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Kim SJ, Gil YW, Sung IH. Preoperative patient's expectations and clinical outcomes after rheumatoid forefoot deformity reconstruction by joint sacrificing surgery. JOURNAL OF RHEUMATIC DISEASES 2024; 31:33-40. [PMID: 38130962 PMCID: PMC10730808 DOI: 10.4078/jrd.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
Objective To study the clinical and radiologic factors related with overall patient satisfaction of joint scarifying reconstruction on severe rheumatoid forefoot deformity (RFD). Methods Forty cases of RFD were retrospectively enrolled. A questionnaire on the factors for patient's expectations and satisfactions of the greater and lesser toes was administered, including repression of relapse in deformity (D), pain reduction (P), improvement in shoe wearing (S), barefoot activity (B), and appearance (A). Overall satisfaction were assessed using the 5-digit-scale. Hallux valgus angle, 1, 2 intermetatarsal angle, and other radiologic parameters were measured. Pearson's correlation and multiple linear regression analyses were used to evaluate the relationships between these factors and overall satisfaction. Results Overall satisfaction was 4.0±0.82. Postoperative radiologic parameters were corrected in adequate range. Visual analog scale (VAS) was reduced from 7.2±2.1 to 2.2±1.8. For the greater toe, patient's expectations (D, P, S, B, and A) were 4.2, 4.1, 3.0, 2.5, 2.7 and satisfactions were 4.2, 4.0, 3.4, 3.5, 3.3, respectively. For the lesser toes, patient's expectations (D, P, S, B, and A) were 3.9, 4.1, 3.4, 3.0, 2.8, and satisfactions were 3.4, 4.0, 3.4, 3.6, 2.9, respectively. Satisfactions with P and B, and reduction amounts of VAS were significantly correlated with overall satisfaction. Conclusion Although forefoot reconstruction with a joint sacrificing procedure is non-physiological, it could be a good surgical option for severe RFD. Each patient's expectations and satisfactions with this procedure could vary. Thus, it seems important to inform patients preoperatively that expectation could be fulfilled well or less.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Young-Woon Gil
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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2
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Cazzulino A, Bach K, Cordero R, Swarup I. Patient Expectations and Satisfaction in Pediatric Orthopedics. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09869-5. [PMID: 37728727 DOI: 10.1007/s12178-023-09869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW The purpose of the current review is to analyze the current literature regarding the tools available to evaluate patient expectations and satisfaction. There have been an increasing number of tools that have been developed and validated for various orthopedic procedures. Despite the growing number of tools, there are a limited number of tools available for pediatric patients. RECENT FINDINGS Several tools have been developed in orthopedics to evaluate patient expectations. However, there are no tools that have been validated in the pediatric population. In addition, pediatric patient expectations should be collected in conjunction with parent/caregiver expectations. Although not specifically validated for pediatric patients, there are several tools available that may pertain to pediatric patients including the HSS ACL Expectations Survey, HSS Shoulder Expectations Survey, HSS Knee Surgery Expectations Survey, HSS Foot and Ankle Surgery Expectation Survey, Sunnybrook Surgery Expectations Survey, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) Instruments, Quick DASH, and DASH. In terms of patient satisfaction, there are even fewer tools available. Several tools have been developed to evaluate patient satisfaction and five additional tools within orthopedics. Of these tools, there are two that have been validated for pediatric patients: The Swedish Parents Satisfaction Questionnaire and the Scoliosis Research Society-22. There are a growing number of tools to evaluate patient's expectations and satisfaction in the orthopedic literature. Given most of these tools pertain to adult patients, there is a need for further development of tools specifically validated for pediatric patients and their parents/caregivers. Through the measurement of expectations and satisfaction, medical professionals can hope to improve satisfaction and outcomes.
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Affiliation(s)
- Alejandro Cazzulino
- Department of Orthopedic Surgery, University of California San Francisco, 500 Parnassus Ave. Millberry Union MU 320 W, San Francisco, CA, USA.
| | - Katherine Bach
- Department of Orthopedic Surgery, University of California San Francisco, 500 Parnassus Ave. Millberry Union MU 320 W, San Francisco, CA, USA
| | | | - Ishaan Swarup
- Department of Orthopedic Surgery, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, USA
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Mew L, Heaslip V, Immins T, Wainwright TW. A Patient and Public Involvement Study to Explore the Need for Further Research into the Experience of Younger Patients Undergoing Total Hip Arthroplasty. J Patient Exp 2022; 9:23743735221083166. [PMID: 35274035 PMCID: PMC8902004 DOI: 10.1177/23743735221083166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Total Hip Arthroplasty (THA) is one of the most commonly performed operations in orthopaedics. It is an operation usually performed in older patients, however the need for THA in younger patients is increasing. There is a lack of literature examining whether current recovery pathways address the specific needs of younger patients. Public and Patient Involvement (PPI) is a core aspect of good research practice and is recommended throughout the research process, including the formulation and refinement of pertinent research questions. Therefore, the explicit aim of this PPI study was to collect qualitative data from patients on the feasibility and requirement for further research into the experience of younger hip arthroplasty patients. Methods: Qualitative data was collected via an online questionnaire that was advertised on social media, requesting the input of anybody who had experienced a lower limb musculoskeletal injury or condition before the age of 50. The survey asked the respondents to describe their experiences and reflect on their priorities and goals throughout their recovery. Results: There were 71 respondents, of which 90% were female, with an average age of 43. Qualitative responses identified many concerns that were issues that could be translated across all patient ages. However, other priorities were raised that are not always recognised as important when measuring successful outcomes after a THA. Furthermore, many respondents described not feeling listened to by clinicians or treatment options not being sufficiently addressed and explored. Multiple respondents reported being told they were too young to have anything serious or that nothing could be done until they were older. Conclusions: The responses to the survey indicate that current care pathways are not fulfilling the needs and priorities in younger patients. Further research is required to explore these priorities and goals in more depth in order to understand how healthcare professionals can address them.
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Affiliation(s)
- L. Mew
- Milton Keynes University Hospital, Standing Way, Milton Keynes, MK6 5LD
- Louise Mew, Research and Development, Academic Centre, Milton Keynes University Hospital, Standing Way, Milton Keynes, MK6 5LD.
| | - V. Heaslip
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, UK
- Department of Social Work, Stavanger University, Norway
| | - T. Immins
- Orthopaedic Research Institute, Bournemouth University, UK
| | - T. W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust
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4
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Dismore L, van Wersch A, Murty AN, Swainston K. A qualitative study with orthopaedic surgeons on pain catastrophizing and surgical outcomes: shifting from a medical towards a biopsychosocial model of surgery. Br J Pain 2022; 16:14-22. [PMID: 35111310 PMCID: PMC8801688 DOI: 10.1177/20494637211004658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Pain catastrophizing (PC) moderates surgical outcomes and behavioural interventions are recommended to optimise post-operative results. Less is known about surgeons' experiences of providing care and their attitudes towards the use of interventions in practice. OBJECTIVE It is therefore invaluable to understand surgeons' views on how best to support patients who may be at risk of suboptimal recovery. Eleven surgeons and three registrar orthopaedic practitioners took part in semi-structured interviews within a hospital setting. The surgical decision-making process, views of PC and the use of behavioural interventions in surgical practice were explored. RESULTS Thematic analysis identified five themes: pain expressions and pain behaviours affect the surgeons' decision-making process, when pathologies and symptoms do not match, psychological factors pertaining to unsatisfactory outcomes, a service gap in surgical care and the acceptability of using a screening tool in surgical practice to identify patients at risk of suboptimal recovery. CONCLUSION Orthopaedic surgeons face challenges in identifying who is likely to reach optimal versus suboptimal outcome. Surgeons are becoming increasingly aware of patient psychological distress being detrimental to outcomes, and they support the use of behavioural interventions to optimise post-operative outcomes or stop unnecessary treatments. The surgeons accept the use of a screening tool in surgical practice with better access to support services with input from allied health professionals. A screening tool may provide great utility for identifying at risk patients, to allow for modification of surgical patients care plans.
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Affiliation(s)
- Lorelle Dismore
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK,Lorelle L Dismore, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, Tyne and Wear, North Shields NE29 8NH, UK.
| | - Anna van Wersch
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Aradhyula N Murty
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Katherine Swainston
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
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Aoude A, Litowski M, Aldebeyan S, Fisher C, Hall H, Manson N, Bailey CS, Ahn H, Abraham E, Nataraj A, Paquet J, Stratton A, Christie S, Cadotte D, Nicholls F, Soroceanu A, Rampersaud YR, Thomas KC. A Comparison of Patient and Surgeon Expectations of Spine Surgical Outcomes. Global Spine J 2021; 11:331-337. [PMID: 32875885 PMCID: PMC8013940 DOI: 10.1177/2192568220907603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Ambispective cohort study. OBJECTIVE Limited data exists comparing surgeon and patient expectations of outcome following spine surgery. The objective of this study was to elicit whether any differences exist between patient and surgeon expectations for common spine surgeries. METHODS Ten common age-appropriate clinical scenarios were generated and sent to Canadian spine surgeons to determine surgeon expectations for standard spine surgeries. Patients in the Canadian Spine Outcomes and Research Network (CSORN) registry matching the clinical scenarios were identified. Aggregated patient expectations were compared with surgeon responses for each scenario. A χ2 analysis was then completed to determine discrepancies between surgeon and patient expectations for each scenario. RESULTS A total of 51 Canadian spine surgeons completed the survey on surgical expectations. A total of 919 patients from multiple centers were identified within the CSORN database that matched the clinical scenarios. Our results demonstrated that patients tend to be more optimistic about the expected outcomes of surgery compared with the treating surgeon. The majority of patients in all clinical scenarios anticipated improvement in back or neck pain after surgery, which differed from surgeon expectations. Results also highlighted the effect of patient age on both patient and surgeon expectations. Discrepancies between patient and surgeon expectations were higher for older patients. CONCLUSION We present data on patient and surgeon expectations for spine surgeries and show that differences exist particularly concerning the improvement of neck or back pain. Patient age plays a role in the agreement between the treating physicians and patients in regard to surgical expectations. The reasons for the discrepancies remain unclear.
