This document provides an overview of the REPAIR and ACTION studies, which aim to study how an educational intervention can affect African American patients' decisions about knee pain treatment options. The studies are recruiting patients over 50 with knee osteoarthritis to receive an educational video on knee replacement surgery or pamphlet (control group). Patients will complete follow-up interviews to assess any impact on views of knee pain and surgery. The goal is to increase utilization of effective treatments and improve quality of life for minority patients with osteoarthritis.

1. REPAIR and ACTION Studies
with Said Ibrahim, MD, MPH
Jessica Clymer
SUMR 2011 Scholar

2.  Background information
 Project overview
 Methods
 Significance/Aims
 My role
 What I learned
 Thank yous!

3.  The clinical issue
 Arthritis or rheumatism is the most common
cause of disability among US adults (17.5% of all
disability)
 Key findings from previous studies
 Attitudes toward treatment options for
osteoarthritis vary by race
 Patient preference varies by race and is a
function of surgical outcome expectations
 Patient race is not a significant predictor of
surgical recommendation at the orthopedic level

4.  Joint Replacement surgery is an effective
treatment option for osteoarthritis
 More than 90% report improvement in pain/function
 Less than 1% mortality rate
 Joint prosthesis lasts up to 20 years
 .5 million joint replacement surgeries are done
annually
 State knee replacement rate is up 45% between 2000-
2004
 Marked variation in the utilization of knee/hip
joint replacement in the African American
community
 Patient factors are considered to be the cause in
variation of treatments

5.  Consider patient factors:
 Attitudes toward joint replacement
 Knowledge about the treatment
 Patient preferences
 Surgical outcome expectancy
 Lookingto see how an educational
intervention affects patients’ decisions about
their knee pain.

6.  Recruiting African American patients over the age of
50 with a history of osteoarthritis.
 Screened for exclusion factors and used the WOMAC
scale to ensure severe knee pain
 assesses the pain, joint stiffness, physical, social & emotional
function of a person with osteoarthritis in determining the
overall level of disability.
 Patients undergo a baseline phone interview.
 For the REPAIR study, they are met at their primary
care appointment for an educational intervention.
 For the ACTION study, they are met at their
orthopedic specialist appointment for an educational
intervention.

7.  Educationalintervention is done when a staff
member meets the patient before his/her
appointment, and it consists of a DVD explaining
knee replacement surgery.
 For REPAIR patients, they also have a discussion after the
video to answer questions.
 Patients in the control group receive a pamphlet
prior to their appointments that discusses different
treatment options for knee osteoarthritis other
than knee replacement surgery.

9.  Forthe REPAIR study, patients complete a 2-
week, 3-month and 1-year follow up phone
interview about their views on their knee
pain and knee replacement surgery.
 1 year after their educational intervention, we
will look into their medical records.
 ForACTION study, we look into their records
after six months, and do a 1-year follow up
phone interview.

10.  More utilization of an effective treatment
 Potential opportunity to improve the quality
of life for minority patients with
osteoarthritis
 Potential opportunity to improve
management of other deadly co morbidities
 Model for understanding how education
shapes elective treatment decisions

11.  Began the summer doing quality assurance
 Learned how to do follow-up interviews
 Eventually learned baseline and screening
interviews
 Helped with recruitment: mailing and screening
patients from the list of potential participants from
UPHS (Penn Care, Presbyterian, Ralston, Penn
Family Care)

12.  Trackingand entering data
 Phone surveys
 Recruitment strategies:
 working within UPHS to find patients, sending
letters and following up with phone calls,
 advertising with Metro and SEPTA,
 expanding to the VA and possibly other outside
providers
 IRB
 Effectivetime management!
 Job application process

13.  Principal
investigator and my mentor for the
SUMR program, Dr. Said Ibrahim
 My wonderful TEAM of mentors:
 Heather, Brandon, Ro, Becky, Erik, Emma, Craig
 Joanne Levy, Lissy Madden and LDI Staff
 Fellow scholars