Is consumer information about arthroscopy available in Australia adequate for optimal evidence-infomed decision-making?

Article type
Year
Authors
Buchbinder R1, Macpherson A2
1Cochrane Musculoskeletal, Cabrini Institute and Monash University, Australia
2Cabrini Institute and Monash University, Australia
Abstract
Background: Australian and international data indicate continued use of arthroscopic treatment for knee osteoarthritis despite evidence this is a 'low-value' treatment. A paucity of easy to understand and reliable consumer information about knee arthroscopy may be one explanatory factor.

Objectives: To determine whether consumer information about knee arthroscopy for osteoarthritis in Australia is adequate to inform good decision-making.

Methods: We performed a critical appraisal of leaflets about knee arthroscopy for osteoarthritis and/or degenerative meniscal tears provided to patients by orthopaedic surgeons or easily accessible on the internet. Information relating to other knee conditions or solely focused upon postoperative care, and other forms of communication were excluded. Information sources were identified from Australian Commission on Quality and Safety in Health Care and internet searches conducted 20-28 May 2015. Search terms were ‘knee arthroscopy’, ‘knee pain’, ‘osteoarthritis knee’ and ‘meniscal tear’, and ‘orthopaedic surgeon’ linked to each capital city. Two independent reviewers selected documents for inclusion and extracted data. The main outcomes were reference to guidelines, presentation of the evidence base, and explicit advice against use of arthroscopic treatment for all/most people with knee osteoarthritis and/or degenerative meniscal tears.

Results: Forty-nine documents were analysed in full and 44 provided limited information. None mentioned guidelines and only eight (5 limited, 3 full) made a clear recommendation against use of arthroscopy for all/most people with knee osteoarthritis. Of the 49 analysed in full, 11 (22.4%) specified an information source, three (6.1%) provided a specific reference to support advice, six (12.2%) provided information from research evidence to support their statements. While five referred to placebo-controlled trial evidence none gave a sense as to the quality and/or strength of the evidence. Overall, Wikipedia provided the most valid information.

Conclusions: Consumer information about knee arthroscopy in Australia is variable and may be inadequate to inform optimal decision-making.