The achievement of pre-operative expectations in patients undergoing knee arthroplasty: a cohort study evaluating unique patient goals.
Knee arthroplasty
Objectives/Goals
Osteoarthritis
Patient expectation
Journal
Journal of patient-reported outcomes
ISSN: 2509-8020
Titre abrégé: J Patient Rep Outcomes
Pays: Germany
ID NLM: 101722688
Informations de publication
Date de publication:
06 Jun 2024
06 Jun 2024
Historique:
received:
29
11
2023
accepted:
19
05
2024
medline:
6
6
2024
pubmed:
6
6
2024
entrez:
6
6
2024
Statut:
epublish
Résumé
Total knee arthroplasty (TKA) is a common procedure employed to treat end-stage osteoarthritis. While TKA is generally believed to have acceptable outcomes, many patients report pain or functional deficits not in line with their expectation following the procedure. It has been postulated that patient's pre-operative expectations regarding post-operative treatment outcomes play a significant role in satisfaction. It is therefore important to assess if the outcomes of surgery truly align with patient's individual expectations. Thus, the purpose of this study was to determine the degree to which patient expectations of TKA are achieved and the contribution of TKA to achieving patient goals one year after surgery. A consecutive sample of 110 patients booked for total knee arthroplasty were asked to identify their most important goals to inform the Direct Questioning of Objectives Index (DQO Index, range 0 to 1) and identify their surgical goals and grade their expectation that a knee arthroplasty would achieve each goal on an 11-point scale. One year after surgery, the DQO Index was repeated to assess their current ability to achieve each pre-operative goal, and asked to estimate the contribution of their knee arthroplasty in achieving each goal. Mean differences between baseline and one year follow-up were calculated regarding the DQO Index and expected achievement of pre-operative goals. According to the DQO Index at one year, patients improved from a poor quality of life pre-operatively (mean ± standard deviation: 0.20 ± 0.18) to moderately high quality of life (mean ± standard deviation: 0.71 ± 0.21) reflecting a large improvement in ability to achieve each goal. Although achievement improved, for each goal, the patient estimates of the extent to which the knee arthroplasty had contributed to achieving the goal was lower than their initial expectation provided pre-operatively (mean difference range: 0.6 to 1.9 on an 11-point scale). Patients undergoing TKA have high expectations that their surgery will address their primary goals. Despite surgery largely achieving these goals (improved pain and function), the extent to which the goals were achieved was lower than patients had expected pre-operatively.
Sections du résumé
BACKGROUND
BACKGROUND
Total knee arthroplasty (TKA) is a common procedure employed to treat end-stage osteoarthritis. While TKA is generally believed to have acceptable outcomes, many patients report pain or functional deficits not in line with their expectation following the procedure. It has been postulated that patient's pre-operative expectations regarding post-operative treatment outcomes play a significant role in satisfaction. It is therefore important to assess if the outcomes of surgery truly align with patient's individual expectations. Thus, the purpose of this study was to determine the degree to which patient expectations of TKA are achieved and the contribution of TKA to achieving patient goals one year after surgery.
METHODS
METHODS
A consecutive sample of 110 patients booked for total knee arthroplasty were asked to identify their most important goals to inform the Direct Questioning of Objectives Index (DQO Index, range 0 to 1) and identify their surgical goals and grade their expectation that a knee arthroplasty would achieve each goal on an 11-point scale. One year after surgery, the DQO Index was repeated to assess their current ability to achieve each pre-operative goal, and asked to estimate the contribution of their knee arthroplasty in achieving each goal. Mean differences between baseline and one year follow-up were calculated regarding the DQO Index and expected achievement of pre-operative goals.
RESULTS
RESULTS
According to the DQO Index at one year, patients improved from a poor quality of life pre-operatively (mean ± standard deviation: 0.20 ± 0.18) to moderately high quality of life (mean ± standard deviation: 0.71 ± 0.21) reflecting a large improvement in ability to achieve each goal. Although achievement improved, for each goal, the patient estimates of the extent to which the knee arthroplasty had contributed to achieving the goal was lower than their initial expectation provided pre-operatively (mean difference range: 0.6 to 1.9 on an 11-point scale).