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Affiliation(s)
- Ahmed Aoude
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Madison Litowski
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Sultan Aldebeyan
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada,National Neuroscience Institute, Riyadh, Saudi Arabia
| | - Charles Fisher
- University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Neil Manson
- Dalhousie University, Halifax, Nova Scotia, Canada,Canada East Spine Centre, Saint John, New Brunswick, Canada
| | | | - Henry Ahn
- University of Toronto, Toronto, Ontario, Canada,St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Edward Abraham
- Dalhousie University, Halifax, Nova Scotia, Canada,Canada East Spine Centre, Saint John, New Brunswick, Canada
| | | | - Jerome Paquet
- CHU de Québec-Université Laval, Laval, Quebec, Canada
| | | | | | - David Cadotte
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Fred Nicholls
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Alex Soroceanu
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Y. Raja Rampersaud
- University of Toronto, Toronto, Ontario, Canada,University Health Network, Krembil Research Institute, Toronto, Ontario, Canada
| | - Kenneth C. Thomas
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada,Kenneth C. Thomas, Foothills Medical Centre, 1403 29th St NW, Calgary, Alberta, Canada T2N 2T9.
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Hafkamp FJ, de Vries J, Gosens T, den Oudsten BL. High Pre-Operative Expectations Precede Both Unfulfilled Expectations and Clinical Improvement After Total Hip and Total Knee Replacement. J Arthroplasty 2020; 35:1806-1812. [PMID: 32201110 DOI: 10.1016/j.arth.2020.02.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This prospective study aimed to examine whether patients' and physicians' outcome expectations were related to subjective (ie, fulfillment of expectations) and objective outcomes (ie, change in pain and function) in hip and knee arthroplasty patients up to 6 months post-surgery. METHODS Patients' (N = 395) and physicians' outcome expectations were examined 1 week post-consultation. Patients' post-operative functional status and the extent of fulfillment of expectations were examined 5 weeks, 3 months, and 6 months post-surgery. Patients and physicians completed the Hospital for Special Surgery Hip/Knee Replacement (Fulfillment) Expectations Survey. Patients completed the Hip/Knee injury and Osteoarthritis Outcome Score. Linear regression analyses were performed to examine the relationship between physicians' expectations and patients' change in pain and function and extent of fulfillment of expectations, and a possible mediated effect of patients' pre-operative expectations. RESULTS Patients' high expectations were consistently associated with better objective outcomes (ie, change in pain and function). Yet, high expectations in patients were also negatively related to subjective outcomes (ie, the extent of fulfillment of expectations). Physicians' expectations were only positively associated with objective improvement in knee patients, and not in hip patients. Additionally, knee patients' expectations partly mediated the relationship between physicians' expectations and change in pain and function, 6 months post-surgery. CONCLUSION Although patients' high expectations were associated with better objective outcomes, improvement was still less than patients expected. Thus, patients often have too high expectations of outcomes of surgery. In addition, physicians were able to influence patients' expectations and to change experienced knee patients' outcomes.
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Affiliation(s)
- Frederique J Hafkamp
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands; Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Taco Gosens
- Department of Orthopedics, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
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7
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Postler A, Goronzy J, Günther KP, Lange T, Redeker I, Schmitt J, Zink A, Callhoff J. Which disease-related factors influence patients' and physicians' willingness to consider joint replacement in hip and knee OA? Results of a questionnaire survey linked to claims data. BMC Musculoskelet Disord 2020; 21:352. [PMID: 32503503 PMCID: PMC7275466 DOI: 10.1186/s12891-020-03368-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/25/2020] [Indexed: 02/04/2023] Open
Abstract
Background A great heterogeneity in total joint replacement (TJR) rates has been reported for osteoarthritis (OA), most likely arising from a gap between patients’ and physicians’ views on the need for TJR. The purpose of this study therefore was to analyze potential cofactors which might influence the desire of patients to undergo TJR and physicians’ willingness to discuss surgery with their patients. Methods A total of 8995 patients in Germany with a claims data diagnosis of hip or knee OA or polyarthrosis were asked to complete a questionnaire for this cross-sectional study of sociodemographic factors, indicators of current joint function (WOMAC score), willingness to undergo TJR and whether they had already discussed TJR with a physician. The overall response rate was 40%. Responders with polyarthrosis and individuals without current or chronic symptoms in the corresponding joints, pain in already replaced joints or simultaneous symptomatic hip and knee OA were excluded. We linked the survey results to claims data. Separate logistic regression models were used to assess which parameters were associated with patients’ willingness to undergo TJR and physicians’ discussion of surgery. Results We analyzed 478 hip OA and 932 knee OA patients. Just 17% with hip OA and 14% with knee OA were willing to undergo TJR, although 44 and 45% had already discussed surgery with their physicians. Patients’ willingness was associated with higher WOMAC scores, a deterioration of symptoms over the last 2 years, and previous TJR for another joint. The discussion with a physician was influenced by the impact on personal life and previous arthroplasty. Older age (odds Ratio (OR) 1.2 per 10 years), male sex (OR 0.69 vs female), longer symptom duration (OR 1.08 per 5 years), deterioration of symptoms (OR 2.0 vs no change/improvement), a higher WOMAC score (OR 1.3 per 10% deterioration) and reduced well-being (OR 1.1 per 10% deterioration) were associated with physician discussion in knee OA patients. Conclusions The proportion of patients willing to undergo TJR is lower than the proportion in whom physicians discuss surgery. While previous TJR seems to enhance patients’ and surgeons’ willingness, the influence of other cofactors is heterogeneous.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedics and Traumatology, University Medicine Carl, Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Jens Goronzy
- University Center of Orthopaedics and Traumatology, University Medicine Carl, Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl, Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Toni Lange
- Center for Evidence-Based Healthcare, Medical Faculty, Technical University, Dresden, Dresden, Germany
| | - Imke Redeker
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty, Technical University, Dresden, Dresden, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Johanna Callhoff
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Swarup I, Henn CM, Gulotta LV, Henn RF. Patient expectations and satisfaction in orthopaedic surgery: A review of the literature. J Clin Orthop Trauma 2019; 10:755-760. [PMID: 31316250 PMCID: PMC6611830 DOI: 10.1016/j.jcot.2018.08.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/02/2018] [Indexed: 11/20/2022] Open
Abstract
Patient expectations have been shown to be an independent predictor of outcomes in clinical medicine. In the orthopaedic literature, the majority of studies have focused on the relationship between pre-operative expectations and post-operative outcomes in patients undergoing total hip arthroplasty, total knee arthroplasty, shoulder surgery, and spine surgery. Various methodologies have been used to assess patient expectations in orthopaedic surgery, including direct questioning, short questionnaires, and validated surveys. Multiple patient factors have been associated with greater expectations prior to elective orthopaedic surgery, and greater pre-operative expectations have been shown to be associated with better subjective and objective outcomes after total hip and knee arthroplasty, shoulder surgery, and spine surgery. While there are very few validated measures of patient satisfaction after orthopaedic surgery, increased post-operative patient satisfaction is consistently associated with meeting pre-operative patient expectations. Given the relationship between pre-operative patient expectations and post-operative outcomes and patient satisfaction, understanding and defining expectations prior to elective orthopaedic surgery may optimize outcomes. In this review, we aim to summarize the current literature on patient expectations in orthopaedic surgery.
