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Background: Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients. Methods: We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups. Results: We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period (p < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, p < 0.001), infection (p < 0.001), death (p = 0.004), and surgical complications (p < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation (p < 0.001) and less likely to present to the emergency department (p < 0.001) than Canadian-born patients. Conclusion: Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty. Contexte : Les personnes immigrantes et r fugi es la recherche de soins pour une arthrite grave sont confront es des difficult s particuli res lorsqu'elles veulent s'y retrouver dans les m andres du syst me de sant , cause d'une m connaissance du syst me et des options th rapeutiques ou de probl mes d'acc s. Cette tude avait pour but d' valuer le recours l'arthroplastie pour proth se totale du genou (PTG), les r sultats chirurgicaux et le recours aux ressources hospitali res chez les personnes immigrantes et r fugi es comparativement aux malades n s au Canada. M thodes : Nous avons inclus tous les adultes soumis une intervention pour PTG primaire de janvier 2011 d cembre 2020 en Ontario. Les cohortes taient n es au Canada ou immigrantes et r fugi es. Nous avons valu les changements annuels du recours la PTG pour d gager une tendance. Nous avons compar les diff rences de taux de r vision 1 an et d'infection, de thromboembolie veineuse (TEV) 30 jours, les consultations aux services d'urgence, et les r admissions entre les groupes de patients n s au Canada et immigrants et r fugi s. R sultats : Nous avons inclus 158 031 cas de PTG. En tout, 11 973 (7,6%) appartenaient au groupe de personnes immigrantes et r fugi es, et 146 058 (92,4%), au groupe n au Canada. La proportion de PTG effectu es chez des personnes immigrantes et r fugi es en Ontario a presque doubl au cours de la p riode de 10 ans tudi e (p < 0,001). Apr s appariement, les personnes immigrantes taient expos es un risque relativement moindre de r vision 1 an (0,9% c. 1,6%, p < 0,001), d'infection (p < 0,001), de mortalit (p = 0,004), et de complications chirurgicales (p < 0,001). On n'a observ aucune diff rence quant au taux de TEV 30 jours ou quant la dur e du s jour hospitalier. Les personnes immigrantes taient plus susceptibles de recevoir leur cong pour aller en centre de r adaptation (p < 0,001) et moins susceptibles de consulter dans un service d'urgence (p < 0,001) que les personnes n es au Canada. Conclusion : Comparativement aux personnes n es au Canada, les personnes immigrantes et r fugi es obtiennent de bons r sultats chirurgicaux et des taux similaires d'utilisation des ressources apr s leur PTG. Nous avons observ une sous-utilisation de ces interventions par rapport leur proportion dans la population. Cela pourrait t moigner des diff rences de perception de la douleur chronique ou des probl mes d'acc s l'arthroplastie., Total knee arthroplasty (TKA) is a successful procedure performed more than 75 000 times a year in Canada. (1) Whereas the outcomes of this procedure are well documented, there has [...]

The design, analysis, and interpretation of cluster randomized clinical trials (RCTs) require accounting for potential correlation of observations on individuals within the same cluster. Reporting of observed intracluster correlation coefficients (ICCs) in cluster RCTs, as recommended by Consolidated Standards of Reporting Trials (CONSORT), facilitates sample size calculation of future cluster RCTs and understanding of the trial statistical power. Our objective was to summarize observed ICCs in osteoarthritis (OA) cluster RCTs. Systematic review of knee/hip OA cluster RCTs. We searched Cochrane Central Register of Controlled Trials for trials published from 2012, when CONSORT cluster RCTs extension was published, to September 2022. We calculated the proportion of cluster RCTs that reported observed ICCs. Of those that did, we extracted observed ICCs. PROSPERO: CRD42022365660. We screened 1121 references and included 20 cluster RCTs. Only 5 trials (25%) reported the observed ICC for at least one outcome variable. ICC values for pain outcomes were: 0, 0.01, 0.18; for physical function outcomes were: 0, 0.06, 0.13 (knee)/0.27 (hip); Western Ontario and McMaster Universities Arthritis Index (WOMAC) total: 0.02, 0.02; symptoms of anxiety/depression: 0.22; disability: 0; and global change: 0. One out of four (25%) trials reported an ICC that was larger than the ICC used for sample size calculation and thus was underpowered. Despite CONSORT statement recommendations for reporting cluster RCTs, few OA trials reported the observed ICC. Given the importance of the ICC to interpretation of trial results and future trial design, this reporting gap warrants attention. [ABSTRACT FROM AUTHOR]