CONCLUSION
CONCLUSIONS
Patients undergoing TKA have high expectations that their surgery will address their primary goals. Despite surgery largely achieving these goals (improved pain and function), the extent to which the goals were achieved was lower than patients had expected pre-operatively.
Identifiants
pubmed: 38842595
doi: 10.1186/s41687-024-00734-8
pii: 10.1186/s41687-024-00734-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
56Informations de copyright
© 2024. Crown.
Références
Carr A, Robertsson O, Graves S, Price A, Arden N, Judge A et al (2012) Knee Replace Lancet 379(9823):1331–1340. https://doi.org/10.1016/s0140-6736(11)60752-6
doi: 10.1016/s0140-6736(11)60752-6
pubmed: 22398175
Stone O, Duckworth A, Curran D, Ballantyne J, Brenkel I (2017) Severe arthritis predicts greater improvements in function following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(8):2573–2579. https://doi.org/10.1007/s00167-015-3806-2
doi: 10.1007/s00167-015-3806-2
pubmed: 26441252
Skou S, Roos E, Laursen M, Rathleff M, Arendt-Nielsen L, Simonsen O et al (2015) A randomized, controlled trial of total knee replacement. N Engl J Med 373(17):1597–1606. https://doi.org/10.1056/NEJMoa1505467
doi: 10.1056/NEJMoa1505467
pubmed: 26488691
Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ et al (2021) Clinical course of pain and function following total knee arthroplasty: a systematic review and meta-regression. J Arthroplasty 36(12):3993–4002e37. https://doi.org/10.1016/j.arth.2021.06.019
doi: 10.1016/j.arth.2021.06.019
pubmed: 34275710
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32(12):3854–3860. https://doi.org/10.1016/j.arth.2017.07.021
doi: 10.1016/j.arth.2017.07.021
pubmed: 28844632
Adie S, Harris I, Chuan A, Lewis P, Naylor JM (2019) Selecting and optimising patients for total knee arthroplasty. Med J Aust 210(3):135–141. https://doi.org/10.5694/mja2.12109
doi: 10.5694/mja2.12109
pubmed: 30656689
Mancuso CA, Sculco TP, Wickiewicz TL, Jones EC, Robbins L, Warren RF et al (2001) Patients’ expectations of knee surgery. J Bone Joint Surg Am 83(7):1005–1012. https://doi.org/10.2106/00004623-200107000-00005
doi: 10.2106/00004623-200107000-00005
pubmed: 11451969
Neuprez A, Delcour JP, Fatemi F, Gillet P, Crielaard JM, Bruyère O et al (2016) Patients’ expectations impact their satisfaction following total hip or knee arthroplasty. PLoS ONE 11(12):e0167911. https://doi.org/10.1371/journal.pone.0167911
doi: 10.1371/journal.pone.0167911
pubmed: 27977711
pmcid: 5158008
Wright JG, Santaguida PL, Young N, Hawker GA, Schemitsch E, Owen JL (2010) Patient preferences before and after total knee arthroplasty. J Clin Epidemiol 63(7):774–782. https://doi.org/10.1016/j.jclinepi.2009.08.022
doi: 10.1016/j.jclinepi.2009.08.022
pubmed: 20004554
Mannion AF, Kämpfen S, Munzinger U, Kramers-de Quervain I (2009) The role of patient expectations in predicting outcome after total knee arthroplasty. Arthritis Res Ther 11(5):R139. https://doi.org/10.1186/ar2811
doi: 10.1186/ar2811
pubmed: 19772556
pmcid: 2787271
Sepucha KR, Stacey D, Clay CF, Chang Y, Cosenza C, Dervin G et al (2011) Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation. BMC Musculoskelet Disord 12:149. https://doi.org/10.1186/1471-2474-12-149
doi: 10.1186/1471-2474-12-149
pubmed: 21729315
pmcid: 3146909
Karunaratne S, Harris IA, Trevena L, Horsley M, Solomon M (2021) Observing the use of knee arthroplasty appropriateness tools in clinical practice: do appropriateness criteria tools predict surgeon decision-making? Osteoarthritis Cartilage 29(9):1275–1281. https://doi.org/10.1016/j.joca.2021.06.009