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Affiliation(s)
- Ishaan Swarup
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
- Corresponding author.
| | - Curtis M. Henn
- Department of Orthopaedic Surgery, Medstar Georgetown Orthopaedic Institute, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Lawrence V. Gulotta
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207, USA
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Harmsen RTE, den Oudsten BL, Putter H, Leichtenberg CS, Elzevier HW, Nelissen RGHH. Patient Expectations of Sexual Activity After Total Hip Arthroplasty: A Prospective Multicenter Cohort Study. JB JS Open Access 2018; 3:e0031. [PMID: 30882057 PMCID: PMC6400513 DOI: 10.2106/jbjs.oa.18.00031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background This study aimed to evaluate patients' expectations of postoperative sexual activity (SA) after total hip arthroplasty. Methods A prospective multicenter cohort study of 1,271 patients managed with total hip arthroplasty was performed using patient-reported outcome measures of the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis Study (LOAS). Preoperative SA expectations and their fulfillment after 1 year were assessed with the Hospital for Special Surgery expectations survey. The Hip disability and Osteoarthritis Outcome Score (HOOS) was used to measure functional status, and the Short Form-12 Mental and Physical Component Summary scores (SF-12 MCS and SF-12 PCS) and EuroQol-5 Dimensions (EQ-5D) questionnaire were used to measure health status. Two subgroups were defined preoperatively: the SA-Expecting Group and the No-SA-Expecting Group. The postoperative outcomes with regard to SA (i.e., the difference between postoperative and preoperative SA scores) were classified as "unfulfilled" (score, ≤-1), "fulfilled" (score, 0), or "exceeded" (score, ≥1). Multivariate regression analyses were used, with t tests to compare means between groups. Results In total, 952 (74.9%) patients returned both preoperative and postoperative HSS questionnaires. Preoperatively, 605 patients (63.6%) expected to have postoperative SA. At 1 year, 43.5% of participants reported that this expectation was unfulfilled. In the No-SA-Expecting Group, 18.2% (63 of 347) regained SA, predominantly men. Postoperative SA fulfillment was related to preoperative musculoskeletal (p = 0.001) and non-musculoskeletal comorbidities (p = 0.004) and the postoperative HOOS, SF-12 PCS, SF-12 MCS, EQ-5D, and EQ-5D visual analog scale (VAS) scores (p < 0.001). Postoperative HOOS-symptoms (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.02 to 1.06; p < 0.001), and HOOS-sport (OR, 1.01; 95% CI, 1.00 to 1.03; p = 0.032) were associated with postoperative SA fulfillment, as was older age (inversely; e.g., ≥76 years compared with ≤60 years: OR, 0.28; 95% CI, 0.13 to 0.62; p = 0.002). Correspondingly, for the No-SA-Expecting Group, higher age was also inversely associated with regaining postoperative SA (e.g., ≥76 years: OR, 0.07; 95% CI, 0.02 to 0.21; p < 0.001). Conclusions Of the patients who expected to be sexually active after surgery, 43.5% perceived this expectation to be unfulfilled; 24.3% were still sexually inactive despite most having expected a return to normal SA. Approximately one-fifth of patients who did not expect postoperative SA in fact regained SA. During preoperative consultations, surgeons should pay attention to expectation management surrounding SA. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Rita T E Harmsen
- Departments of Biomedical Data Sciences (H.P.), Orthopaedics (R.T.E.H., C.S.L., and R.G.H.H.N.), and Urology and Medical Decision Making (H.W.E.), Leiden University Medical Center, Leiden, the Netherlands
| | - Brenda L den Oudsten
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Hein Putter
- Departments of Biomedical Data Sciences (H.P.), Orthopaedics (R.T.E.H., C.S.L., and R.G.H.H.N.), and Urology and Medical Decision Making (H.W.E.), Leiden University Medical Center, Leiden, the Netherlands
| | - Claudia S Leichtenberg
- Departments of Biomedical Data Sciences (H.P.), Orthopaedics (R.T.E.H., C.S.L., and R.G.H.H.N.), and Urology and Medical Decision Making (H.W.E.), Leiden University Medical Center, Leiden, the Netherlands
| | | | - Henk W Elzevier
- Departments of Biomedical Data Sciences (H.P.), Orthopaedics (R.T.E.H., C.S.L., and R.G.H.H.N.), and Urology and Medical Decision Making (H.W.E.), Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Departments of Biomedical Data Sciences (H.P.), Orthopaedics (R.T.E.H., C.S.L., and R.G.H.H.N.), and Urology and Medical Decision Making (H.W.E.), Leiden University Medical Center, Leiden, the Netherlands
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10
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Effect of an e-Learning Tool on Expectations and Satisfaction Following Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2018; 33:2153-2158. [PMID: 29555496 DOI: 10.1016/j.arth.2018.02.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Orthopedic surgeons recognize patient expectations of total knee arthroplasty (TKA) can be managed through education. E-learning is the application of educational technology. The objective of this study was to evaluate whether an e-learning tool could affect whether patients' expectations were met and they were satisfied 1 year following TKA. METHODS Patients with osteoarthritis from the London Health Sciences Centre, Canada, were randomly assigned to either a control group (n = 207) receiving standard patient education or an intervention group (n = 209) using the e-learning tool in addition to the standard. We used a web-based system with permuted block sizes, stratified by surgeon and first or second TKA. Preoperative measures were completed following the patients' preadmission clinic visit. Postoperative patient-reported outcome measures were completed at 6 weeks, 3 months, and 1 year after TKA. One year after TKA, risk difference was used to determine between-group differences for patient satisfaction and expectations being met. RESULTS One year postoperatively, the risk that expectations of patients were not met was 21.8% in the control group and 21.4% in the intervention group for an adjusted risk difference of 1.3% (95% confidence interval, -7.8% to 10.4%, P = .78). The proportion of patients satisfied with their TKA at 1 year postoperative was 78.6% in the intervention and 78.2% in the control groups. CONCLUSION There was no between-group difference at 1 year between intervention and control groups for either the risk that expectations of patients were not met or the proportion of patients who were dissatisfied with their TKA.
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Lenguerrand E, Wylde V, Gooberman-Hill R, Sayers A, Brunton L, Beswick AD, Dieppe P, Blom AW. Trajectories of Pain and Function after Primary Hip and Knee Arthroplasty: The ADAPT Cohort Study. PLoS One 2016; 11:e0149306. [PMID: 26871909 PMCID: PMC4752224 DOI: 10.1371/journal.pone.0149306] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022] Open
Abstract
Background and Purpose Pain and function improve dramatically in the first three months after hip and knee arthroplasty but the trajectory after three months is less well described. It is also unclear how pre-operative pain and function influence short- and long-term recovery. We explored the trajectory of change in function and pain until and beyond 3-months post-operatively and the influence of pre-operative self-reported symptoms. Methods The study was a prospective cohort study of 164 patients undergoing primary hip (n = 80) or knee (n = 84) arthroplasty in the United Kingdom. Self-reported measures of pain and function using the Western Ontario and McMaster Universities Osteoarthritis index were collected pre-operatively and at 3 and 12 months post-operatively. Hip and knee arthroplasties were analysed separately, and patients were split into two groups: those with high or low symptoms pre-operatively. Multilevel regression models were used for each outcome (pain and function), and the trajectories of change were charted (0–3 months and 3–12 months). Results Hip: Most improvement occurred within the first 3 months following hip surgery and patients with worse pre-operative scores had greater changes. The mean changes observed between 3 and twelve months were statistically insignificant. One year after surgery, patients with worse pre-operative scores had post-operative outcomes similar to those observed among patients with less severe pre-operative symptoms. Knee: Most improvement occurred in the first 3 months following knee surgery with no significant change thereafter. Despite greater mean change during the first three months, patients with worse pre-operative scores had not ‘caught-up’ with those with less severe pre-operative symptoms 12 months after their surgery. Conclusion Most symptomatic improvement occurred within the first 3 months after surgery with no significant change between 3–12 months. Further investigations are now required to determine if patients with severe symptoms at the time of their knee arthroplasty have a different pre-surgical history than those with less severe symptoms and if they could benefit from earlier surgical intervention and tailored rehabilitation to achieve better post-operative patient-reported outcomes.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Female
- Hip Joint/physiopathology
- Humans
- Knee Joint/physiopathology
- Male
- Middle Aged
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/complications
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain/complications
- Pain/epidemiology
- Pain Measurement
- Prospective Studies
- Recovery of Function
- Self Report
- Treatment Outcome
- United Kingdom/epidemiology
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Affiliation(s)
- Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Luke Brunton
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D. Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Ashley W. Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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Gonzalez Saenz de Tejada M, Escobar A, Bilbao A, Herrera-Espiñeira C, García-Perez L, Aizpuru F, Sarasqueta C. A prospective study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement. BMC Musculoskelet Disord 2014; 15:248. [PMID: 25055728 PMCID: PMC4123493 DOI: 10.1186/1471-2474-15-248] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 07/16/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patient expectations regarding surgery may be related to outcomes in total joint replacement (TJR). The aim of this study was to determine the association of patient expectations with health related quality of life (HRQoL) outcomes measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 12 (SF-12) and satisfaction with current symptoms measured on a 4-point Likert scale, one year after surgery, adjusting for Body Mass Index (BMI), age, gender, joint, education, previous intervention and baseline scores. METHODS Consecutive patients preparing for TJR of the knee or hip due to primary osteoarthritis (OA) in 15 hospitals in Spain were recruited for the study. Patients completed questionnaires before surgery and 12 months afterwards: five questions about expectations before surgery; an item to measure satisfaction; two HRQoL instruments-WOMAC and SF-12; as well as questions about sociodemographic information. To determine the association of patient expectations at baseline, with changes in HRQoL 12 months after surgery and with satisfaction, general linear models and logistic regression analysis were performed. RESULTS A total of 892 patients took part in the study. Patients who had higher pain relief or ability to walk expectations improved more in HRQoL at 12 months. Moreover, patients with high daily activity expectations were more satisfied. CONCLUSIONS Patients with higher baseline expectations for TJR, improved more in HRQoL at one year and had more likelihood to be satisfied than patients with lower expectations, adjusted for BMI, age, gender, joint, education, previous intervention and HRQoL baseline scores.
