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Samant P, Tawde P, Tawde DN. Understanding How Patients With Lumbar Radiculopathy Make Sense of and Cope With Their Symptoms. Cureus 2024; 16:e56987. [PMID: 38665744 PMCID: PMC11045257 DOI: 10.7759/cureus.56987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Lumbar radiculopathy, characterized by pain radiating along a nerve root, significantly diminishes the quality of life due to its neuropathic nature. Patients' understanding of their illness and the coping strategies they employ directly influence how they manage their condition. Understanding these illness representations from the patient's perspective is crucial for healthcare providers seeking to optimize treatment outcomes. This study adopted a qualitative interpretive/constructive paradigm to explore this dynamic. A qualitative evidence synthesis approach, utilizing best-fit framework synthesis for data extraction, was applied to analyze primary qualitative studies focused on patient experiences with lumbar radiculopathy. Using SPiDER (Sample, Phenomenon of interest, Design, Evaluation, Research type) to guide the search strategy, extracted data was mapped against the Common-Sense Model of Self-Regulation (CSM) framework. Sixteen studies, with moderate to minor methodological quality concerns, were included in the analysis. Data mapping across CSM domains generated 14 key review findings. Results suggest that patients with high-threat illness representations often exhibit maladaptive coping behaviors (e.g., activity avoidance) driven by emotional responses. In contrast, problem-solving techniques appear to contribute to positive outcomes (e.g., exercise adherence and effective self-management) in patients who perceive their condition as less threatening. These findings highlight the potential benefits of interventions designed to reduce perceived threat levels and enhance self-efficacy in patients with lumbar radiculopathy, leading to improved self-management and ultimately better health outcomes.
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Affiliation(s)
- Pooja Samant
- Physical Therapy, Cardiff University, Cardiff, GBR
| | - Poonam Tawde
- Medicine, Avalon University School of Medicine, Willemstad, CUW
- Medicine, Chandler Regional Medical Center, Chandler, USA
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Dy CJ, Brogan DM, Lee SK, Desai MJ, Loeffler BJ, Tuffaha SH. The Influence of Psychosocial Factors on Disability and Expected Improvement Before Surgery for Adult Traumatic Brachial Plexus Injury. J Hand Surg Am 2023:S0363-5023(23)00302-7. [PMID: 37498270 PMCID: PMC10818022 DOI: 10.1016/j.jhsa.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Psychosocial factors influence pain and recovery after extremity trauma and may be targets for early intervention. This may be of particular interest for patients with adult traumatic brachial plexus injury (BPI), given the broad and devastating impact of the injury. We hypothesized that there would be an association between depressive symptoms, anxiety, and pain interference with preoperative disability and expectations for improvement after BPI surgery. METHODS We enrolled 34 patients into a prospective multicenter cohort study for those undergoing surgery for adult traumatic BPI. Before surgery, participants completed Patient-Reported Outcome Measurement Information System scales for pain interference, anxiety, and depressive symptoms, and a validated BPI-specific measure of disability and expected improvement. We performed Pearson correlation analysis between pain interference, anxiety symptoms, and depressive symptoms with (A) disability and (B) expected improvement. We created separate linear regression models for (A) disability and (B) expected improvement including adjustment for severity of plexus injury, age, sex, and race. RESULTS Among 34 patients, there was a moderate, statistically significant, correlation between preoperative depressive symptoms and higher disability. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. There was no association between severity of plexus injury and disability. Depressive symptoms also were moderately, but significantly, correlated with higher expected improvement. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. CONCLUSIONS Depressive symptoms are associated with greater disability and higher expected improvement before BPI surgery. Screening for depressive symptoms can help BPI teams identify patients who would benefit from early referral to mental health specialists and tailor appropriate expectations counseling for functional recovery. We did not find an association between severity of BPI and patient-reported disability, suggesting either that the scale may lack validity or that the sample is biased. LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Steve K Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Mihir J Desai