doi: 10.1016/j.joca.2021.06.009
pubmed: 34217825
Kriston L, Scholl I, Hölzel L, Simon D, Loh A, Härter M (2010) The 9-item Shared decision making questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns 80(1):94–99. https://doi.org/10.1016/j.pec.2009.09.034
doi: 10.1016/j.pec.2009.09.034
pubmed: 19879711
Sullivan MJL, Bishop SR, Pivik J (1995) The pain catastrophizing scale: development and validation. Psychol Assess 7(4):524–532. https://doi.org/10.1037/1040-3590.7.4.524 . 32
doi: 10.1037/1040-3590.7.4.524
Detsky AS, McLaughlin JR, Abrams HB, L’Abbe KA, Whitwell J, Bombardier C et al (1986) Quality of life of patients on long-term total parenteral nutrition at home. J Gen Intern Med 1(1):26–33. https://doi.org/10.1007/bf02596321
doi: 10.1007/bf02596321
pubmed: 3095514
Byrne CM, Pager CK, Rex J, Roberts R, Solomon MJ (2002) Assessment of quality of life in the treatment of patients with neuropathic fecal incontinence. Dis Colon Rectum 45(11):1431–1436. https://doi.org/10.1007/s10350-004-6444-1
doi: 10.1007/s10350-004-6444-1
pubmed: 12432287
McLeod RS, Churchill DN, Lock AM, Vanderburgh S, Cohen Z (1991) Quality of life of patients with ulcerative colitis preoperatively and postoperatively. Gastroenterology 101(5):1307–1313. https://doi.org/10.1016/0016-5085(91)90081-u
doi: 10.1016/0016-5085(91)90081-u
pubmed: 1936801
Karunaratne S, Harris IA, Horsley M, Trevena L, Solomon M (2024) Establishing a hierarchy of total knee arthroplasty patients’ goals and its congruity to health professionals’ perceptions: a cohort study. ANZ J Surg 94(1–2):234–240. https://doi.org/10.1111/ans.18817
doi: 10.1111/ans.18817
pubmed: 38071494
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The strengthening the reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008
doi: 10.1016/j.jclinepi.2007.11.008
Machin D, Campbell M, Fayers P, Pinol A (1997) Sample size tables for clinical studies, 2nd edn. Blackwell Science, Malden, MA
Zar J (1984) Biostatistical analysis, 2nd edn. Prentice-Hall, Englewood Cliffs, New Jersey
Lange T, Schmitt J, Kopkow C, Rataj E, Günther KP, Lützner J (2017) What do patients expect from total knee arthroplasty? A Delphi consensus study on patient treatment goals. J Arthroplasty 32(7):2093. https://doi.org/10.1016/j.arth.2017.01.053 . 9.e1
doi: 10.1016/j.arth.2017.01.053
pubmed: 28259490
Wunderlich F, Eckhard L, Büttner M, Lange T, Konradi J, Betz U et al (2022) The INDICATE knee expectations survey detects general patient treatment goals for total knee arthroplasty and the influence of demographic factors on patients expectations. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07012-4
doi: 10.1007/s00167-022-07012-4
pubmed: 35687147
pmcid: 9958169
Lützner C, Postler A, Beyer F, Kirschner S, Lützner J (2019) Fulfillment of expectations influence patient satisfaction 5 years after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27(7):2061–2070. https://doi.org/10.1007/s00167-018-5320-9
doi: 10.1007/s00167-018-5320-9
pubmed: 30547305
Conner-Spady BL, Bohm E, Loucks L, Dunbar MJ, Marshall DA, Noseworthy TW (2020) Patient expectations and satisfaction 6 and 12 months following total hip and knee replacement. Qual Life Res 29(3):705–719. https://doi.org/10.1007/s11136-019-02359-7
doi: 10.1007/s11136-019-02359-7
pubmed: 31741216
Toye FM, Barlow J, Wright C, Lamb SE (2006) Personal meanings in the construction of need for total knee replacement surgery. Soc Sci Med 63(1):43–53. https://doi.org/10.1016/j.socscimed.2005.11.054
doi: 10.1016/j.socscimed.2005.11.054
pubmed: 16473445
