patients with valuable feedback for managing recovery expectations; 2) Motivation: patients and clinicians felt the tool motivated patients to participate in rehabilitation by providing positive reinforcement and/or a form of competition; 3) Influence on practice: some patients and clinicians indicated that the tool helped guide treatment decisions or provided opportunities for patient education, but most felt it did not influence clinical decision making; and 4) Clarity and comprehension: the majority of patients understood the tool’s “take-home” message, however, some patients and clinicians felt the use of percentiles, line graphs, and medical jargon decreased patients’ clarity and comprehension of the tool.ConclusionsOverall, participants reported that the tool helped to shape patients’ expectations for postoperative recovery and increase patient motivation to participate in rehabilitation. Participants had mixed perceptions on how the tool influenced clinical care. Finally, participants identified some limitations in patient comprehension of the tool, which will inform future revisions to the tool to accommodate varying levels of health literacy.