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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3
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Dandurand C, Urquhart J, Bailey CS, Ailon T, Charest-Morin R, Dea N, Dvorak M, Glennie A, Kwon BK, Paquette S, Rampersaud YR, Street JT, Hounjet C, Mashayekhi MS, Fisher CG. Patient's expectations of surgery for lumbar degenerative spondylolisthesis: analysis by type of surgery and patient factors from the Canadian Spine Outcomes and Research Network (CSORN). Spine J 2023:S1529-9430(23)00045-1. [PMID: 36764585 DOI: 10.1016/j.spinee.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/01/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND CONTEXT Preoperative expectations influence postoperative outcomes. Patients with lumbar degenerative spondylolisthesis have especially high expectations of pain relief and overall functional well-being compared to patients with lumbar stenosis. PURPOSE The primary objective was to analyze preoperative expectations of lumbar DS patients with respect to the type of surgery proposed (decompression vs decompression and fusion). Secondarily, we aimed to assess the associations between preoperative expectations and patient and clinical factors as well as postoperative expectations fulfillment. STUDY DESIGN/SETTING Patients were prospectively enrolled in a multicenter, prospective cohort study evaluating the assessment and management of degenerative spondylolisthesis utilizing the infrastructure of the Canadian Spine Outcomes and Research Network (CSORN) surgical registry. PATIENT SAMPLE Patients with a diagnosis of degenerative spondylolisthesis with symptoms of neurogenic claudication or radiculopathy with or without back pain, unresponsive to nonoperative management over at least 3 months were included. Patients who underwent decompression, decompression and posterolateral fusion or decompression and interbody fusion at Canadian spine centers between January 2015 and September 2021 were included. OUTCOME MEASURES The North American Spine Society Lumbar Spine Questionnaire was utilized for expectations measurement. The expectation questionnaire was completed following consent and before surgery and at 1 year. METHODS Expectations for pain relief and improvements in overall functional well-being were rated on a scale of 0 to 100. Preoperative expectation in terms of pain relief and functional well-being score were calculated. Multivariate linear regression was used to evaluate the association between expected preoperative patient factors and pain relief and functional well-being. The factors associated with the most important expectation were evaluated using multivariable multinomial logistic regression. RESULTS Three hundred fifty-two patients were included with 100 patients undergoing decompression and 252 patients also undergoing fusion. The seven items of preoperative expectations did not differ between the procedure groups nor did expected change. The mean pain relief and overall functional well-being expectation scores did not significantly differ between procedures. Higher expectations were associated with having more comorbidities [β=-2.0 (SE 0.8), p=.020], being physically active [β=8.4 (SE 3.2), p=.010] and having more leg pain [β=1.6 (SE 0.7), p=.015]. Better perceived physical health measured by SF12 PCS was associated with lower expectation of pain relief [β= -0.4 (SE 0.2), p=.039] and functional well-being [β=-0.84 (SE 0.2), p=.001]. Better perceived mental health measured by SF12 MCS was associated with lower expectation of functional well-being [β=-0.8 (SE 0.2), p=.001]. Postoperative expectations fulfillment did not differ between procedures. CONCLUSION Preoperative expectations in terms of pain relief and functional well-being were similar between the two most common procedures performed, decompression ± fusion. Secondarily, higher preoperative expectations were associated with greater pain, disability and being physically active. Expectations fulfillment did not differ between procedures.
