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The Importance of Patient Expectations in Predicting Functional Outcomes After Total Joint Arthroplasty
NIZAR N. MAHOMED, MATTHEW H. LIANG, EARL F. COOK, LAWREN H. DALTROY, PAUL R. FORTIN, ANNE H. FOSSEL, and JEFFREY N. KATZ
ABSTRACT.
Methods. This prospective cohort study included patients undergoing primary total hip (THA) and knee arthroplasty (TKA). Patients were evaluated with self-report questionnaires prior to surgery and 6 months post-surgery. Medical Outcomes Study Short Form 36 (SF-36), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and a satisfaction scale were used to evaluate outcomes at final followup. Multivariate regression models were used to evaluate the impact of expectations on outcomes. Results. There were 102 patients with THA and 89 with TKA. Mean age was 66 years. All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery. Patient expectations regarding surgery were not associated with their age, gender, index joint of surgery, marital status, or race. Expectations were not correlated with pre-operative functional health status. Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery. Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction. Conclusions. Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA. Greater understanding of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA. (J Rheumatol 2002;29:1273-9) Key Indexing Terms:
HIP
From the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, the Department of Health Administration, University of Toronto, Toronto, ON, Canada; and the Division of Rheumatology and Immunology, and Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital, Boston, MA, USA. Supported in part by NIH Grant no. AR36308, an Arthritis Foundation Investigator Award (to Dr. Katz) and a Hip Hip Hooray Grant of the Canadian Orthopaedic Foundation. Dr. Mahomed is a recipient of the Canadian Arthritis Society Research Fellowship No. 95035, and Health Services Research Fellowship from the American Academy of Orthopaedic Surgeons and the Orthopaedic Research and Education Foundation. Dr. Fortin is a Junior Research Scholar of the Canadian Arthritis Society. N.N. Mahomed, MD, ScD, FRCSC, Division of Orthopaedic Surgery, Toronto Western Hospital and Department of Health Administration, University of Toronto; M.H. Liang, MD, MPH, Division of Rheumatology and Immunology; E.F. Cook, MD; L.H. Daltroy, DRPH, Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital; P.R. Fortin, MD, MPH, Division of Rheumatology, Toronto Western Hospital; A.H. Fossel; J.N. Katz, MD, MSc, Division of Rheumatology and Immunology, and Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital. Address reprint requests to Dr. N.N. Mahomed, Toronto Western Hospital, 399 Bathurst Street, ECW 1-002, Toronto, ON, Canada M5T 2S8. Submitted November 2, 2000; revision accepted November 11, 2001. |