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Affiliation(s)
- Marta Gonzalez Saenz de Tejada
- Research Unit, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Basurto University Hospital, Jado, 4th Floor, Avda, Montevideo 18, 48013 Bilbao, Spain.
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13
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Klika AK, Higuera CA, Saleh A, Patel P, Suarez J, Barsoum WK. Defining Value in Hip and Knee Arthroplasty in the United States. JBJS Rev 2014; 2:01874474-201407000-00001. [PMID: 27490059 DOI: 10.2106/jbjs.rvw.m.00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A41, Cleveland, OH 44195
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14
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Noble PC, Fuller-Lafreniere S, Meftah M, Dwyer MK. Challenges in outcome measurement: discrepancies between patient and provider definitions of success. Clin Orthop Relat Res 2013; 471:3437-45. [PMID: 23955192 PMCID: PMC3792266 DOI: 10.1007/s11999-013-3198-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Some orthopaedic procedures, including TKA, enjoy high survivorship but leave many patients dissatisfied because of residual pain and functional limitations. An important cause of patient dissatisfaction is unfulfilled preoperative expectations. This arises, in part, from differences between provider and patient in their definition of a successful outcome. WHERE ARE WE NOW?: Patients generally are less satisfied with their outcomes than surgeons. While patients are initially concerned with symptom relief, their long-term expectations include return of symptom-free function, especially in terms of activities that are personally important. While surgeons share their patients' desire to achieve their goals, they are aware this will not always occur. Conversely, patients do not always realize some of their expectations cannot be met by current orthopaedic procedures, and this gap in understanding is an important source of discrepancies in expectations and patient dissatisfaction. WHERE DO WE NEED TO GO?: An essential prerequisite for mutual understanding is information that is accurate, objective, and relevant to the patient's condition and lifestyle. This critical information must also be understandable within the educational and cultural background of each patient to enable informed participation in a shared decision making process. Once this is achieved, it will become easier to formulate similar expectations regarding the likely level of function and symptom relief and the risk of adverse events, including persistent pain, complications, and revision surgery. HOW DO WE GET THERE?: Predictive models of patient outcomes, based on objective data, are needed to inform decision making on the individual level. This can be achieved once comprehensive data become available capturing the lifestyles of patients of diverse ages and backgrounds, including data documenting the frequency and intensity of participation in sporting and recreational activities. There is also a need for greater attention to the process of informing patients of the outcome of orthopaedic procedures, not simply for gaining more meaningful consent, but so that patients and providers may achieve greater alignment of expectations and increased acceptance of both the benefits and limitations of alternative treatments.
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Affiliation(s)
- Philip C. Noble
- />Institute of Orthopedic Research and Education, 6550 Fannin, Suite 2503, Houston, TX 77030 USA , />Baylor College of Medicine, 6620 Main Street, Suite 1325, Houston, TX USA
| | - Sophie Fuller-Lafreniere
- />Institute of Orthopedic Research and Education, 6550 Fannin, Suite 2503, Houston, TX 77030 USA
| | - Morteza Meftah
- />The Methodist Hospital, 6550 Fannin Street, Suite 2503, Houston, TX USA
| | - Maureen K. Dwyer
- />Kaplan Joint Center, Newton Wellesley Hospital, 2000 Washington Street, Suite 361, Newton, MA 02462 USA
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15
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Abstract
BACKGROUND Advances in the surgical treatment of musculoskeletal conditions have resulted in an interest in better defining and understanding patients' expectations of these procedures, but the best ways to do this remain a topic of considerable debate. QUESTIONS/PURPOSES (1) What validated instruments for the assessment of patient expectations of orthopaedic surgery have been used in published studies to date? (2) How were these expectation measures developed and validated? (3) What unvalidated instruments for the assessment of patient expectations have been used in published studies to date? METHODS A systematic literature search was performed using the OVID Medline and EMBASE databases, in duplicate, to identify all studies that assessed patient expectations in orthopaedic surgery. Sixty-six studies were ultimately included in the present review. RESULTS Seven validated expectation instruments were identified, all of which use patient-reported questionnaires. Five were specific to a particular procedure or affected anatomic location, whereas two were broadly applicable. Details of reliability and validity testing were available for all but one of these instruments. Forty additional unvalidated expectation assessment tools were identified. Thirteen were based on existing clinical outcome tools, and the others were study-specific, custom-developed tools. Only one of the unvalidated tools was used in more than one study. CONCLUSIONS Several validated expectation instruments have been developed for use by patients undergoing orthopaedic surgery. However, many tools have been reported without evidence of testing and validation. The wide range of untested instruments used in single studies substantially limits the interpretation and comparison of data concerning patient expectations.
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Dy CJ, Gonzalez Della Valle A, York S, Rodriguez JA, Sculco TP, Ghomrawi HMK. Variations in surgeons' recovery expectations for patients undergoing total joint arthroplasty: a survey of the AAHKS membership. J Arthroplasty 2013; 28:401-5. [PMID: 23142456 DOI: 10.1016/j.arth.2012.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/12/2012] [Accepted: 06/24/2012] [Indexed: 02/01/2023] Open
Abstract
Recovery expectations (RE) after total hip and knee arthroplasty (THA-TKA) influence outcomes. We surveyed AAHKS members to determine variation in surgeon RE. Four vignettes depicting patients with high and low expectations after THA and TKA were distributed with a validated RE survey. Responses were analyzed for clinically significant differences between surgeons and within surgeons. Of 1049 surgeons surveyed, 358 (34%) responded. There was a clinically significant difference in 85% (high-THA), 46% (low-THA), 74% (high-TKA), and 57% (low-TKA) of pairs. Disagreement was significantly greater in high expectation vignettes. Individual surgeons distinguished between high and low expectation patients in 76% (THA) and 72% (TKA) of cases. There was no association between surgeon RE and practice demographics. Wide variations in RE were observed, especially among high expectation patients.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery-Hospital for Special Surgery, New York, NY 10021, USA
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17
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Jourdan C, Poiraudeau S, Descamps S, Nizard R, Hamadouche M, Anract P, Boisgard S, Galvin M, Ravaud P. Comparison of patient and surgeon expectations of total hip arthroplasty. PLoS One 2012; 7:e30195. [PMID: 22272303 PMCID: PMC3260245 DOI: 10.1371/journal.pone.0030195] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 12/13/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Analysis of discrepancies between patient and surgeon expectations before total hip arthroplasty (THA) should enable a better understanding of motives of dissatisfaction about surgery, but this question has been seldom studied. Our objectives were to compare surgeons' and patients' expectations before THA, and to study factors which affected surgeon-patient agreement. METHODS 132 adults (mean age 62.8+/-13.7 years, 52% men) on waiting list for THA in three tertiary care centres and their 16 surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (range 0-100). Patients' and surgeons' answers were compared, for the total score and for the score of each item. Univariate analyses tested the effect of patients' characteristics on surgeons' and patients' expectations separately, and on surgeon-patient differences. RESULTS Surgeon and patient expectations' mean scores were high (respectively 90.9+/-11.1 and 90.0+/-11.6 over 100). Surgeons' and patients' expectations showed no systematic difference, but there was little agreement on Bland and Altman graph and correlation coefficient was low. Patients had higher expectations than surgeons for sports. Patients rated their expectations according to trust in physician and mental quality of life, surgeons considered disability. More disabled patients and patients from a low-income professional category were often "more optimistic" than their surgeons. CONCLUSION Surgeons and patients often do not agree on what to expect from THA. More disabled patients expect better outcomes than their surgeons.
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Affiliation(s)
- Claire Jourdan
- AP-HP, Hôpital R. Poincaré, Service de Médecine Physique et Réadaptation, Garches, France.
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18
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Niemeyer P, Porichis S, Salzmann G, Südkamp NP. What Patients Expect About Autologous Chondrocyte Implantation (ACI) for Treatment of Cartilage Defects at the Knee Joint. Cartilage 2012; 3:13-9. [PMID: 26069615 PMCID: PMC4297184 DOI: 10.1177/1947603511415840] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although autologous chondrocyte implantation (ACI) has become an established surgical treatment for cartilage defects of the knee, little is known about what patients expect about this surgery. DESIGN A total of 150 patients who underwent ACI for cartilage defects at the knee were assigned to the present study and asked about their expectations and estimation concerning the ACI procedure. Patients were asked to answer 4 questions of a web-based questionnaire concerning their expectations on clinical outcome and on factors they considered relevant for clinical outcome. RESULTS A total of 118 (79%) returned questionnaires. Mean patient age was 32.6 years and mean defects size was 4.1 cm(2). A proportion of 70% (n = 83) of patients expected pain-free sports participation as a result of the ACI surgery, including 24 patients who expected to return to high-impact sports without any restrictions. Only 12.7% expected a reduction but persistence of pain during everyday activities. Concerning factors that influence outcome, the majority of the patients (55.1%) considered defect characteristics (i.e., size and location) most important for clinical outcome, whereas only a small proportion of patients considered rehabilitation (7.6%), cell quality (10.2%), or prior surgeries (4.2%) more relevant for final outcome. CONCLUSION The present study illustrates that expectations of ACI patients are demanding and quite high. The ACI technique seems generally considered to be able to restore pain-free sports participation. Patients do not seem to be aware of all factors of possible importance concerning clinical outcome.