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Mancuso CA. Editorial Commentary: Assessing Outcomes in Terms of Fulfillment of Patient Expectations Is Complementary to Traditional Measures Including Satisfaction. Arthroscopy 2022; 38:1876-1878. [PMID: 35660182 DOI: 10.1016/j.arthro.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
The topic of patients' expectations is receiving increasing attention as a patient-centered variable in preoperative orthopaedic assessment. Formally querying patients about expectations is necessary because surgeons may not be aware of these expectations, which often derive from multiple sources outside encounters with surgeons. Validated patient-derived surveys now exist for diverse orthopaedic surgeries to preoperatively measure expectations for improvement in symptoms and physical and psychological well-being. Assessing results of surgery in terms of fulfillment of these expectations is a patient-centered outcome that complements traditional measurements of satisfaction and pre- to postoperative change in symptoms and function. Validated follow-up surveys also now exist that ask patients for each item they expected before surgery, how much improvement have they actually received after surgery. The amount of improvement expected versus the amount of improvement received constitutes a measure of fulfilled expectations. The advantages of fulfillment of expectations as an outcome are that it prospectively includes both pre- and postoperative patients' perspectives and, because it is composed of multiple items, it can identify which symptoms and functions have improved to expected levels and which have not, thus providing the rationale for why patients rate outcomes the way they do. Therefore, measured in this way, postoperative fulfillment of expectations is a unique and novel patient-centered assessment for the comprehensive evaluation of orthopaedic surgical outcomes.
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Affiliation(s)
- Carol A Mancuso
- Hospital for Special Surgery and Weill Cornell Medical College
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5
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Deme P, Perera A, Chilakapati S, Stutzman S, Singh R, Eldridge CM, Caruso J, Vira S, Aoun SG, Makris UE, Bagley CA, Adogwa O. Patient and Spine Surgeon Perceptions on Shared Decision-Making in the Treatment of Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity. Spine (Phila Pa 1976) 2022; 47:730-6. [PMID: 34652306 DOI: 10.1097/BRS.0000000000004257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE To understand patients' and spine surgeons' perspectives about decision-making around surgery for adult spinal deformity. SUMMARY OF BACKGROUND DATA Surgery for correction of adult spinal deformity is often beneficial; however, in over 20% of older adults (≥ 65 yrs of age), outcomes from surgery are less desirable. MATERIALS AND METHODS We conducted semistructured, in-depth interviews with six patients and five spine surgeons. Two investigators independently coded the transcripts using constant comparative method, as well as an integrative, team-based approach to identify themes. RESULTS Patients themes: 1) patients felt surgery was their only choice because they were running out of time to undergo invasive procedures; 2) patients mentally committed to surgery prior to the initial encounter with their surgeon and contextualized the desired benefits while minimizing the potential risks; 3) patients felt that the current decision support tools were ineffective in preparing them for surgery; and 4) patients felt that pain management was the most difficult part of recovery from surgery. Surgeons themes: 1) surgeons varied substantially in their interpretations of shared decision-making; 2) surgeons did not consider patients' chronological age as a major contraindication to undergoing surgery; 3) there is a goal mismatch between patients and surgeons in the desired outcomes from surgery, where patients prioritize complete pain relief whereas surgeons prioritize concrete functional improvement; and 4) surgeons felt that patient expectations from surgery were often established prior to their initial surgery visit, and frequently required recalibration. CONCLUSION Older adult patients viewed the decision to have surgery as time-sensitive, whereas spine surgeons expressed the need for recalibrating patient expectations and balancing the risks and benefits when considering surgery. These findings highlight the need for improved understanding of both sides of shared decision-making which should involve the needs and priorities of older adults to help convey patient-specific risks and choice awareness. LEVEL OF EVIDENCE 3.
