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Comparison of a validated decision-support tool to a standard of care triage system for knee osteoarthritis assessment. A proof-of-concept study

Study in conjunction with Thunder Bay regional Health Services Authority. Paige Wagar, Simrun Chahal, Rabail Siddiqui, Shalyn Littlefield, Caroline Fanti, Claude Cullinan, Kurt Droll, Travis E. Marion, T. Derek Cooke and David Puscas. Published in Canadian Journal of Surgery May 2023.


Patients with knee osteoarthritis (OA) in Northwestern Ontario (NWO) are referred by their primary care provider (PCP) to a centralized assessment clinic for evaluation by an advanced practice physiotherapist
(APP) to determine if patients require surgical management. However, many assessed patients are
found to not require surgical management, resulting in delays for patients who do. To address this issue, a decision-support tool was developed to guide treatment options by determining the need for surgical or non-surgical approaches.


To assess the use of the decision-support tool in NWO, a proof-of-concept method was used. Data from100 consecutive patients assessed for knee OA management were collected from the Thunder Bay centralized assessment clinic. Two level of agreement (calculated using Cohen’s kappa statistic, 𝜅)
analyses were performed: 1) between the APP assessment decision (surgical or non-surgical) and the
decision-support tool and 2) between surgeon decision (surgical or non-surgical) and the decision
support tool.


A near perfect agreement (𝜅 = 0.870, n = 65) between the APP decision and the decision-support tool
recommendation was found when controlled for patient preference. There was substantial level of
agreement (𝜅 = 0.618, n = 72) between the decision-support tool recommendation and the surgeon


Discussion and Conclusion
The decision-support tool showed significant agreement with APP and surgeon decision indicating that it could be a valuable tool to guide PCPs caring for patients with knee OA. The applicability of a decision support tool in NWO displayed promising results, but further research is needed to examine the
feasibility in a primary care setting.

To read the full article click here.

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