Implementation of the ‘Avon Knee Chart’ shared decision-making tool
Research type
Research Study
Full title
IMPlementation of the ‘Avon Knee chart’ shared decision-making tool (IMPAKt)
IRAS ID
306463
Contact name
Andrew Moore
Contact email
Duration of Study in the UK
0 years, 9 months, 15 days
Research summary
Summary of Research
Osteoarthritis of the knee is an long-term condition that can cause severe pain and disability. Every year, 10% of UK adults go to their family doctor issues related to osteoarthritis. The recommended treatments for osteoarthritis are: information, education, exercise, physiotherapy, weight-loss, and medication. These should be offered before referral for knee replacement surgery. However, there are concerns that knee replacement surgery is overused. There is evidence that referral rates for TKR are higher than the uptake of non-surgical treatments, such as weight loss and exercise.Qualitative studies have found that patients have high expectation they will receive surgery for osteoarthritis of the knee. But that a high number of people are dissatisfied with the results following knee replacement surgery. This is partly due to unrealistically high expectations of treatment outcomes. It has been found that clinicians do not have time to provide up-to-date information on alternatives to surgery, or to discuss patient preferences for treatment.
The Bristol North Somerset and South Gloucestershire Clinical Commissioning Group is introducing a new shared decision-making tool for knee osteoarthritis. The ‘Avon Knee Chart’ aims to ensure patients have access to appropriate treatments at every stage of the disease process.
We will conduct interviews with patients and healthcare professionals to establish whether the Avon Knee Chart is acceptable for these groups. We will explore whether the tool is used as intended, and what the users think of it. The findings from this study will guide improvements to the Avon Knee Chart.Summary of Results
Osteoarthritis (OA) is a common condition that causes pain and disability, especially in the knee. It affects a significant number of people worldwide, including 10% of adults in the United Kingdom. Shared Decision-Making (SDM) is a method that aims to help patients to make the right choice about their treatment by providing clear information about the potential benefits and disadvantages of all of their treatment options. In this study, researchers looked at the experience of a team that adapted an online SDM tool for knee OA for use in a specific region in Southwest England. The tool provides up to date information about treatment options at different stages of the disease, aiming to prepare patients and doctors for SDM.
To understand the team's experience in adapting the SDM tool and its potential for use in the region, the researchers conducted an online survey to gather feedback from clinicians who used the tool and conducted interviews with the health care commissioners, and clinical service leads who were involved in adapting it and preparing it for use (implementation) in the local healthcare system.
The survey involved 23 clinicians, including physiotherapists and general practitioners, while the interviews included eight healthcare commissioners/clinical leads. The participants discussed the challenges and they encountered during the adaptation and implementation process. Barriers included a lack of support and resources for SDM within organizations, low awareness of the tool and buy-in from clinicians, difficulties with accessibility and usability, and the tool not being adapted for underserved communities. Facilitators included the belief of clinical leaders that SDM tools can improve patient outcomes and better use of healthcare resources, as well as positive experiences reported by clinicians who used the tool.
In conclusion, this study revealed the barriers and facilitators associated with adapting and implementing tools in different healthcare settings. We recommend selecting tools for adaptation that have a strong evidence base, including evidence of their effectiveness and acceptability in the original context in which they were used. We also suggest seeking legal advice regarding intellectual property early on in the project and using existing guidance for developing and adapting interventions. Research and healthcare teams should work with end-users, patients and clinicians to improve the accessibility and acceptability of adapted tools.REC name
West of Scotland REC 5
REC reference
21/WS/0163
Date of REC Opinion
22 Dec 2021
REC opinion
Further Information Favourable Opinion