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Brusalis CM, Duculan R, Cammisa FP, Sama AA, Hughes AP, Mancuso CA, Girardi FP. Low Back Pain Versus Back-Related Leg Pain: How Do Patient Expectations and Outcomes of Lumbar Spine Surgery Compare? HSS J 2022; 18:83-90. [PMID: 35087337 PMCID: PMC8753548 DOI: 10.1177/15563316211010489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/28/2021] [Indexed: 02/03/2023]
Abstract
Background: An increasing number of lumbar spine conditions are treated surgically. Such intervention, however, is commonly thought to be more effective in addressing leg pain than low back pain. Patient expectations may also contribute to self-reported surgical outcomes. Questions/Purposes: We sought to compare the expectations of patients in 2 groups undergoing lumbar spine surgery: those with predominantly low back pain and those with predominantly leg pain. We also sought to evaluate how these expectations were fulfilled for each group. Methods: We carried out a retrospective analysis of prospectively collected data from a prior study in which patients scheduled for lumbar spine surgery at a single institution completed validated surveys preoperatively and at 2 years postoperatively, including a 20-item survey on expectations for lumbar spine surgery. The patients were enrolled in the study between February 2010 and August 2012, and were divided into 2 cohorts: a "Back > Leg" group that consisted of patients with back pain that was isolated or greater than leg pain, and a "Leg ≥ Back" group that consisted of patients with leg pain that equaled or exceeded back pain. The primary analysis compared composite expectation scores (range, 0-100) between groups. Results: A total of 366 patients were deemed eligible for the study; of these, 162 patients were allocated to the Back > Leg group and 204 patients were allocated to the Leg ≥ Back group. Patients in the Leg ≥ Back group had a greater mean preoperative expectation score compared with those in the Back > Leg group. Multivariate analysis demonstrated that higher preoperative expectations were associated with leg pain symptoms after controlling for disease diagnosis. Both groups reported similar proportions of fulfilled expectations. Conclusion: Patients with predominantly leg pain hold greater preoperative expectations for lumbar spine surgery than do patients with predominantly back pain. That these patient groups reported similar fulfillment of their expectations at 2 years postoperatively illustrates the greater clinical outcomes achieved among patients who presented with predominantly leg pain.
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Affiliation(s)
- Christopher M. Brusalis
- Hospital for Special Surgery, New York, NY, USA,Christopher M. Brusalis, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | | | | | | | | | - Carol A. Mancuso
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
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Bovonratwet P, Shen TS, Islam W, Sculco PK, Padgett DE, Su EP. Is There an Association Between Negative Patient-Experience Comments and Perioperative Outcomes After Primary Total Hip Arthroplasty? J Arthroplasty 2021; 36:2016-2023. [PMID: 33551144 DOI: 10.1016/j.arth.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Multiple stakeholders are interested in improving patient experience after primary total hip arthroplasty due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data. METHODS The records of 383 patients who underwent primary total hip arthroplasty between August 2016 and August 2019 were combined with vendor-supplied patient satisfaction data, which included patient free-text comments and the Press Ganey satisfaction survey. A total of 1295 patient comments were analyzed for sentiment, and negative comments were categorized into nine themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not. Multivariable regression was used to determine perioperative variables associated with providing a negative comment. RESULTS Of the 1295 patient comments: 54% were positive, 24% were negative, 10% were mixed, and 12% were neutral. Top two themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in studied outcomes (eg. peak pain intensity, length of stay, or improvements in hip injury and osteoarthritis outcome scores Jr. and pain visual analog scale scores at 6-week follow-up) between those who provided negative comments vs those who did not (P > .05). However, patients who made negative comments were less likely to recommend their hospital care to peers (P < .001). Finally, patients who had >2 allergies (P = .024) were more likely to provide negative comments. CONCLUSION The present study demonstrates that patient satisfaction appears not to be a reliable sole proxy for traditional objective outcome measures of pain relief and functional improvement.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Tony S Shen
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Wasif Islam
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Douglas E Padgett
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Edwin P Su