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Affiliation(s)
- Philipp Niemeyer
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Germany
| | - Stella Porichis
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Germany
| | - Gian Salzmann
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Germany
| | - Norbert P. Südkamp
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Germany
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19
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Hambly K. Activity profile of members of an online health community after articular cartilage repair of the knee. Sports Health 2011; 3:275-82. [PMID: 23016018 PMCID: PMC3445167 DOI: 10.1177/1941738111402151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Articular cartilage repair (ACR) procedures aim to alleviate pain and restore function for individuals with chondral defects. Rehabilitation is lengthy, and there are limited data on return to sports and exercise activities after ACR in non-elite-athlete populations. The Internet is a growing source of health-related information for patients, and it has resulted in the emergence of online health communities. PURPOSE To establish a postoperative activity profile of users of an online health community who have undergone ACR of the knee and to compare this profile with those from the same community who have undergone initial anterior cruciate ligament reconstruction (ACLR). STUDY DESIGN Cross-sectional. METHODS Tegner Activity Scale ratings were collected via a self-reported online questionnaire from 201 participants of an online health community who had undergone tibiofemoral and/or patellofemoral ACR (n = 75) or ACLR (n = 126). RESULTS A higher Tegner activity level was significantly correlated to time from surgery for ACR (P < 0.005) and ACLR (P < 0.01). At a minimum of 24 months' follow-up, the ACR group had a median postoperative Tegner score of 3, compared with 6 for the ACLR group. Tegner score was significantly negatively correlated with age at time of surgery for ACLR (P < 0.05) but not for ACR. Men demonstrated significantly higher Tegner activity levels than did women for both ACLR and ACR (P < 0.05). CONCLUSIONS Activity levels after ACR in this population increased with postoperative time but remained lower than expected when compared with current published clinical and normative data. CLINICAL RELEVANCE Engagement with an online health community may influence expectations regarding return to sports and exercise activities. Reporting of activity-level data within clinical studies should be differentiated on the basis of sex. Further research is needed to elucidate factors that determine return to sports and exercise activities after ACR.
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Affiliation(s)
- Karen Hambly
- Centre for Sports Studies, University of Kent, Chatham Maritime, Kent, United Kingdom
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20
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Recovery of physical functioning after total hip arthroplasty: systematic review and meta-analysis of the literature. Phys Ther 2011; 91:615-29. [PMID: 21393418 DOI: 10.2522/ptj.20100201] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND After total hip arthroplasty (THA), patients today (who tend to be younger and more active than those who previously underwent this surgical procedure) have high expectations regarding functional outcome. Therefore, patients need to be well informed about recovery of physical functioning after THA. PURPOSE The purpose of this study was to review publications on recovery of physical functioning after THA and examine the degree of recovery with regard to 3 aspects of functioning (ie, perceived physical functioning, functional capacity to perform activities, and actual daily activity in the home situation). DATA SOURCES Data were obtained from the MEDLINE and EMBASE databases from inception to July 2009, and references in identified articles were tracked. STUDY SELECTION Prospective studies with a before-after design were included. Patients included in the analysis had to have primary THA for osteoarthritis. DATA EXTRACTION AND SYNTHESIS Two reviewers independently checked the inclusion criteria, conducted the risk of bias assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model. RESULTS A total of 31 studies were included. For perceived physical functioning, patients recovered from less than 50% preoperatively to about 80% of that of controls (individuals who were healthy) 6 to 8 months postsurgery. On functional capacity, patients recovered from 70% preoperatively to about 80% of that of controls 6 to 8 months postsurgery. For actual daily activity, patients recovered from 80% preoperatively to 84% of that of controls at 6 months postsurgery. LIMITATIONS Only a few studies were retrieved that investigated the recovery of physical functioning longer than 8 months after surgery. CONCLUSIONS Compared with the preoperative situation, the 3 aspects of physical functioning showed varying degrees of recovery after surgery. At 6 to 8 months postoperatively, physical functioning had generally recovered to about 80% of that of controls.
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21
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Yoo JH, Chang CB, Kang YG, Kim SJ, Seong SC, Kim TK. Patient expectations of total knee replacement and their association with sociodemographic factors and functional status. ACTA ACUST UNITED AC 2011; 93:337-44. [DOI: 10.1302/0301-620x.93b3.25168] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We aimed to document the pre-operative expectations in Korean patients undergoing total knee replacement using an established survey form and to determine whether expectations were influenced by sociodemographic factors or pre-operative functional status. Expectations regarding 17 items in the Knee Replacement Expectation Survey form were investigated in 454 patients scheduled for total knee replacement. The levels and distribution patterns of summated expectation and of five expectation categories (relief from pain, baseline activity, high flexion activity, social activity and psychological well-being) constructed from the 17 items were assessed. Univariate analyses and multivariate logistic regression were performed to examine the associations of expectations with the sociodemographic factors and the functional status. The top three expectations were relief from pain, restoration of walking ability, and psychological well-being. Of the five expectation categories, relief from pain was ranked the highest, followed by psychological well-being, restoration of baseline activity, ability to perform high flexion activities and ability to participate in social activities. An age of < 65 years, being employed, a high Western Ontario and McMaster Universities osteoarthritis index function score and a low Short-form 36 social score were found to be significantly associated with higher overall expectations.
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Affiliation(s)
- J. H. Yoo
- Joint Reconstruction Centre, Seoul National University, Bundang Hospital, 300 Gumidong, Bundang-gu, Seongnam-si, Gyunggi-do 463-707, Korea
| | - C. B. Chang
- Joint Reconstruction Centre, Seoul National University, Bundang Hospital, 300 Gumidong, Bundang-gu, Seongnam-si, Gyunggi-do 463-707, Korea
| | - Y. G. Kang
- Joint Reconstruction Centre, Seoul National University, Bundang Hospital, 300 Gumidong, Bundang-gu, Seongnam-si, Gyunggi-do 463-707, Korea
| | - S. J. Kim
- Department of Statistics Korea University, Anam-dong Seongbuk-gu, Seoul 136-701, Korea
| | - S. C. Seong
- Joint Reconstruction Centre, Seoul National University, Bundang Hospital, 300 Gumidong, Bundang-gu, Seongnam-si, Gyunggi-do 463-707, Korea
| | - T. K. Kim
- Joint Reconstruction Centre, Seoul National University, Bundang Hospital, 300 Gumidong, Bundang-gu, Seongnam-si, Gyunggi-do 463-707, Korea
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22
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Hayes DA, Watts MC, Anderson LJ, Walsh WR. Knee arthroplasty: a cross-sectional study assessing energy expenditure and activity. ANZ J Surg 2010; 81:371-4. [PMID: 21518189 DOI: 10.1111/j.1445-2197.2010.05570.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND What has been missing from current assessment tools post knee arthroplasty is a means by which a patient's mobility and activity levels can be objectively measured over time in a real world setting. The Intelligent Device for Energy Expenditure and Activity (Minisun, Fresno, USA) (IDEEA) is one such device that meets these criteria. It quantifies activity by measuring energy expenditure and records the type of activity performed. The purposes of this study were to (i) determine if there were differences in energy expenditure in different groups of patients at various time points pre- and post-surgery and (ii) determine the correlations between energy expenditure and each of the subjective International Knee Documentation Committee (IKDC), Oxford and Tegner scoring systems. METHODS Sixty-five total knee arthroplasty (TKA) patients were recruited into a cross-sectional study to collect energy expenditure and activity data using the IDEEA. Data were collected preoperatively and post-operatively at 6-week, 3-month, 6-month and 12-month time intervals. RESULTS Energy expenditure and type of activity did not significantly change over the five recording periods. The patients spent <5% of the recording time walking, stepping or in transitions between movements. Energy expenditure showed a low to moderate correlation with the subjective IKDC, Oxford and Tegner questionnaires. CONCLUSIONS Current evaluation questionnaires may not accurately record activity levels and TKA patients spend less time walking than the normal population. We believe the IDEEA is an effective tool for objectively measuring activity and energy expenditure following knee arthroplasty.
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Affiliation(s)
- David A Hayes
- Brisbane Orthopaedic & Sports Medicine Centre, Brisbane, Queensland, Australia
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23
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van den Akker-Scheek I, van Raay JJAM, Reininga IHF, Bulstra SK, Zijlstra W, Stevens M. Reliability and concurrent validity of the Dutch hip and knee replacement expectations surveys. BMC Musculoskelet Disord 2010; 11:242. [PMID: 20958990 PMCID: PMC2973929 DOI: 10.1186/1471-2474-11-242] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 10/19/2010] [Indexed: 11/12/2022] Open
Abstract
Background Preoperative expectations of outcome of total hip and knee arthroplasty are important determinants of patients' satisfaction and functional outcome. Aims of the study were (1) to translate the Hospital for Special Surgery Hip Replacement Expectations Survey and Knee Replacement Expectations Survey into Dutch and (2) to study test-retest reliability and concurrent validity. Methods Patients scheduled for total hip (N = 112) or knee replacement (N = 101) were sent the Dutch Expectations Surveys twice with a 2 week interval to determine test-retest reliability. To determine concurrent validity, the Expectation WOMAC was sent. Results The results for the Dutch Hip Replacement Expectations Survey revealed good test-retest reliability (ICC 0.87), no bias and good internal consistency (alpha 0.86) (N = 72). The correlation between the Hip Expectations Score and the Expectation WOMAC score was 0.59 (N = 86). The results for the Dutch Knee Replacement Expectations Survey revealed good test-retest reliability (ICC 0.79), no bias and good internal consistency (alpha 0.91) (N = 46). The correlation with the Expectation WOMAC score was 0.52 (N = 57). Conclusions Both Dutch Expectations Surveys are reliable instruments to determine patients' expectations before total hip or knee arthroplasty. As for concurrent validity, the correlation between both surveys and the Expectation WOMAC was moderate confirming that the same construct was determined. However, patients scored systematically lower on the Expectation WOMAC compared to the Dutch Expectation Surveys. Research on patients' expectations before total hip and knee replacement has only been performed in a limited amount of countries. With the Dutch Expectations Surveys it is now possible to determine patients' expectations in another culture and healthcare setting.
