Hierarchization of Patient and Healthcare Professional Preferences Among the 24 Items of the WOMAC Following Total Hip and Total Knee Arthroplasty: A Best-Worst Scaling Study

OBJECTIVES: In an increasingly patient-centered vision of health care, patient preferences must be considered. The primary objective of this study was to determine a hierarchy of preferences among the 24 improvements that can be described by the 24 items of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients undergoing revalidation for total hip replacement (THR) or total knee replacement (TKR). The secondary objective was to compare this patient hierarchy with that of healthcare professionals (HCPs) caring for these patients.

METHODS: A cross-sectional preference study was conducted using an online questionnaire proposed to patients hospitalized for revalidation after THR/TKR and to HCPs caring for these patients. The 24 possible improvements, as described by the 24 WOMAC attributes, were investigated using best-worst scaling (BWS) analysis. Counting analysis, Bayesian hierarchical estimation, and a measure of the differences between the two groups' relative importance scores (RIS) for each of the 24 items of the WOMAC were performed.

RESULTS: Overall, 20 patients and 56 HCPs participated in the survey. Count analyses revealed two different rankings between patients and HCPs. RIS analyses showed that the most important improvement estimated by the patients was item #22 “Physical function - Getting on/off toilet” (RIS_Patients=7.76±2.49 [CI95% 6.67-8.85]). For HCPs, the most important improvement was item #13 “Physical function - Walking on a flat surface” (RIS_HCPs=8.68±2.29 [CI95% 8.08-9.27]). Significant differences were found between the patient RIS and the HCPs RIS for 10 of the 24 WOMAC items.

CONCLUSIONS: The BWS method allows prioritization of preferences among the 24 improvements that can be described by the 24 WOMAC attributes. Analysis of the improvement priorities reveals discrepancies between patients and HCPs. Awareness of these discrepancies could improve the efficiency of care by tailoring support to patients undergoing revalidation according to their specific preference profile.