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J Knee Surg 2023; 36(14): 1405-1412
DOI: 10.1055/a-2154-9065
Special Focus Section

Patient Adherence Following Knee Surgery: Evidence-Based Practices to Equip Patients for Success

Kylee Rucinski 
1   Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
2   Thompson Laboratory for Regenerative Orthopedics, University of Missouri System, Columbia, Missouri
,
Abdoulie Njai
1   Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
,
Renée Stucky
1   Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
,
Cory R. Crecelius
1   Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
,
James L. Cook
1   Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
2   Thompson Laboratory for Regenerative Orthopedics, University of Missouri System, Columbia, Missouri
› Author Affiliations Funding None.
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Abstract

Patient adherence with postoperative wound care, activity restrictions, rehabilitation, medication, and follow-up protocols is paramount to achieving optimal outcomes following knee surgery. However, the ability to adhere to prescribed postoperative protocols is dependent on multiple factors both in and out of the patient's control. The goals of this review article are (1) to outline key factors contributing to patient nonadherence with treatment protocols following knee surgery and (2) to synthesize current management strategies and tools for optimizing patient adherence in order to facilitate efficient and effective implementation by orthopaedic health care teams. Patient adherence is commonly impacted by both modifiable and nonmodifiable factors, including health literacy, social determinants of health, patient fear/stigma associated with nonadherence, surgical indication (elective vs. traumatic), and distrust of physicians or the health care system. In addition, health care team factors, such as poor communication strategies or failure to follow internal protocols, and health system factors, such as prior authorization delays, staffing shortages, or complex record management systems, impact patient's ability to be adherent. Because the majority of factors found to impact patient adherence are nonmodifiable, it is paramount that health care teams adjust to better equip patients for success. For health care teams to successfully optimize patient adherence, focus should be paid to education strategies, individualized protocols that consider patient enablers and barriers to adherence, and consistent communication methodologies for both team and patient-facing communication.