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Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, Carr A. Factors associated with satisfaction in patients undergoing elbow surgery: a prospective study. J Shoulder Elbow Surg 2010; 19:635-44. [PMID: 20452243 DOI: 10.1016/j.jse.2010.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 02/03/2010] [Accepted: 02/08/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Evidence on factors associated with patient satisfaction with elbow surgery is sparse; outcomes of surgery are not necessarily related to patient satisfaction. This study explored the hypothesis that condition-specific outcome measures would more closely reflect patient satisfaction than generic measures. MATERIALS AND METHODS The prospective cohort comprised 104 consecutive patients/elbows undergoing elbow surgery. Preoperative and 6 month postoperative outcome questionnaires included the Oxford Elbow Score (OES), Disabilities of the Arm, Shoulder and Hand (DASH), and Short Form (SF)-36 general health survey. Clinical assessments used the standard Mayo Elbow Performance Score (MEPS). Patients who were "very pleased" with surgery were compared with others regarding which factors were associated with being "very pleased" at 6 months after surgery. RESULTS By 6 months, 54% of patients were very pleased with their surgery. Preoperative scores were generally not associated with subsequent patient satisfaction. Postoperative scores and change scores for the OES Pain and Social-Psychological scales and the DASH were moderately to highly correlated with patient satisfaction (r(s), -0.43 to -0.72; all P < .001), whereas SF-36 and MEPS change scores were only correlated to a small extent (r < or = 0.34; all P < .05). A multivariable analysis revealed that patients' age, postoperative elbow pain, and change in elbow function each independently influenced the odds of patients being very pleased with surgery. DISCUSSION Associations between outcome measures and patient satisfaction revealed likely differences between patients' and clinicians' perceptions of which aspects of outcome rated as important. CONCLUSIONS Patient-reported results are more likely than clinically assessed outcome measures, and condition-specific are more likely than generic measures, to reflect patient-rated satisfaction with elbow surgery.
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Affiliation(s)
- Jill Dawson
- Department of Public Health, University of Oxford, Oxford, UK.
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Suda AJ, Seeger JB, Bitsch RG, Krueger M, Clarius M. Are Patients' Expectations of Hip and Knee Arthroplasty Fulfilled? A Prospective Study of 130 Patients. Orthopedics 2010. [DOI: 10.3928/01477447-20100104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Suda AJ, Seeger JB, Bitsch RG, Krueger M, Clarius M. Are patients' expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics 2010; 33:76-80. [PMID: 20192137 DOI: 10.3928/01477447-20100104-07] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Total hip arthroplasty (THA) is the most successful procedure in orthopedic and trauma surgery. Patients' expectations of joint replacement surgery prior to and after the procedure are often discounted. This study investigated the expectations of patients before and 3 years after THA or total knee arthroplasty (TKA). A total of 130 patients (70 hips, 60 knees) received a modified FFbH-OA survey with 6 additional questions concerning patients' expectations before and 3 years after joint replacement surgery. The overall response rate was 78.8% (101 patients). Patients who underwent THA had a mean age of 63.7 years, and those who underwent TKA had a mean age of 67.4 years.Sixty-three percent of all respondents reported that their expectations had been fulfilled or exceeded 3 years postoperatively (THA, 65%; TKA, 61%). A high negative correlation in the THA group could be seen between patients' expectations and clinical scores: the lower the clinical score, the less the patient's expectations had been fulfilled. A statistically significant increase of change in personal relationships was found, as well as a statistically significant decrease in worries and less complications than had been expected before joint replacement.Thirty-seven percent of all respondents felt that their expectations regarding joint replacement had not been fulfilled. Looking at the results of this study, the 37% of patients whose expectations had not been fulfilled did not exhibit a lower postoperative functioning than those who were satisfied.
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Affiliation(s)
- Arnold J Suda
- Department of Orthopedic Surgery, University of Heidelberg, Heidelberg, Germany.
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Howell SM, Rogers SL. Method for quantifying patient expectations and early recovery after total knee arthroplasty. Orthopedics 2009; 32:884. [PMID: 19968214 DOI: 10.3928/01477447-20091020-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Many components of a surgeon's total knee arthroplasty (TKA) treatment regimen affect the rate of recovery, such as patient selection, preoperative education, surgical technique, pain management, and postoperative rehabilitation. Therefore, accurate counseling requires that the surgeon quantifies patient expectations and early recovery of the treatment regimen with a method that minimizes interviewer bias. Preoperatively and 4 to 5 weeks after TKA, 285 patients (306 consecutive primary TKAs) responded to a survey consisting of customized questions, the Oxford score, the SF-12, and Knee Society scores on a handheld data acquisition device. The average response to each question on the 4- to 5-week postoperative survey defined patient expectations, and the change in a response between the 4- to 5-week postoperative and the preoperative survey determined whether the surgical intervention improved the patient. At 4 to 5 weeks postoperatively, 80% of patients walked without a cane, 54% drove a car, 88% thought the treated knee was functioning better than before surgery, 93.5% thought the treated knee was normal or nearly normal, and 98% thought the alignment of their limb was "just right." By 4 to 5 weeks, patients experienced less pain and showed significant improvements in 11 of 12 activities queried by the Oxford score, SF-12 physical score, Knee function score, Knee Society score, and knee extension. Flexion was significantly less at 4 to 5 weeks, and the SF-12 mental score was not significantly different. Average hospital stay was 2 nights, with 98% discharged home. Surgeons should consider a method that minimizes interviewer bias to quantify patient expectations and rate of recovery of their specific treatment regimen, and then use this information to counsel their patients to avoid disappointment after TKA.
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Affiliation(s)
- Stephen M Howell
- Department of Mechanical Engineering, University of California, Davis, USA.
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Mannion AF, Kämpfen S, Munzinger U, Kramers-de Quervain I. The role of patient expectations in predicting outcome after total knee arthroplasty. Arthritis Res Ther 2009; 11:R139. [PMID: 19772556 PMCID: PMC2787271 DOI: 10.1186/ar2811] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 08/26/2009] [Accepted: 09/21/2009] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Patient's expectations are variably reported to influence self-rated outcome and satisfaction after medical treatment; this prospective study examined which of the following was the most important unique determinant of global outcome/satisfaction after total knee arthroplasty (TKA): baseline expectations; fulfillment of expectations; or current symptoms and function. METHODS One hundred and twelve patients with osteoarthritis of the knee (age, 67 +/- 9 years) completed a questionnaire about their expectations regarding months until full recovery, pain, and limitations in everyday activities after TKA surgery. Two years postoperatively, they were asked what the reality was for each of these domains, and rated the global outcome and satisfaction with surgery. Multivariable regression analyses using forward conditional selection of variables (and controlling for age, gender, other joint problems) identified the most significant determinants of outcome. RESULTS Patients significantly underestimated the time for full recovery (expected 4.7 +/- 2.8 months, recalled actual time, 6.1 +/- 3.7 months; P = 0.005). They were also overly optimistic about the likelihood of being pain-free (85% expected it, 43% were; P < 0.05) and of not being limited in usual activities (52% expected it, 20% were; P < 0.05). Global outcomes were 46.2% excellent, 41.3% good, 10.6% fair and 1.9% poor. In multivariable regression, expectations did not make a significant unique contribution to explaining the variance in outcome/satisfaction; together with other joint problems, knee pain and function at 2 years postoperation predicted global outcome, and knee pain at 2 years predicted satisfaction. CONCLUSIONS In this group, preoperative expectations of TKA surgery were overly optimistic. The routine analysis of patient-orientated outcomes in practice should assist the surgeon to convey more realistic expectations to the patient during the preoperative consultation. In multivariable regression, expectations did not predict global outcome/satisfaction; the most important determinants were other joint problems and the patient's pain and functional status 2 years postoperatively.
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Affiliation(s)
- Anne F Mannion
- Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland.