Rastogi R, Davis AM, Chesworth BM (2007) A cross-sectional look at patient concerns in the first six weeks following primary total knee arthroplasty. Health Qual Life Outcomes 5:48. https://doi.org/10.1186/1477-7525-5-48
doi: 10.1186/1477-7525-5-48
pubmed: 17678532
pmcid: 1950700
Neogi T (2013) The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 21(9):1145–1153. https://doi.org/10.1016/j.joca.2013.03.018
doi: 10.1016/j.joca.2013.03.018
pubmed: 23973124
pmcid: 3753584
Bunzli S, O’Brien P, Klem N, Incoll I, Singh J, Davaris M et al (2020) Misconceived expectations: patient reflections on the total knee replacement journey. Musculoskelet Care 18(4):415–424. https://doi.org/10.1002/msc.1475
doi: 10.1002/msc.1475
Leung L (2015) Validity, reliability, and generalizability in qualitative research. J Family Med Prim Care 4(3):324–327. https://doi.org/10.4103/2249-4863.161306
doi: 10.4103/2249-4863.161306
pubmed: 26288766
pmcid: 4535087
Australian Orthopaedic Assosciation National Joint Replacement Registry (2021) Hip, knee & shoulder arthroplasty: 2021 annual report. https://aoanjrr.sahmri.com/annual-reports-2021 . Accessed 15 Dec 2022
Nutbeam D (2000) Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 15(3):259–267. https://doi.org/10.1093/heapro/15.3.259
doi: 10.1093/heapro/15.3.259
Saposnik G, Redelmeier D, Ruff CC, Tobler PN (2016) Cognitive biases associated with medical decisions: a systematic review. BMC Med Inf Decis Mak 16(1):138. https://doi.org/10.1186/s12911-016-0377-1
doi: 10.1186/s12911-016-0377-1
Solomon MJ, Pager CK, Keshava A, Findlay M, Butow P, Salkeld GP et al (2003) What do patients want? Patient preferences and surrogate decision making in the treatment of colorectal cancer. Dis Colon Rectum 46(10):1351–1357. https://doi.org/10.1097/01.Dcr.0000084432.45536.83
doi: 10.1097/01.Dcr.0000084432.45536.83
pubmed: 14530674
Harrison JD, Solomon MJ, Young JM, Meagher A, Butow P, Salkeld G et al (2008) Patient and physician preferences for surgical and adjuvant treatment options for rectal cancer. Arch Surg 143(4):389–394. https://doi.org/10.1001/archsurg.143.4.389
doi: 10.1001/archsurg.143.4.389
pubmed: 18427027
van der Sluis G, Jager J, Punt I, Goldbohm A, Meinders MJ, Bimmel R et al (2021) Current status and future prospects for shared decision making before and after total knee replacement surgery: a scoping review. Int J Environ Res Public Health 18(2). https://doi.org/10.3390/ijerph18020668
Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z et al (2017) A three-talk model for shared decision making: multistage consultation process. BMJ 359:j4891. https://doi.org/10.1136/bmj.j4891
doi: 10.1136/bmj.j4891
pubmed: 29109079
pmcid: 5683042
National Health Service (2017) Patient reported outcome measures (PROMs) in England: a guide to PROMs methodology. https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/patient-reported-outcome-measures-proms . Accessed 18 Nov 2022
Rolfson O, Wissig S, van Maasakkers L, Stowell C, Ackerman I, Ayers D et al (2016) Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and knee osteoarthritis Working Group. Arthritis Care Res (Hoboken) 68(11):1631–1639. https://doi.org/10.1002/acr.22868
doi: 10.1002/acr.22868
pubmed: 26881821
Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB et al (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 4(4):Cd001431. https://doi.org/10.1002/14651858.CD001431.pub5
doi: 10.1002/14651858.CD001431.pub5
pubmed: 28402085
Karunaratne S, Harris IA, Trevena L, Horsley M, Fajardo M, Solomon M (2021) Online decision aids for knee arthroplasty: an environmental scan. JBJS Rev 9(4). https://doi.org/10.2106/jbjs.Rvw.20.00088