Keywords

adherence - knee surgery - integrated care - knee pain


Publication History

Received: 31 July 2023

Accepted: 15 August 2023

Accepted Manuscript online:
16 August 2023

Article published online:
08 September 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Aronson JK. Compliance, concordance, adherence. Br J Clin Pharmacol 2007; 63 (04) 383-384
    CrossrefPubMedGoogle Scholar
  • 2 Anghel LA, Farcas AM, Oprean RN. An overview of the common methods used to measure treatment adherence. Med Pharm Rep 2019; 92 (02) 117-122
    PubMedGoogle Scholar
  • 3 World Health Organization (WHO). Adherence to Long-Term Therapies: Evidence for Action. Accessed November 4, 2020 at: http://www.who.int/chp/knowledge/publications/adherence_report/en/
    PubMedGoogle Scholar
  • 4 Avilucea FR, Szalay EA, Bosch PP, Sweet KR, Schwend RM. Effect of cultural factors on outcome of Ponseti treatment of clubfeet in rural America. J Bone Joint Surg Am 2009; 91 (03) 530-540
    CrossrefPubMedGoogle Scholar
  • 5 Layon DR, Johns WL, Morrell AT. et al. Does adherence to preoperative surgical selection criteria reduce the rate of prosthetic joint infection in primary and revision total knee arthroplasties?. Arthroplast Today 2020; 6 (03) 410-413
    CrossrefPubMedGoogle Scholar
  • 6 DiMatteo MR. Evidence-based strategies to foster adherence and improve patient outcomes. JAAPA 2004; 17 (11) 18-21
    PubMedGoogle Scholar
  • 7 Sciberras N, Gregori A, Holt G. The ethical and practical challenges of patient noncompliance in orthopaedic surgery. J Bone Joint Surg Am 2013; 95 (09) e61
    CrossrefPubMedGoogle Scholar
  • 8 Stone Jr ME, Marsh J, Cucuzzo J, Reddy SH, Teperman S, Kaban JM. Factors associated with trauma clinic follow-up compliance after discharge: experience at an urban level I trauma center. J Trauma Acute Care Surg 2014; 76 (01) 185-190
    CrossrefPubMedGoogle Scholar
  • 9 Soumerai SB, Pierre-Jacques M, Zhang F. et al. Cost-related medication nonadherence among elderly and disabled Medicare beneficiaries: a national survey 1 year before the Medicare drug benefit. Arch Intern Med 2006; 166 (17) 1829-1835
    CrossrefPubMedGoogle Scholar
  • 10 Mertz K, Eppler SL, Thomas K. et al. The association of financial distress with disability in orthopaedic surgery. J Am Acad Orthop Surg 2019; 27 (11) e522-e528
    CrossrefPubMedGoogle Scholar
  • 11 Rucinski K, Crecelius CR, Cook JL. Patient and healthcare team adherence in orthopaedics: a systematic review to initiate optimized definitions, metrics, and implementation strategies. Lupus Sci Med 2022; 9 (01) e000720
    PubMedGoogle Scholar
  • 12 Rucinski K, Cook JL, Crecelius CR, Stucky R, Stannard JP. Effects of compliance with procedure-specific postoperative rehabilitation protocols on initial outcomes after osteochondral and meniscal allograft transplantation in the knee. Orthop J Sports Med 2019; 7 (11) 2325967119884291
    CrossrefPubMedGoogle Scholar
  • 13 Bassett SF, Phty D. The assessment of patient adherence to physiotherapy rehabilitation. undefined. 2003 . Accessed February 26, 2021 at: https://www.semanticscholar.org/paper/The-assessment-of-patient-adherence-to-Bassett-Phty/c759c3a3d7e8cb6ee3aa81f6e3f61abb98357d3c
    PubMedGoogle Scholar
  • 14 Sluijs EM, Kok GJ, van der Zee J. Correlates of exercise compliance in physical therapy. Phys Ther 1993; 73 (11) 771-782 , discussion 783–786
    CrossrefPubMedGoogle Scholar
  • 15 Stannard JP, Cook JL. Prospective assessment of outcomes after primary unipolar, multisurface, and bipolar osteochondral allograft transplantations in the knee: a comparison of 2 preservation methods. Am J Sports Med 2020; 48 (06) 1356-1364
    CrossrefPubMedGoogle Scholar
  • 16 Bhandari M, Smith J, Miller LE, Block JE. Clinical and economic burden of revision knee arthroplasty. Clin Med Insights Arthritis Musculoskelet Disord 2012; 5: 89-94
    CrossrefPubMedGoogle Scholar
  • 17 Sloan M, Sheth N, Lee GC. Is obesity associated with increased risk of deep vein thrombosis or pulmonary embolism after hip and knee arthroplasty? A large database study. Clin Orthop Relat Res 2019; 477 (03) 523-532