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LISKA WILLIAMD, DOYLE NANCYD. Canine Total Knee Replacement: Surgical Technique and One-Year Outcome. Vet Surg 2009; 38:568-82. [DOI: 10.1111/j.1532-950x.2009.00531.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mancuso CA, Graziano S, Briskie LM, Peterson MGE, Pellicci PM, Salvati EA, Sculco TP. Randomized trials to modify patients' preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res 2008; 466:424-31. [PMID: 18196427 PMCID: PMC2505138 DOI: 10.1007/s11999-007-0052-z] [Citation(s) in RCA: 200] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 11/02/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED Patients have multiple expectations of THA and TKA. We asked whether preoperative educational classes addressing recovery during the first year could modify patients' expectations of their 12-month postoperative recovery. Participants were enrolled consecutively in two randomized, controlled trials, one for THA (177 patients) and one for TKA (143 patients). Control patients preoperatively received a standard THA or TKA class addressing recovery immediately after surgery. Intervention patients preoperatively received the standard class plus a joint-specific module addressing recovery during the first 12 months. Before and after the class, patients completed either a hip-specific or knee-specific validated expectations survey. The main outcome was the within-patient change in expectation scores (maximum increase, +100; maximum decrease, -100) before and after the class but preoperatively. Mean changes in hip scores were +3.3+/-8 for intervention patients (range, -22+/-32) and +4.9+/-8 for control patients (range, -13+/-29). Mean changes in knee scores were -3.4+/-10 for intervention patients (range, -26+/-33) and +2.4+/-10 for control patients (range, -30+/-30). Patients' preoperative expectations of their recovery from THA or TKA can be modified by preoperative educational classes. LEVEL OF EVIDENCE Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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MESH Headings
- Adaptation, Psychological
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Humans
- Male
- Middle Aged
- Patient Education as Topic/methods
- Preoperative Care/methods
- Recovery of Function
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Affiliation(s)
- Carol A Mancuso
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Gandhi R, de Beer J, Petruccelli D, Winemaker M. Does patient perception of alignment affect total knee arthroplasty outcome? Can J Surg 2007; 50:181-6. [PMID: 17568489 PMCID: PMC2384287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE This study was designed to address a recurring observation in our centre that, despite a satisfactory postoperative radiographic limb alignment, some patients are dissatisfied with the alignment and appearance of their operated leg. We carried out a prospective survey to determine patient perception of limb alignment after total knee arthroplasty (TKA) and whether level of satisfaction with alignment affects clinical outcome. METHODS Patients self-rated their alignment, their satisfaction with alignment and their level of knee pain on a visual analogue scale (VAS). Additional outcome measures included pre- and postoperative Knee Society Score (KSS), Oxford Knee Score (OKS) and the Health Survey Short Form (SF-12). RESULTS Twenty of 87 (23%) patients were dissatisfied with their new leg alignment and had a poorer perception of pain and range of motion after TKA. Despite this finding, KSS and OKS were no different between patients who were satisfied and those who were dissatisfied with their limb alignment. The SF-12 showed a trend toward lower scores in patients who were dissatisfied with their limb alignment. CONCLUSIONS Satisfaction with perceived limb alignment appears to influence outcome after TKA and is not reflected in current outcome scales. Perhaps patients should be counselled on how alignment is restored and on what to expect of their limb alignment and appearance after TKA.
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Affiliation(s)
- Rajiv Gandhi
- Hamilton Arthroplasty Group, Hamilton Health Sciences Henderson Hospital, affiliated with the Faculty of Health Sciences, McMaster University, Hamilton, Ont, Canada
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Dreinhöfer KE, Dieppe P, Stürmer T, Gröber-Grätz D, Flören M, Günther KP, Puhl W, Brenner H. Indications for total hip replacement: comparison of assessments of orthopaedic surgeons and referring physicians. Ann Rheum Dis 2006; 65:1346-50. [PMID: 16439438 PMCID: PMC1798326 DOI: 10.1136/ard.2005.047811] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyse differences of opinions on indications for primary total hip replacements (THRs) within and between groups of orthopaedic surgeons and the physicians who refer patients to them. METHODS 22 orthopaedic centres in 12 European countries took part, resulting in a postal survey of 304 orthopaedic surgeons and 314 referring physicians. Each participant was asked to state what importance different domains (pain, functional impairment, physical examination and radiographs) have on their decision to recommend THR and to select the most appropriate level of severity of each symptom or sign for recommending THR. In addition, the participants were asked to prioritise other personal or environmental factors that affect their decision to undertake a THR. RESULTS Rest pain, pain with activity and functional limitations were the most important criteria for THR, although range of motion and radiographic changes were of least importance. Both similarities and differences were observed within and between groups of surgeons and referring physicians in the overall approach to indications and the most appropriate level of severity of disease for recommending THR. Most surgeons agreed on severity levels in only 4 of 11 items and most referring physicians in only one. Between the groups, major differences occurred with regard to the importance of activities of daily living and the appropriate level of symptoms for THR. In general, compared with surgeons, referring physicians reported that the disease needed to be more advanced to warrant surgery. CONCLUSION Currently, no consensus exists on objective indication criteria for THR. The observed differences between the gatekeepers (referring physicians) and surgeons can lead to variations and perhaps inequities in the provision of care.
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Affiliation(s)
- K E Dreinhöfer
- Department of Orthopaedic Surgery, University of Ulm, Germany
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Velanovich V, Kamolz T, Pointner R, Contini S. Qualitative analysis of the expectations of antireflux surgical outcomes of patients from different nationalities. Dis Esophagus 2006; 19:88-93. [PMID: 16643176 DOI: 10.1111/j.1442-2050.2006.00546.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient-reported outcomes have grown in importance in assessing the value of a variety of treatments. One of the methods of assessing patient-reported outcomes is qualitative analysis. The purpose of this study was to assess if qualitative analysis can be used to assess patient expectations for antireflux surgery in different nationalities. Patients referred for antireflux surgery (ARS) in the US, Austria and Italy were prospectively studied. Preoperatively, they were asked: (i) 'How do you expect the surgery to affect your symptoms?'; (ii) 'What do you expect the possible complications or side effects to be?' These patients then underwent open or laparoscopic antireflux surgery. At 2-3 months postoperatively, they were asked: (i) 'Are you satisfied with your surgery? If so, why? If not, why not?'; (ii) 'Did your surgery meet your expectations? If not, why not?' Twenty patients in the US, 24 in Austria, and 18 in Italy completed the study. Preoperatively, there were significant differences between the patients in demographics and objective measurements of GERD. Symptomatic relief was the most common expectation. There was variation in question #2, with Austrian and Italian patients more likely to mention conversion and postoperative side effects. Postoperatively, 90% of American, 88% of Austrian, and 89% of Italian patients were satisfied. Causes for dissatisfaction were postoperative complications, symptomatic recurrences, or side effects. Ninety percent of American, 96% of Austrian, and 94% of Italian patients said that their expectations were met. Patients who did not mention the possibility of side effects or complications were more likely to be dissatisfied. Qualitative analysis is a useful tool in assessing patient expectations. Expectations were remarkably similar. Patients who did not mention postoperative adverse events as possibilities preoperatively were more likely to be dissatisfied.
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Affiliation(s)
- V Velanovich
- Division of General Surgery, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA.
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Perka C, Tohtz S, Matziolis G. Achskorrektur bei Knietotalendoprothesenrevisionen. DER ORTHOPADE 2006; 35:136-42. [PMID: 16362140 DOI: 10.1007/s00132-005-0905-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Implant malalignment is a major cause for early loosening, increased wear, painful limitation of motion, and patient dissatisfaction in total knee arthroplasty. Validated diagnostic algorithms and a deeper understanding of the pathological mechanisms underlying functional deficits and pain resulting from malalignment explain the increasing number of revision operations on unloosened prostheses, which are now nearly as common as revisions for implant loosening. Common reasons are component malpositioning are a shifted joint line, or a non-physiological patella position. The success of any revision procedure basically depends on: (1) correct component positioning, (2) equal and symmetrical flexion and extension gaps, (3) restoration of joint line, and (4) a physiological patella height. The adequate grade of implant constraint has to be determined intra-operatively. A higher loosening rate of constrained implants as well as increased wear and painful limitation of motion in case of instability have to be taken into account. In the present work, a diagnostic and therapeutic algorithm for malalignment of knee prostheses is presented.
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Affiliation(s)
- C Perka
- Zentrum für Muskuloskeletale Chirurgie, Orthopädische Klinik, Charité, Universitätsmedizin, Berlin.
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Toyone T, Tanaka T, Kato D, Kaneyama R, Otsuka M. Patients' expectations and satisfaction in lumbar spine surgery. Spine (Phila Pa 1976) 2005; 30:2689-94. [PMID: 16319756 DOI: 10.1097/01.brs.0000187876.14304.15] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective consecutive series. OBJECTIVE To determine patient expectations in lumbar spine surgery and assess the level of fulfillment of those expectations. SUMMARY OF BACKGROUND DATA Little has been offered in the literature in specific regards to lumbar spine surgery. METHODS Ninety-eight patients, 49 patients who underwent discectomy for lumbar disc herniation (Group 1) and 49 patients who underwent laminotomy for lumbar spinal stenosis (Group 2), completed the self-report questionnaire. Preoperative expectations, reasons for surgery, and expected postoperative status were inquired before surgery and the satisfaction at 2 years after surgery. RESULTS Concerning patients' expectations, half of the patients expected to become completely leg pain free, and more than three fourths of the patients expected to become unlimited in their walking ability in both groups. More than half of the patients expected to have a 90% or greater chance of complete success of surgery. With regard to satisfaction, 42 of the 49 patients (86%) in Group 1 and 35 of the 49 patients (71%) in Group 2 chose "Surgery met my expectations" at the follow-up. The remaining patients selected "I did not improve as much as I had hoped." Positive expectations were associated with better satisfaction in Group 1 only. Of the patients who had achieved the expected postoperative status with respect to their no.1 reason for surgery, 2 of 34 patients in Group 1 (6%) and 5 of the 26 patients in Group 2 (19%) nonetheless reported "unfulfilled expectations." In patients whose no. 1 concern was further progression, 3 (38%) of the 8 patients in Group 1 and 2 (40%) of the 5 patients in Group 2 demonstrated unfulfilled expectations. CONCLUSIONS Even if the clinical expectations were met, some patients were still dissatisfied. Patients with spinal stenosis (Group 2) seem to have more unrealistic expectations than patients with disc herniation (Group 1).