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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Glennie RA, Canizares M, Perruccio AV, Abraham E, Nicholls F, Nataraj A, Phan P, Attabib N, Johnson MG, Richardson E, McIntosh G, Ahn H, Fisher CG, Manson N, Thomas K, Rampersaud YR. The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study. J Neurosurg Spine 2021:1-8. [PMID: 34020418 DOI: 10.3171/2020.11.spine201490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients undergoing spine surgery generally have high expectations for improvement postoperatively. Little is known about how these expectations are affected by the diagnosis. The purpose of this study was to examine whether preoperative expectations differ based on diagnostic pathoanatomical patterns in elective spine surgery patients. METHODS Patients with common degenerative cervical/lumbar pathology (lumbar/cervical stenosis, lumbar spondylolisthesis, and cervical/lumbar disc herniation) who had given their consent for surgery were analyzed using the Canadian Spine Outcomes and Research Network (CSORN). Patients reported the changes they expected to experience postoperatively in relation to 7 separate items using a modified version of the North American Spine Society spine questionnaire. Patients were also asked about the most important item that would make them consider the surgery a success. Sociodemographic, lifestyle, and clinical variables were also collected. RESULTS There were 3868 eligible patients identified within the network for analysis. Patients with lumbar disc herniation had higher expectations for relief of leg pain compared with stenosis and lumbar degenerative spondylolisthesis cohorts within the univariate analysis. Cervical stenosis (myelopathy) patients were more likely to rank general physical capacity as their most important expectation from spine surgery. The multinomial regression analysis showed that cervical myelopathy patients have lower expectations for relief of arm or neck pain from surgery (OR 0.54, 0.34-0.88; p < 0.05). Patient factors, including age, symptoms (pain, disability, depression), work status, and lifestyle factors, were significantly associated with expectation, whereas the diagnoses were not. CONCLUSIONS Patients with degenerative spinal conditions consenting for spine surgery have high expectations for improvement in all realms of their daily lives. With the exception of patients with cervical myelopathy, patient symptoms rather than diagnoses had a more substantial impact on the dimensions in which patients expected to improve or their most important expected change. Determination of patient expectation should be individualized and not biased by pathoanatomical diagnosis.
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Affiliation(s)
- R Andrew Glennie
- 1Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia
| | - Mayilee Canizares
- 2The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario
| | - Anthony V Perruccio
- 2The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario
| | - Edward Abraham
- 3Department of Surgery, Dalhousie University.,11Canada East Spine Centre; and
| | - Fred Nicholls
- 4Department of Surgery, University of Calgary, Alberta
| | - Andrew Nataraj
- 5Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta
| | | | - Najmedden Attabib
- 3Department of Surgery, Dalhousie University.,12Department of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick
| | - Michael G Johnson
- 7Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba
| | - Eden Richardson
- 8Canadian Spine Outcomes and Research Network.,11Canada East Spine Centre; and
| | | | - Henry Ahn
- 9Department of Surgery, University of Toronto, Toronto, Ontario; and
| | - Charles G Fisher
- 10Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil Manson
- 3Department of Surgery, Dalhousie University.,11Canada East Spine Centre; and
| | | | - Y Raja Rampersaud
- 1Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia.,9Department of Surgery, University of Toronto, Toronto, Ontario; and
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bovonratwet P, Shen TS, Islam W, Ast MP, Haas SB, Su EP. Natural Language Processing of Patient-Experience Comments After Primary Total Knee Arthroplasty. J Arthroplasty 2021; 36:927-34. [PMID: 33127238 DOI: 10.1016/j.arth.2020.09.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is interest in improving patient experience after total knee arthroplasty (TKA) due to recent shifts toward value-based medicine. Patient narratives are a valuable but unexplored source of information. METHODS Records of 319 patients who had undergone primary TKA between August 2016 and August 2019 were linked with vendor-supplied patient satisfaction data, which included patient comments and the Press Ganey satisfaction survey. Using machine-learning-based natural language processing, 1048 patient comments were analyzed for sentiment and classified into themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not (positive, neutral, mixed grouped together). Multivariable regression was used to determine perioperative variables associated with providing a negative comment. RESULTS Of the 1048 patient comments, 25% were negative, 58% were positive, 8% were mixed, and 9% were neutral. Top 2 themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in most of the studied outcomes (eg, peak pain intensity, length of stay, or Knee Injury and Osteoarthritis Outcome Score Junior and pain scores at 6-week follow-up) between the 2 cohorts (P > .05). However, patients who made negative comments were less likely to highly recommend their hospital care to peers (P < .001). Finally, patients who had higher American Society of Anesthesiologists Score and those who received a scopolamine patch were more likely to provide negative comments (P < .05). CONCLUSION Although the current study showed that patient satisfaction might not be a proxy for traditional objective perioperative outcomes, efforts to improve the nontechnical aspects of medicine are still crucial in providing patient-centered care.
