Older adults' knowledge and beliefs about osteoporosis: results of semistructured interviews used for the development of educational materials.

OBJECTIVE: Although osteoporosis and associated fractures have been recognized as a significant public health problem, underdiagnosis and undertreatment are common. We investigated older adults' knowledge and beliefs regarding osteoporosis and its prevention, in order to develop effective osteoporosis health education messages and materials. These messages will be used as part of a trial that will test the efficacy of both public and doctor education to improve osteoporosis management. METHODS: We conducted semistructured one-on-one interviews with 15 older adult volunteers. A standard interview guide was developed and used for all interviews, which were audiotaped and transcribed. Key themes were extrapolated by 3 study staff using data abstraction forms. The data forms were then compared for consistency. RESULTS: We found that the term "osteoporosis" was well recognized, but many participants had only a fragmented understanding of its meaning. All participants identified osteoporosis as a serious condition, but many did not perceive themselves to be at personal risk for developing the condition. Many participants were confused about the difference between osteoporosis and osteoarthritis. Participants expressed reservations about taking prescription medications because of concerns over cost, side effects, and interactions with their current medications. CONCLUSION: Osteoporosis awareness is high, but the older adults interviewed had an incomplete understanding of the condition. This could hinder efforts to improve prevention and treatment of osteoporosis.

Which patients with knee problems are likely to benefit from nonarthroplasty surgery? Development of a clinical prediction rule.

BACKGROUND: We examined factors associated with the clinical presentation of patients judged likely by orthopedic surgeons to benefit from nonarthroplasty knee surgery. METHODS: Consecutive patients presenting to orthopedic surgeons were eligible for the study and 103 were recruited. A trained research assistant took histories, performed physical examinations, and administered a standardized questionnaire. Surgeons provided diagnoses and, in each case, rated their confidence that nonarthroplasty knee surgery would help the patient. We assessed the relationship between patient characteristics and the orthopedic surgeon's level of confidence that the patient was likely to benefit from knee surgery. RESULTS: In multivariable logistic regression models, the following characteristics were associated with a surgeon's judgment that a patient would likely benefit from knee surgery: a history of sports-related trauma, low functional status, limited knee flexion or extension, medial or lateral knee joint line tenderness, a click or pain noted with the McMurray test, and a positive Lachmann or anterior drawer test (c statistic from model, 0.83). These items were combined into a clinical prediction score, and low-, medium-, and high-risk categories were identified. Independent evaluation by surgeons indicated that only 8% of patients in the low-risk category but 84% of patients in the high-risk category were judged likely to benefit from surgery (P for trend <.001). CONCLUSION: Using a small group of easily accessible patient characteristics, we developed a clinical prediction score that clearly differentiated patients who were viewed by experienced orthopedic knee surgeons as likely or not likely to benefit from nonarthroplasty knee surgery.