Objectives

To determine the effectiveness of patient decision aids (PtDAs) compared to alternative interventions (including usual care) on decision quality and quality of the decision-making process for adults with hip and knee osteoarthritis considering primary elective total joint arthroplasty.

Methods

A systematic review guided by Cochrane methods and PRISMA reporting guidelines. Studies were searched in five databases. Included studies were RCTs evaluating the effect of PtDAs on total joint arthroplasty decision-making. Study quality was appraised with Cochrane's risk of bias tool. Quality and strength of recommendations were appraised with GRADE.

Results

Ten included studies were conducted in North American using the same PtDA. Compared to usual care, PtDA groups demonstrated increased decision quality (e.g., higher knowledge, more informed values-based choices) and quality of the decision making process (e.g., decreased decisional conflict) (6 trials). Secondary outcomes showed increased surgeon satisfaction within the consultation and no difference in patient satisfaction or uptake of the chosen option (surgery: RR 1.03, 95% CI = 0.84 to 1.25; I² = 66%; 4 trials). When PtDAs formtats were compared, there were similar effects but no difference between PtDAs (4 trials).

Conclusions

There was low to very low GRADE certainty of evidence for the effect of PtDAs on decision quality and quality of the decision-making process compared to usual care. No differences were found when different formats of PtDAs were compared (moderate to very low GRADE certainty of evidence).

中文翻译：

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患者决策辅助对全髋关节和膝关节置换术决策的有效性：系统评价

目标

确定患者决策辅助 (PtDA) 与替代干预措施（包括常规护理）相比对考虑初次选择性全关节置换术的成年髋膝骨关节炎患者决策质量和决策过程质量的有效性。

方法

由 Cochrane 方法和 PRISMA 报告指南指导的系统评价。在五个数据库中检索了研究。纳入的研究是评估 PtDAs 对全关节置换术决策影响的随机对照试验。使用 Cochrane 的偏倚风险工具评估研究质量。建议的质量和强度使用 GRADE 进行评估。

结果

在北美使用相同的 PtDA 进行了 10 项纳入研究。与常规护理相比，PtDA 组表现出更高的决策质量（例如，更高的知识、更明智的基于价值观的选择）和决策过程的质量（例如，减少的决策冲突）（6 项试验）。次要结果显示外科医生在咨询过程中的满意度有所提高，而患者满意度或对所选选项的接受程度没有差异（手术：RR 1.03，95% CI = 0.84 至 1.25；I ²  = 66%；4 项试验）。当比较 PtDAs 形式时，有相似的效果，但 PtDAs 之间没有差异（4 次试验）。

结论

与常规护理相比，PtDA 对决策质量和决策过程质量的影响的证据等级确定性从低到非常低。比较不同格式的 PtDA 时未发现差异（中等至极低 GRADE 证据确定性）。