    CrossrefPubMedGoogle Scholar
  • 18 Committee on Health Literacy, Board on Neuroscience and Behavioral Health, Institute of Medicine. Nielsen-Bohlman L, Panzer AM, Kindig DA. eds. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004
    Google Scholar
  • 19 CDC. What Is Health Literacy?. 2022 Accessed December 6, 2022 at: https://www.cdc.gov/healthliteracy/learn/index.html
    PubMedGoogle Scholar
  • 20 Kadakia RJ, Tsahakis JM, Issar NM. et al. Health literacy in an orthopedic trauma patient population: a cross-sectional survey of patient comprehension. J Orthop Trauma 2013; 27 (08) 467-471
    CrossrefPubMedGoogle Scholar
  • 21 Salt E, Frazier SK. Predictors of medication adherence in patients with rheumatoid arthritis. Drug Dev Res 2011; 72 (08) 756-763
    CrossrefPubMedGoogle Scholar
  • 22 Kressin NR, Orner MB, Manze M, Glickman ME, Berlowitz D. Understanding contributors to racial disparities in blood pressure control. Circ Cardiovasc Qual Outcomes 2010; 3 (02) 173-180
    CrossrefPubMedGoogle Scholar
  • 23 Akinleye SD, Krochak R, Richardson N, Garofolo G, Culbertson MD, Erez O. Readability of the most commonly accessed arthroscopy-related online patient education materials. Arthroscopy 2018; 34 (04) 1272-1279
    CrossrefPubMedGoogle Scholar
  • 24 Ó Doinn T, Broderick JM, Abdelhalim MM, Quinlan JF. Readability of patient educational materials in pediatric orthopaedics. J Bone Joint Surg Am 2021; 103 (12) e47
    CrossrefPubMedGoogle Scholar
  • 25 Yahanda AT, Lafaro KJ, Spolverato G, Pawlik TM. A systematic review of the factors that patients use to choose their surgeon. World J Surg 2016; 40 (01) 45-55
    CrossrefPubMedGoogle Scholar
  • 26 Roberts L, Cornell C, Bostrom M. et al. Communication skills training for surgical residents: learning to relate to the needs of older adults. J Surg Educ 2018; 75 (05) 1180-1187
    CrossrefPubMedGoogle Scholar
  • 27 Calkins DR, Davis RB, Reiley P. et al. Patient-physician communication at hospital discharge and patients' understanding of the postdischarge treatment plan. Arch Intern Med 1997; 157 (09) 1026-1030
    CrossrefPubMedGoogle Scholar
  • 28 Narayanan AS, Stoll KE, Pratson LF, Lin FC, Olcott CW, Del Gaizo DJ. Musculoskeletal health literacy is associated with outcome and satisfaction of total knee arthroplasty. J Arthroplasty 2021; 36 (7S): S192-S197
    CrossrefPubMedGoogle Scholar
  • 29 Wilkinson R, Marmot M. eds. Social Determinants of Health: The Solid Facts. Geneva: World Health Organization; 2003
    Google Scholar
  • 30 Abtahi AM, Presson AP, Zhang C, Saltzman CL, Tyser AR. Association between orthopaedic outpatient satisfaction and non-modifiable patient factors. J Bone Joint Surg Am 2015; 97 (13) 1041-1048
    CrossrefPubMedGoogle Scholar
  • 31 Delanois RE, Tarazi JM, Wilkie WA. et al. Social determinants of health in total knee arthroplasty: are social factors associated with increased 30-day post-discharge cost of care and length of stay?. Bone Joint J 2021; 103-B (6, Supple A): 113-118
    CrossrefPubMedGoogle Scholar
  • 32 Jekielek R. MITRE-Harris Poll Survey on Health Insurance Literacy and Perception: A survey Exploring the American Public's understanding and opinions of health insurance. 2021 . Accessed August 24, 2023 at: https://www.youtube.com/watch?v=O8wZWqNs5pU
    PubMedGoogle Scholar
  • 33 Alexander GC, Casalino LP, Meltzer DO. Patient-physician communication about out-of-pocket costs. JAMA 2003; 290 (07) 953-958
    CrossrefPubMedGoogle Scholar
  • 34 Cosic F, Kimmel L, Edwards E. Health literacy in orthopaedic trauma patients. J Orthop Trauma 2017; 31 (03) e90-e95
    CrossrefPubMedGoogle Scholar
  • 35 Phillips KA, Ospina NS, Montori VM. Physicians interrupting patients. J Gen Intern Med 2019; 34 (10) 1965-1965
    CrossrefPubMedGoogle Scholar
  • 36 Whiting PS, Greenberg SE, Thakore RV. et al. What factors influence follow-up in orthopedic trauma surgery?. Arch Orthop Trauma Surg 2015; 135 (03) 321-327
    CrossrefPubMedGoogle Scholar
  • 37 Schexnayder SP, Valentino JL, Leonardi C, Bronstone AB, Dasa V. Factors associated with loss to follow-up during the first year after total knee arthroplasty. Orthopedics 2023; 46 (02) 93-97
