Patient and Clinician Perceptions of a Clinical Decision Support Tool for Personalized Rehabilitation after Total Knee Arthroplasty: A Qualitative Interview Study

Objective We developed a clinical decision support tool to help physical therapists (PTs) address the varied expectations and recoveries of the total knee arthroplasty (TKA) population. The tool uses a “people-like-me” algorithm to predict recovery after TKA. The purpose of this study was to explore patients’ and clinicians’ perceptions and experiences with the tool during rehabilitation after TKA. Methods We piloted the tool in 2 outpatient physical therapy clinics. We conducted in-depth semi-structured interviews with 1) patients who underwent TKA and were exposed to the tool during rehabilitation and 2) clinicians who used the tool with patients after TKA. Two members of the research team coded the interview data using a descriptive content analysis. Results 16 patients and 10 clinicians were interviewed. We identified 4 common themes: 1) Expectations: most patients and clinicians felt the tool provided patients with valuable feedback for managing recovery expectations; 2) Motivation: patients and clinicians felt the tool motivated patients to participate in rehabilitation by providing positive reinforcement and/or a form of competition; 3) Influence on practice: some patients and clinicians indicated that the tool helped guide treatment decisions or provided opportunities for patient education, but most felt it did not influence clinical decision making; and 4) Clarity and comprehension: the majority of patients understood the tool’s “take-home” message, however, some patients and clinicians felt the use of percentiles, line graphs, and medical jargon decreased patients’ clarity and comprehension of the tool. Conclusions Overall, participants reported that the tool helped to shape patients’ expectations for postoperative recovery and increase patient motivation to participate in rehabilitation. Participants had mixed perceptions on how the tool influenced clinical care. Finally, participants identified some limitations in patient comprehension of the tool, which will inform future revisions to the tool to accommodate varying levels of health literacy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project was supported by the Agency for Healthcare and Research Quality (AHRQ) R01:HS025692 (Stevens-Lapsley). The funder played no role in the design, conduct, or reporting of this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Colorado Multiple Institute Review Board of University of Colorado, Anschutz Medical Campus, gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * (TKA) : total knee arthroplasty (PT) : physical therapist (ROM) : range of motion (TUG) : Timed Up and Go