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Mancuso CA, Duculan R, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Yang J, Ghomrawi HMK, Girardi FP. Concordance Between Patients' and Surgeons' Expectations of Lumbar Surgery. Spine (Phila Pa 1976) 2021; 46:249-58. [PMID: 33156286 DOI: 10.1097/BRS.0000000000003775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVE The aims of this study were to measure concordance between patients' and surgeons' preoperative expectations of lumbar surgery, and determine which member of the dyad more closely predicted fulfillment of expectations, defined as patient-reported status postoperatively. SUMMARY OF BACKGROUND DATA Concordant patient-surgeon expectations reflect effective communication and should foster better outcomes. METHODS Preoperatively patients and surgeons completed identical surveys measuring expectations for improvement in symptoms and physical/psychosocial function. Responses ranged from "complete improvement" to "do not have this expectation"; scores for each survey ranged from 0 to 100 (greatest expectations). Concordance between pairs of patient-surgeon scores was measured with the intraclass correlation coefficient (ICC). Postoperatively, fulfillment of expectations was measured from patient-reported amount of improvement received and was calculated as the proportion of patient-reported postoperative score relative to patient-reported preoperative score, and surgeon-reported preoperative score (range 0 [no expectations fulfilled] to >1.2 [expectations surpassed]). Clinical measures included patient-reported spine-related disability. RESULTS For 402 patient-surgeon pairs, mean survey scores were 73 ± 19 (patients) and 57 ± 16 (surgeons); 84% of patients had higher scores than surgeons, mainly due to expecting complete improvement, whereas surgeons expected a lot/moderate/little improvement. The ICC for the entire sample was .31 (fair agreement); for subgroups, the greatest difference in ICC was for patients with more spine-related disability (ICC = .10, 95% confidence interval [CI]:0.00-0.23) versus less disability (ICC = .46, 95% CI: 0.34-0.56). 96% of patients were contacted ≥2.0 years postoperatively. Proportions of expectations fulfilled were 0.79 (0-3.00) (patients) and 1.01 (0-2.29) (surgeons). Thus patients were less likely to anticipate subsequent postoperative status (odds ratio [OR] 0.34, 95% CI 0.25-0.45) versus surgeons who were more likely to anticipate patient-reported postoperative status (OR 2.98, 95% CI: 2.22-4.00). CONCLUSION Concordance between patients' and surgeons' expectations was fair; due mostly to patients expecting complete improvement whereas surgeons expected a lot/moderate/little improvement. Compared to patients' expectations, surgeons' expectations more closely coincided with patient-reported fulfillment of expectations 2 years postoperatively.Level of Evidence: 1.