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Affiliation(s)
- Tomoaki Toyone
- Division of Orthopaedic Surgery, Kimitsu Chuo Hospital, Kisarazu-city, Chiba, Japan.
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Bremander AB, Dunbar M, Knutson K, Petersson IF, Robertsson O. Revision in previously satisfied knee arthroplasty patients is the result of their call on the physician, not on pre-planned follow-up: a retrospective study of 181 patients who underwent revision within 2 years. Acta Orthop 2005; 76:785-90. [PMID: 16470430 DOI: 10.1080/17453670510045372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Degree of satisfaction with a knee arthroplasty is said to be correlated to reduced pain and better function. During a validation of the Swedish Knee Arthroplasty Register in 1997, previously operated patients were asked how satisfied they were with their knee. A subgroup of "satisfied" patients was identified who underwent revision within 2 years of having expressed satisfaction. Our aim was to study the revision diagnosis, to determine whether the problem leading to revision had been discovered as a result of routine follow-up, and also to find out when the symptoms leading to revision had started. METHODS We retrospectively studied the medical records of 181 patients (181 knees), with a median age of 74 (31-88) years. 68% were women and the median time between primary operation and revision was 8 (3-21) years. RESULTS Aseptic loosening (74/181) was the most common diagnosis. 2 cases were revised as a result of routine follow-up. 44% of the medical records included reports of pain in the replaced knee prior to answering the satisfaction questionnaire. INTERPRETATION Few patients were admitted to knee revision surgery due to medical findings discovered during routine follow-up. The term "satisfaction" must be interpreted with care, as it seems to have a more complex meaning for the patients than absence of knee pain.
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Affiliation(s)
- Ann B Bremander
- Department of Orthopedics, Lund University Hospital, Lund, SE-221 85, Sweden.
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Stürmer T, Dreinhöfer K, Gröber-Grätz D, Brenner H, Dieppe P, Puhl W, Günther KP. Differences in the views of orthopaedic surgeons and referring practitioners on the determinants of outcome after total hip replacement. ACTA ACUST UNITED AC 2005; 87:1416-9. [PMID: 16189319 DOI: 10.1302/0301-620x.87b10.16702] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to assess current opinions on the long-term outcome after primary total hip replacement, we performed a multicentre, cross-sectional survey in 22 centres from 12 European countries. Different patient characteristics were categorised into 'decreases chances', 'does not affect chances', and 'increases chances' of a favourable long-term outcome, by 304 orthopaedic surgeons and 314 referring practitioners. The latter were less likely to associate age older than 80 years and obesity with a favourable outcome than orthopaedic surgeons (p < 0.001 and p = 0.006, respectively) and more likely to associate age younger than 50 years with a favourable outcome (p = 0.006). Comorbidity, rheumatoid arthritis, and poor bone quality were thought to be associated with a decreased chance of a favourable outcome. We found important differences in the opinions regarding long-term outcome after total hip replacement within and between referring practitioners and orthopaedic surgeons. These are likely to affect access to and the provision of total hip replacement.
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Affiliation(s)
- T Stürmer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA
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Wylde V, Learmonth ID, Cavendish VJ. The Oxford hip score: the patient's perspective. Health Qual Life Outcomes 2005; 3:66. [PMID: 16259627 PMCID: PMC1283979 DOI: 10.1186/1477-7525-3-66] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 10/31/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the last 25 years, assessment of orthopaedic intervention has become patient focused, with the development of self-completion patient-centred outcome measures. The Oxford hip score (OHS) is a joint specific outcome measure tool designed to assess disability in patients undergoing total hip replacement (THR). Although the psychometric properties of the OHS have been rigorously examined, there is little research on the patient's perspective of the OHS. Therefore, the aim of this study is to assess whether the OHS is an adequate disability measure from the patient's perspective using qualitative analysis of annotations written on the OHS by patients. METHODS In total, 276 orthopaedic patients completed an OHS between April 2004 and May 2005. One hundred and fifty six pre-operative patients listed for a THR completed the OHS during a pre-admission assessment clinic, and 120 post-operative patients completed the OHS postally in the home setting. Patient's unprompted annotations in response to the questions on the OHS were recorded and grouped into thematic categories. RESULTS In total, 46 (17%) patients made 52 annotations when completing the OHS. These annotations identified five main areas of difficulty that patients experienced: lack of question clarity (particularly concerning the use of aids), difficulty in reporting measurements of pain, restrictive and irrelevant questions, the influence of co-morbidities on responses, and double-barrelled questions. CONCLUSION Although the OHS is a useful short tool for the assessment of disability in patients undergoing THR, this study identified several problem areas that are applicable to patient-centred outcome tools in general. To overcome these current limitations, further work is underway to develop a more individualised patient-centred outcome measure of disability for use in patients with osteoarthritis.
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Affiliation(s)
- Vikki Wylde
- Academic Orthopaedic Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB UK
| | - Ian D Learmonth
- Academic Orthopaedic Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB UK
| | - Victoria J Cavendish
- Academic Orthopaedic Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB UK
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McCarthy M, Jonasson O, Chang CH, Pickard AS, Giobbie-Hurder A, Gibbs J, Edelman P, Fitzgibbons R, Neumayer L. Assessment of patient functional status after surgery. J Am Coll Surg 2005; 201:171-8. [PMID: 16038812 DOI: 10.1016/j.jamcollsurg.2005.03.035] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Revised: 03/28/2005] [Accepted: 03/30/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Improvement in day-to-day functioning is a valued outcome of surgical intervention. A new functional status assessment instrument, the Activities Assessment Scale (AAS), was designed for a randomized clinical trial evaluating laparoscopic versus open hernia repair procedures. STUDY DESIGN The study data set included 2,164 patients at baseline and 1,562 patients at 3-month followup. Only male patients were enrolled in the trial. The psychometric characteristics of the AAS were examined in statistical analyses of cross-sectional and longitudinal data from the trial. Correlational analyses, factor analyses, and t-tests were used to evaluate scale performance. RESULTS We found that the AAS was a reliable measure (Cronbach's Coefficient Alpha =0.85) in the patient population studied. Factor analyses identified three subscales (sedentary activities; ambulatory activities; work and exercise activities). Construct validity was demonstrated by a correlation of 0.65 between the AAS and the physical functioning (PF) dimension of the SF-36 (p < 0.001); comparisons between clinical subgroups further confirmed its validity (p < 0.001). Patients reporting improvement on the physical functioning dimension after surgery showed an effect size of 1.20 for preoperative-postoperative change in their AAS scores. CONCLUSIONS The AAS has been demonstrated to be a reliable, valid, and clinically responsive instrument that can be used to evaluate patient functioning after hernia surgery. It is easy to administer and requires less than 5 minutes of patient time to complete. This measurement system may prove useful in assessing surgical outcomes in both research and office practice settings.
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Affiliation(s)
- Martin McCarthy
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Kazandjian VA, Wicker K, Ogunbo S, Silverman N. Understanding safer practices in health care: a prologue for the role of indicators. J Eval Clin Pract 2005; 11:161-70. [PMID: 15813713 DOI: 10.1111/j.1365-2753.2005.00516.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Patient safety and safer practices are central themes to many national strategies for accountability. The multinational Quality Indicator Project (QI Project) database is used to identify patterns of indicator use to measure safety of care in Asia, Europe, and the USA. The second objective is to assess, within the context of an indicator project, the usefulness of indicators to measure errors or mishaps. DESIGN AND SETTING This descriptive study retrospectively analyses indicator use patterns among hospitals in Asia, Europe, and the USA. The QI Project database is used for the 1999-2002 period. Statistical testing (P-value) of the differences in use percentages across five countries is based on 'country' rather than 'hospital' as the unit of analysis. RESULTS There was a significant increase in overall QI Project indicator use worldwide between 1999 and 2002. The average change in use was 6.8% for safety indicators and 4.2% for all other indicators. When analysed by country (USA, Austria, Belgium, UK, and Taiwan), the average increases in use percentage were highest in Taiwan and Belgium. When the country-specific differences were tested for significance, Taiwan showed the largest (and statistically significant) increase in safety indicator use between 1999 and 2002 (P<0.0001). In the USA, the rates of safety indicator use have decreased (P=0.0502) during the same time period. CONCLUSION This paper identifies, perhaps for the first time, how traditional indicators of hospital performance are being used to understand a hospital's performance and associated safety of care. Although the study's time frame is limited to 3 years, the findings seem to suggest that the interest in using these traditional indicators as proxies for safer practice measures is increasing among the QI Project participants worldwide. The challenge of using inherently value-free indicators as indicators of safety (hence de facto labelled as 'error' focused) should be further studied.
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