Biopsychosocial Determinants for Total Knee Replacement Decisions Among Older Adults With Chronic Knee Osteoarthritis: A Scoping Review.

Abstract

Background: Total knee replacement (TKR) is a common surgical intervention for older adults with chronic knee osteoarthritis (KOA). Given the prevalence of comorbidities in this population, health priorities may vary, influencing decision-making regarding TKR. Despite the increasing number of TKRs, no scoping review has systematically examined the determinants shaping older adults' decisions using a biopsychosocial (BPS) model. Materials and Methods: Searches were undertaken in commercially produced and grey literature sources. Eligible studies included English-language qualitative and quantitative studies that investigated determinants influencing older adults' decision towards TKR. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the BPS model. Results: Out of 999 abstracts screened, 23 studies met the inclusion criteria. The included studies took place in Australia, Canada, Germany, Japan, Kuwait, Sweden, Taiwan, Turkey, the United Kingdom and the United States. Ten studies used qualitative study designs while thirteen used varying quantitative study designs. Under BPS model, these determinants were grouped into biological determinants: baseline physical health, disease severity, and pain symptoms; psychological determinants, including coping strategies, feelings of loss, mental stress, depression, and anxiety; and social determinants: support networks, financial resources, health insurance, and access to referral systems and surgery. Conclusion: The decision for TKR in older adults with chronic KOA is shaped by an intricate interplay of biological, psychological, and social factors. The most consistent determinants included the desire for pain relief and the ability to regain physical function. Religion and spirituality significantly influence stress and anxiety in older adults and transportation system also presents significant challenges for TKR surgery. A multifaceted strategy that improves the structures, processes, and outcomes of decision for TKR surgery is required among older adults with chronic KOA. Future research with large, representative samples and a focus on the BPS framework is needed to further explore this complex decision-making process.