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Improving patient outcomes following total joint arthroplasty: is there an app for that?
  1. Jesse I Wolfstadt1,2,
  2. Christine Soong3,
  3. Sarah E Ward2,4
  1. 1 Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada
  2. 2 Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  3. 3 GIM, Mount Sinai Hospital, Toronto, Ontario, Canada
  4. 4 Department of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Jesse I Wolfstadt, Orthopaedics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada; Jesse.Wolfstadt{at}

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Patient activation, defined as an individual’s knowledge, skill and confidence in managing their health and healthcare, is recognised as a critical aspect of high-quality, patient-centred and safe healthcare.1 In 2004, Judith Hibbard and colleagues published their seminal work on the development of a validated, objective measure of patient activation.1 The Patient Activation Measure (PAM) was designed to assess patient self-reported knowledge, skills and confidence for managing one’s health or chronic illness. The original 22-item PAM was subsequently shortened to a 13-item version and was found to be both reliable and valid for assessing patient activation.2 Patient activation has the potential to reduce healthcare costs, optimise healthcare utilisation, enhance population health by encouraging healthy behaviours and improve patient outcomes and satisfaction.3–5

Total knee arthroplasty (TKA) represents an important opportunity to study the effectiveness of patient activation. Historically, up to 15%–20% of patients remain dissatisfied following a total joint arthroplasty (TJA).6 7 This is especially true of patients undergoing TKA and remains a troublesome challenge for orthopaedic surgeons and their patients.8 To date, it remains unclear why some patients remain unsatisfied with their knee function following TKA, despite having technically successful surgeries when examined from the surgeon’s perspective. Previous attempts to address the subgroup of dissatisfied patients undergoing TKA through modifications to implant design and alterations in surgical technique have generally failed. Focus then shifted to patient characteristics, with some evidence that patient factors such as mental health scores and patient expectations are predictive of postoperative patient satisfaction.9–12 It stands to reason that interventions designed to improve patient activation may modify the risk of poor patient experience.

While promising, the literature investigating patient activation in orthopaedics is scarce and represents opportunity for scientific evaluation.13 14 Identifying patients with low patient activation …

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