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Mancuso CA, Duculan RB, Cammisa FP, Sama AA, Hughes AP, Girardi FP. Unfulfilled Expectations After Surgery for Adult Lumbar Scoliosis Compared with Other Degenerative Conditions. HSS J 2020; 16:452-460. [PMID: 33380980 PMCID: PMC7749892 DOI: 10.1007/s11420-020-09812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients' expectations influence their decisions to undergo surgery for scoliosis, and fulfillment of expectations is an important patient-centered outcome. QUESTIONS/PURPOSES In a 2-year cohort study, we compared the proportion of expectations fulfilled based on the number of vertebrae involved in surgery between adult lumbar scoliosis patients and controls with other degenerative conditions. METHODS Patients pre-operatively completed a valid lumbar surgery expectations survey addressing expected improvements for symptoms, function, and psychosocial well-being (scores from 0 to 100; higher score indicates more expectations). Two years post-operatively, the patients completed another survey, this one recording how much improvement they actually experienced; fulfillment was defined as a proportion (i.e., received improvement/expected improvement). The range was 0 (none fulfilled) to > 1 (expectations surpassed). We further analyzed data according to the number of vertebrae involved in the surgery. RESULTS We included 42 scoliosis patients and 134 controls with similar mean ages (66 vs 64 years, respectively) and pre-operative expectations survey scores (72 vs 70, respectively). When we stratified by < 3 or ≥ 3 vertebrae, we found that the proportion of expectations fulfilled differed for scoliosis patients but not for controls. In multivariable analysis, lower proportion of expectations fulfilled was associated with greater pre-operative expectations, less improvement in pre- to post-operative disability, and the composite interaction of scoliosis and number of vertebrae. CONCLUSIONS Compared with controls, scoliosis patients who required surgery to a greater number of vertebrae were more likely to have unfulfilled expectations 2 years post-operatively. Our findings support the importance of addressing expectations pre-operatively with all patients, especially those with scoliosis who require surgery to ≥ 3 vertebrae.
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Affiliation(s)
- Carol A. Mancuso
- Research Division, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA ,Weill Cornell Medicine, New York, NY 10021 USA
| | - Roland B. Duculan
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Frank P. Cammisa
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Andrew A. Sama
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Alexander P. Hughes
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Federico P. Girardi
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
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Satteson ES, Roe AK, Eppler SL, Yao J, Shapiro LM, Kamal RN. Development and Testing of a Question Prompt List for Common Hand Conditions: An Exploratory Sequential Mixed-Methods Study. J Hand Surg Am 2020; 45:1087.e1-1087.e10. [PMID: 32693988 PMCID: PMC8080683 DOI: 10.1016/j.jhsa.2020.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE A question prompt list (QPL) is a tool that lists possible questions a patient may want to ask their surgeon. Its purpose is to improve patient-physician communication and increase patient engagement. Although QPLs have been developed in other specialties, one does not exist for hand conditions. We sought to develop a QPL for use in the hand surgery clinic using a mixed-methods design. METHODS We drafted a QPL based on prior work outside of hand surgery and then used an exploratory sequential mixed-methods design (both qualitative and quantitative methods) to finalize the QPL. Qualitative evaluation included both a written questionnaire completed by a patient advisory board, hand therapists, and hand surgeons, as well as cognitive interviews conducted with clinic patients using the tool. Revisions to the QPL were made after each phase of qualitative analysis. The final QPL was then evaluated quantitatively using the system usability score (SUS) questionnaire to assess its usability. RESULTS A patient advisory board consisting of 6 patients, 5 hand therapists, and 6 hand surgeons completed the written questionnaire. Thirteen patients completed a cognitive interview of the QPL. We completed a content analysis of the qualitative data and incorporated the findings into the QPL. Twenty patients then reviewed the final QPL pamphlet and completed the SUS questionnaire. The resulting SUS score of 78.8 indicated above-average usability of the QPL tool. CONCLUSIONS The QPL developed in this study, from the perspective of multiple stakeholders, provides a usable tool to engage and prompt patients in asking questions during their visit with their hand surgeon with the potential to improve communication and patient-centered care. CLINICAL RELEVANCE This study provides clinicians with a QPL developed for use in the hand surgery clinic setting, aimed at facilitating more thorough patient-provider discussion.
