High and low value care recommended and undertaken prior to knee or hip arthroplasty: A survey study

Introduction: Interventions for osteoarthritis (OA) vary widely in value. Currently, appointment attendance, audits and practitioner surveys are used to determine which interventions are recommended prior to arthroplasty. The patient perspective is missing from this evidence base. Objective: To describe the prevalence of high and low value care being recommended and undertaken by individuals awaiting OA-related lower limb arthroplasty. To examine sociodemographic or disease-related variables associated with being recommended different levels of care. Methods: : A cross-sectional survey of 339 individuals was conducted in metropolitan and regional hospitals and surgeon consultation rooms. Along with demographic and disease-related questions, respondents were asked what intervention they were recommended by healthcare practitioners, or other sources of information, and what they had undertaken within two years prior to hip or knee arthroplasty. Results: Simple analgesics were most frequently recommended (68% [62.9 to 73.1). 24.8% [20.2 to 29.7] of respondents were recommended high value care only. 75.2% [70.2 to 79.7] of respondents were recommended at least one low value intervention. Respondents awaiting hip arthroplasty, living regionally and without private health insurance had greater odds of recommended rather than core interventions being advised. Conclusion: The prevalence of recommendations and uptake of high value care appears to be increasing. In most cases they are combined with recommendations for low value care. From a patient’s perspective, disease-related and sociodemographic variables influence the level of care recommended.