    CrossrefPubMedGoogle Scholar
  • 38 Furdock RJ, Alejo A, Fraifogl J, Hoffa MT, Vallier HA. Evaluating patient recall following operative orthopaedic trauma. Injury 2023; 54 (06) 1519-1523
    CrossrefPubMedGoogle Scholar
  • 39 Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health 2004; 94 (12) 2084-2090
    CrossrefPubMedGoogle Scholar
  • 40 Jester A, Ruland C, Paryavi E, Zerhusen T, Butler B, O'Toole RV. Do patients know their post-operative plan? A prospective cohort study of orthopaedic trauma patients at a level I trauma center. Injury 2021; 52 (06) 1370-1373
    CrossrefPubMedGoogle Scholar
  • 41 Kattan AE, AlHemsi HB, AlKhawashki AM. et al. Patient compliance with physical therapy following orthopedic surgery and its outcomes. Cureus 2023; 15 (04) e37217
    PubMedGoogle Scholar
  • 42 Lundine KM, Nelson S, Buckley R, Putnis S, Duffy PJ. Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients. Can J Surg 2010; 53 (06) 367-372
    PubMedGoogle Scholar
  • 43 Doucet S, Luke A, Anthonisen G. Hospital-based patient navigation programs for patients who experience injury-related trauma and their caregivers: a scoping review. BMJ Open 2022; 12 (12) e066260
    CrossrefPubMedGoogle Scholar
  • 44 Sawhney M, Teng L, Jussaume L, Costa S, Thompson V. The impact of patient navigation on length of hospital stay and satisfaction in patients undergoing primary hip or knee arthroplasty. Int J Orthop Trauma Nurs 2021; 41: 100799
    CrossrefPubMedGoogle Scholar
  • 45 Wozniak LA, Beaupre LA, Juby A, Kivi P, Majumdar SR, Hanson HM. Successful implementation of a Fracture Liaison Service through effective change management: a qualitative study. Arch Osteoporos 2020; 15 (01) 44
    CrossrefPubMedGoogle Scholar
  • 46 Abdisa E, Fekadu G, Girma S. et al. Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. Int J Ment Health Syst 2020; 14 (01) 56
    CrossrefPubMedGoogle Scholar
  • 47 Heckman BW, Mathew AR, Carpenter MJ. Treatment burden and treatment fatigue as barriers to health. Curr Opin Psychol 2015; 5: 31-36
    CrossrefPubMedGoogle Scholar
  • 48 Hadden KB, Prince LY, Bushmiaer MK, Watson JC, Barnes CL. Health literacy and surgery expectations in total hip and knee arthroplasty patients. Patient Educ Couns 2018; 101 (10) 1823-1827
    CrossrefPubMedGoogle Scholar
  • 49 Huizinga MM, Bleich SN, Beach MC, Clark JM, Cooper LA. Disparity in physician perception of patients' adherence to medications by obesity status. Obesity (Silver Spring) 2010; 18 (10) 1932-1937
    CrossrefPubMedGoogle Scholar
  • 50 Moore KN. Compliance or collaboration? The meaning for the patient. Nurs Ethics 1995; 2 (01) 71-77
    CrossrefPubMedGoogle Scholar
  • 51 Wright BJ, Galtieri NJ, Fell M. Non-adherence to prescribed home rehabilitation exercises for musculoskeletal injuries: the role of the patient-practitioner relationship. J Rehabil Med 2014; 46 (02) 153-158
    CrossrefPubMedGoogle Scholar
  • 52 Dang BN, Westbrook RA, Njue SM, Giordano TP. Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC Med Educ 2017; 17 (01) 32
    CrossrefPubMedGoogle Scholar
  • 53 Badge HM, Churches T, Naylor JM. et al. Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery. PLoS One 2021; 16 (11) e0260146
    CrossrefPubMedGoogle Scholar
  • 54 Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care: an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 (05) 542-549
    CrossrefPubMedGoogle Scholar
  • 55 Lee SR, Dix DB, McGwin G. et al. Correlation of appointment times and subspecialty with the no-show rates in an orthopedic ambulatory clinic. J Healthc Manag 2018; 63 (06) e159-e169
    PubMedGoogle Scholar
  • 56 Grimm C. Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care. Washington, DC: US Dept of Health and Human Services; 2022
    Google Scholar
  • 57 Carvalho E, Bettger JP, Goode AP. Insurance coverage, costs, and barriers to care for outpatient musculoskeletal therapy and rehabilitation services. N C Med J 2017; 78 (05) 312-314
    PubMedGoogle Scholar
  • 58 Edward J, Wiggins A, Young MH, Rayens MK. Significant Disparities exist in consumer health insurance literacy: implications for health care reform. Health Lit Res Pract 2019; 3 (04) e250-e258