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Affiliation(s)
- Ellen S Satteson
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Allison K Roe
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Sara L Eppler
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA; Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
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Raad M, Harris AB, Puvanesarajah V, El Dafrawy MH, Kebaish FN, Neuman BJ, Skolasky RL, Cohen DB, Kebaish KM. Preoperative patient expectations and pain improvement after adult spinal deformity surgery. J Neurosurg Spine 2020; 33:496-501. [PMID: 32534485 DOI: 10.3171/2020.3.spine191311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients' expectations for pain relief are associated with patient-reported outcomes after treatment, although this has not been examined in patients with adult spinal deformity (ASD). The aim of this study was to identify associations between patients' preoperative expectations for pain relief after ASD surgery and patient-reported pain at the 2-year follow-up. METHODS The authors analyzed surgically treated ASD patients at a single institution who completed a survey question about expectations for back pain relief. Five ordinal answer choices to "I expect my back pain to improve" were used to categorize patients as having low or high expectations. Back pain was measured using the 10-point numeric rating scale (NRS) and Scoliosis Research Society-22r (SRS-22r) patient survey. Preoperative and postoperative pain were compared using analysis of covariance. RESULTS Of 140 ASD patients eligible for 2-year follow-up, 105 patients (77 women) had pre- and postoperative data on patient expectations, 85 of whom had high expectations. The mean patient age was 59 ± 12 years, and 46 patients (44%) had undergone previous spine surgery. The high-expectations and low-expectations groups had similar baseline demographic and clinical characteristics (p > 0.05), except for lower SRS-22r mental health scores in those with low expectations. After controlling for baseline characteristics and mental health, the mean postoperative NRS score was significantly better (lower) in the high-expectations group (3.5 ± 3.5) than in the low-expectations group (5.4 ± 3.7) (p = 0.049). The mean postoperative SRS-22r pain score was significantly better (higher) in the high-expectations group (3.3 ± 1.1) than in the low-expectations group (2.6 ± 0.94) (p = 0.019). CONCLUSIONS Despite similar baseline characteristics, patients with high preoperative expectations for back pain relief reported less pain 2 years after ASD surgery than patients with low preoperative expectations.
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Abstract
BACKGROUND To date, no study has assessed fulfillment of patients' expectations after foot and ankle surgery. This study aimed to validate a method of assessing expectation fulfillment in foot/ankle patients postoperatively. METHODS Preoperatively, patients completed the expectations survey, consisting of 23 questions for domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. The FP ranges from 0 (no expectations fulfilled), to between 0 and 1 (expectations partially fulfilled), to 1 (expectations met), to greater than 1 (expectations surpassed). Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) with 95% confidence intervals (CIs) were used to compare the expectations survey to other outcome surveys, including Foot and Ankle Outcome Score, improvement, overall fulfillment, Delighted-Terrible scale, and satisfaction. RESULTS Of the 271 patients (mean age 55.4 years, mean BMI 27.5, 65% female), 34% had expectations surpassed (FP >1), 4% had expectations met, 58% had expectations partially fulfilled (FP between 0 and 1), and 5% had no expectations met. The mean FP was 0.84 ± 0.41 (range 0-3.13), indicating partially fulfilled expectations. FP correlated significantly with all outcome measures (P ≤ .007). FP was associated most closely with satisfaction (r = 0.66 [95% CI 0.57-0.75]; AUC = 0.92 [95% CI 0.88-0.96]; P < .001) and improvement (r = 0.73 [95% CI 0.64-0.81]; AUC = 0.94 [95% CI 0.91-0.96]; P < .001). Based on the associations with satisfaction and improvement outcomes, a clinically important proportion of expectations fulfilled is 0.68, with sensitivity 0.85-0.90 and specificity 0.84-0.86. CONCLUSION The proportion of expectations fulfilled is a novel patient-centered outcome that correlated with validated outcome measures. The expectations survey may be used by surgeons to counsel patients preoperatively and also to assess patients' results postoperatively. LEVEL OF EVIDENCE Level II, prospective comparative series.
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Affiliation(s)
- Jensen K Henry
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew Roney
- Foot & Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth A Cody
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Amelia Hummel
- Foot & Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carol A Mancuso
- Clinical Epidemiology, Hospital for Special Surgery, New York, NY, USA
| | - Scott Ellis
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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