About the tool

Overview

The SMART Choice tool has been developed for patients who are considering a knee replacement. The tool uses simple questions about your age, sex and current symptoms and reports outcomes after knee replacement for people with similar attributes to you who have had a previous surgery. The intention behind developing this tool was to support patients to make better informed decisions about their surgical care.

The SMART Choice tool was created as part of a research project funded by the HCF Research Foundation and developed by independent researchers at the University of Melbourne, ensuring the tool's commitment to patient-centered care. The goal is to support patients in making informed decisions about their knee surgery options.

The Development Process

The development of the SMART Choice tool stems from data captured by the SMART Registry at St. Vincent’s Hospital, Melbourne. This registry includes the data of all patients who have had a hip or knee replacement performed at St. Vincent’s since 1999. From this data, we were able to identify patients who improved and did not improve after surgery. By comparing the characteristics of patients who improved versus patients who did not improve, we could build statistical models to understand future outcomes. These models included machine learning (artificial intelligence) algorithms. Using these models, the SMART Choice tool can receive patient inputs (age, sex, baseline symptoms) and report the likelihood for a successful outcome after knee replacement surgery based on previous data.

Defining Improvement after Surgery

Improvement after surgery is frequently evaluated using a health-related quality of life utility score, which assesses overall health across six key domains: physical functioning, role limitations, social functioning, pain, mental health, and vitality. This score spans from 0, denoting a health state equivalent to death, to 1, indicating perfect health. Prior research has established the minimum improvement in utility score necessary for a patient to perceive a noticeable benefit after surgery.

Research

The tool is a result of a research study investigating how to improve patient selection into surgery, funded by the HCF Research Foundation. Peer-reviewed publications explaining the project protocol, development of the tool, and results of the trial can be found below:

• Zhou Y, Patten L, Spelman T, et al. Predictive Tool Use and Willingness for Surgery in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(3):e240890. doi:10.1001/jamanetworkopen.2024.0890
• Zhou Y, Shadbolt C, Rele S, et al. CALCULATING AND COMPARING THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE FOR VETERANS RAND 12 UTILITY SCORE IN TOTAL KNEE ARTHROPLASTY. Orthop Procs. 2023;105-B(SUPP_3):117-117. doi:10.1302/1358-992X.2023.3.117
• Zhou Y, Dowsey M, Spelman T, Choong P, Schilling C. DEVELOPING AND EVALUATING THE SMART CHOICE (KNEE): A PATIENT-FOCUSED TOOL TO PREDICT HEALTH-RELATED QUALITY OF LIFE OUTCOMES AFTER TOTAL KNEE ARTHROPLASTY. Orthop Procs. 2023;105-B(SUPP_3):118-118. doi:10.1302/1358-992X.2023.3.118
• Zhou, Y., Dowsey, M., Spelman, T., Choong, P. and Schilling, C. (2023), SMART choice (knee) tool: a patient-focused predictive model to predict improvement in health-related quality of life after total knee arthroplasty. ANZ Journal of Surgery, 93: 316-327. https://doi.org/10.1111/ans.18250

Disclaimer

The SMART Choice tool is an educational resource intended to help users learn more about knee replacement surgery and associated factors. It provides general information based on patterns in past patient data but does not constitute personalised medical advice. This tool is not designed to diagnose, prevent, monitor, predict, prognose, treat, or alleviate any disease or condition. It cannot replace the advice of a qualified healthcare professional. All information is for informational purposes only and should not guide medical decisions. For personalised advice, please consult your healthcare provider. By using the SMART Choice tool, you confirm that you have read, understood, and accepted this disclaimer.