Rationale: Total knee arthroplasty is a common surgical procedure but not appropriate for all patients with knee osteoarthritis. Patient decision aids (PtDAs) can promote shared decision making and enhance understanding and expectations of procedures among patients, resulting in better discussions between patients and healthcare providers about whether total knee arthroplasty is the most appropriate option. Aims and Objectives: Evaluate impact of an individualised PtDA for osteoarthritis patients considering total knee arthroplasty 1 year after baseline assessment. Methods: Prospective, randomised controlled trial comparing an intervention arm (IA) and routine care arm (RCA). The IA included an online individualised patient reported outcome measures (PROMs) based PtDA and one‐page summary report for the surgeon. We report secondary outcomes from the final assessment: patient expectations, decisional regret, patient satisfaction with outcomes of knee replacement, health‐related quality‐of‐life (HRQOL) and depression. We report changes in HRQOL between baseline and final assessments, study arms, and surgical versus non‐surgical patients. Descriptive statistics were used to describe participant characteristics and continuous variables. Dichotomous outcomes (expectations, decisional regret, satisfaction) were analyzed using logistic regression and continuous outcomes (HRQOL, depression) were modelled using linear regression. Results: Overall, 140 participants completed all study assessments (IA: n = 69, RCA: n = 71); n = 108 underwent surgery (IA: n = 49, RCA: n = 59). Regardless of study arm, most participants reported expectations were met, minimal decisional regret, satisfaction with outcomes of knee replacement, and had improvements in HRQOL. While no significant differences in study outcomes were found between study arms, IA results were in the direction hypothesised in favour of the PtDA. Conclusions: Although we were not able to detect statistically significant benefits associated with implementing this PROMs‐based PtDA, there was no apparent negative effect on these outcomes 1 year after baseline. We anticipate there may be benefit to implementing this PtDA earlier in the osteoarthritis care pathway where patients have more opportunities to manage their disease non‐surgically. [ABSTRACT FROM AUTHOR]

Background: Upper extremity (UE) trauma represents a common reason for emergency department visits, but the longitudinal economic burden of this public health issue is unknown. This study assessed the 3-year attributable health care use and expenditure after UE trauma requiring acute surgical intervention, with specific focus on injuries that affect function of the hand and wrist. Methods: We conducted an incidence-based, propensity score–matched cohort study (2006–2014) in Ontario, Canada, using linked administrative health care data to identify case patients and matched control patients. We matched adults with hand, wrist and UE nerve trauma requiring surgery 1:4 to control patients. We compared total direct health care costs, including 1-year pre-index costs, between case and control patients using a differences-in-difference methodology. The primary outcome was attributable health care costs within 3 years of injury. Results: We matched patients with trauma (n = 26 123) to noninjured patients (n = 104 353). Mean direct health care costs attributable to UE trauma were $9210 (95% confidence interval [CI] 8880 to 9550) within 3 years. Patients with trauma had significantly more emergency department visits (≥ 3 visits: 25% v. 12%; p < 0.001), mental health visits (34% v. 28%; p < 0.05) and secondary surgeries (25% v. 5%; p < 0.001). Specific patient populations had significantly greater attributable costs: patients requiring post-traumatic mental health visits ($11 360 v. $7090; p < 0.001), inpatient surgery ($14 060 v. $5940, p < 0.001) and complex injuries ($13 790 v. $7930; p < 0.001). Interpretation: Health care expenditure increased more than fivefold in the year after UE trauma surgery and remained greater than the matched cohort for the subsequent 2 years. Those with more serious injuries and post-injury visits for mental health were associated with higher costs, requiring further study for this public health issue. The mean 1-year pre-injury and 1-year post-injury total costs were $1710 and $9350, respectively. [ABSTRACT FROM AUTHOR]