    PubMedGoogle Scholar
  • 59 Weiss B. Health Literacy and Patient Safety: Help Patients Understand. 2nd ed. Chicago, IL: American Medical Association Foundation and American Medical Association; 2007
    Google Scholar
  • 60 Dahodwala M, Geransar R, Babion J, de Grood J, Sargious P. The impact of the use of video-based educational interventions on patient outcomes in hospital settings: a scoping review. Patient Educ Couns 2018; 101 (12) 2116-2124
    CrossrefPubMedGoogle Scholar
  • 61 Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns 2006; 61 (02) 173-190
    CrossrefPubMedGoogle Scholar
  • 62 Katz MG, Kripalani S, Weiss BD. Use of pictorial aids in medication instructions: a review of the literature. Am J Health Syst Pharm 2006; 63 (23) 2391-2397
    CrossrefPubMedGoogle Scholar
  • 63 Yen PH, Leasure AR. Use and effectiveness of the teach-back method in patient education and health outcomes. Fed Pract 2019; 36 (06) 284-289
    PubMedGoogle Scholar
  • 64 Nimmon L, Stenfors-Hayes T. The “handling” of power in the physician-patient encounter: perceptions from experienced physicians. BMC Med Educ 2016; 16 (01) 114
    CrossrefPubMedGoogle Scholar
  • 65 Fiscella K, Meldrum S, Franks P. et al. Patient trust: is it related to patient-centered behavior of primary care physicians?. Med Care 2004; 42 (11) 1049-1055
    CrossrefPubMedGoogle Scholar
  • 66 Landau DA, Bachner YG, Elishkewitz K, Goldstein L, Barneboim E. Patients' views on optimal visit length in primary care. J Med Pract Manage 2007; 23 (01) 12-15
    PubMedGoogle Scholar
  • 67 Bagley CH, Hunter AR, Bacarese-Hamilton IA. Patients' misunderstanding of common orthopaedic terminology: the need for clarity. Ann R Coll Surg Engl 2011; 93 (05) 401-404
    CrossrefPubMedGoogle Scholar
  • 68 Reuter T, Ziegelmann JP, Lippke S, Schwarzer R. Long-term relations between intentions, planning, and exercise: a 3-year longitudinal study after orthopedic rehabilitation. Rehabil Psychol 2009; 54 (04) 363-371
    CrossrefPubMedGoogle Scholar
  • 69 Kimmel LA, Holland AE, Simpson PM, Edwards ER, Gabbe BJ. Validating a simple discharge planning tool following hospital admission for an isolated lower limb fracture. Phys Ther 2014; 94 (07) 1005-1013
    CrossrefPubMedGoogle Scholar
  • 70 Futier E, Lefrant JY, Guinot PG. et al; INPRESS Study Group. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial. JAMA 2017; 318 (14) 1346-1357
    CrossrefPubMedGoogle Scholar
  • 71 Graham S, Brookey J. Do patients understand?. Perm J 2008; 12 (03) 67-69
    CrossrefPubMedGoogle Scholar
  • 72 Jeganathan S, Prasannan L, Blitz MJ, Vohra N, Rochelson B, Meirowitz N. Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2020; 2 (04) 100233
    CrossrefPubMedGoogle Scholar
  • 73 Tiwary A, Rimal A, Paudyal B, Sigdel KR, Basnyat B. Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Wellcome Open Res 2019; 4: 7
    CrossrefPubMedGoogle Scholar
  • 74 Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 2007; 297 (08) 831-841
    CrossrefPubMedGoogle Scholar
  • 75 Iolascon G, Ruggiero C, Fiore P, Mauro GL, Moretti B, Tarantino U. Multidisciplinary integrated approach for older adults with symptomatic osteoarthritis: SIMFER and SI-GUIDA Joint Position Statement. Eur J Phys Rehabil Med 2020; 56 (01) 112-119
    CrossrefPubMedGoogle Scholar
  • 76 Middleton M, Wan B, da Assunçao R. Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing 2017; 46 (03) 465-470
    PubMedGoogle Scholar
  • 77 Reiss-Brennan B, Brunisholz KD, Dredge C. et al. Association of integrated team-based care with health care quality, utilization, and cost. JAMA 2016; 316 (08) 826-834
    CrossrefPubMedGoogle Scholar
  • 78 Schmitt D, Rodts M, Davis B, Summers H, Bernstein M, Lack W. Standardized practice is associated with low rate of surgical site infection in orthopaedic trauma. J Clin Orthop Trauma 2019; 10 (Suppl 1): S95-S99
    CrossrefPubMedGoogle Scholar
  • 79 Singh J, Singh H. Continuous improvement strategies: an overview. IUP J Oper Manag 2013; 12 (Suppl. 01) 32-57
    PubMedGoogle Scholar