Surgeons and patients routinely talk about whether a treatment is “acceptable,” but no one has pinned down what that word actually means in orthopaedic surgery. This project will create the first standardised definition and measurement tool for patient acceptability of orthopaedic surgical interventions. The problem is that “acceptability” is currently a vague, catch-all term. Researchers and funders demand it as an outcome, yet different studies measure it in different ways, making results impossible to compare. Without a clear definition, patients cannot know whether a treatment’s risks, recovery time, or long-term outcomes will feel acceptable to them personally. If this succeeds, the new measurement instrument will give patients concrete, comparable information when deciding whether to undergo hip replacements, knee surgeries, or spinal procedures. Surgeons will have a reliable way to assess whether patients find proposed treatments acceptable, and researchers across orthopaedics will report outcomes consistently. The framework could later be adapted for other surgical fields, standardising how patient perspectives are captured in clinical trials and NHS practice.
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Background The 'acceptability' of healthcare interventions is frequently discussed when evaluating surgical interventions, including orthopaedic surgical interventions. Acceptability is important to patients, treatment providers and those designing and evaluating healthcare interventions. It can inform patients' decision-making regarding willingness to undergo surgery. Additionally, research funders, such as the National Institute of Health and Care Research (NIHR), commonly request 'patient acceptability' as an important outcome in commissioned research. Despite the desire to measure acceptability in evaluations of interventions, it is often poorly conceptualised, with no common definition or measurement used. It is unclear if definitions and frameworks of acceptability developed for behavioural interventions can be applied to surgical interventions, given their additional complexity due to many concomitant factors. There is a need for a standardised definition and measurement instrument for the acceptability of orthopaedic surgical interventions to patients, which would promote consistent evaluation and reporting. Research Aims This research aims to identify factors that are important to patients' regarding the acceptability of orthopaedic surgical interventions. The findings will be used to develop a clear definition and consistent conceptualisation, as well as a measurement instrument to assess the acceptability of orthopaedic surgical interventions to patients. Methods The research project has three-phases; WP1: What aspects of acceptability of orthopaedic surgical interventions are important to patients and health care professionals? Important concepts for the acceptability of orthopaedic surgical interventions to patients will be identified through qualitative semi-structured interviews with patients and healthcare professionals (HCPs) (n=45). Transcripts will be analysed thematically and a comprehensive set of important concepts compiled. WP2: Developing a reliable and valid measure to assess the patient acceptability of orthopaedic surgical interventions. Following recommended methodological guidance and drawing on the WP1 findings, a measurement instrument will be developed to capture the multidimensional aspects of patient acceptability in orthopaedic surgical interventions. Cognitive interviews will be conducted for pilot (n=15) and field testing (n=20). Final form testing (n=100) and analysis will provide information on the measurement instrument's reliability and validity. WP3: How to implement and apply this measurement instrument for patient acceptability of orthopaedic surgical interventions? A nominal group technique consensus study will utilise the knowledge of key experts, including patients, surgeons, physiotherapists, researchers and PPI members to evaluate and prioritise how the newly developed measurement instrument might be effectively implemented in clinical and research practice. Anticipated impact, outputs and dissemination An impact and dissemination plan, developed with the study steering group (SSG) and PPI members, will ensure evidence is shared beyond academia. The ability to measure acceptability will provide patients with clearer information for decision-making regarding orthopaedic surgical treatments and aid standardisation of patient acceptability measurements, which could be adapted for other surgical fields. Outputs will include a definition and conceptual framework for patient acceptability of orthopaedic surgery and three peer-reviewed publications. Clear summaries of each WP's results will be co-produced with the PPI group and provided to participants. Findings will be shared with clinicians and researchers, published in peer-reviewed journals, and presented at research and surgical conferences.
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