Measuring Expectations in Orthopaedic Surgery: A Systematic Review

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.

Patients’ perspective on surgical intervention for Dupuytren’s disease – experiences, expectations and appraisal of results

“…There has been an increasing interest in considering patients' expectations of orthopaedic procedures, with a focus on pain, physical, social and psychological function [37]. However, evidence concerning the importance of fulfilment of preoperative expectations is inconclusive [38].…”

experience of preoperative patient education for women preparing for and recovering from total knee replacement

“…In theory, patients have increased ability before surgery to learn and prepare for surgery, more significant opportunity to address questions, greater opportunity for meaningful engagement, and less anxiety (McDonald, Hetrick, & Green, 2004;McDonald, Page, Beringer, Wasiak, & Sprowson, 2014). TKA surgeries are complex and often daunting for patients who increasingly have high expectations and complex needs (Zywiel, Mahomed, Gandhi, Perruccio, & Mahomed, 2013). Likewise, providers may not only be able to better educate patients, but also create opportunities to build connections amongst providers, patients, and hospitals.…”

“…Research suggests that surgical outcomes and patient satisfaction with the surgery are strongly correlated with patient expectations (Zywiel et al, 2013). They noted that as TKA has progressed from a measure for severely debilitated patients to a more widely adopted treatment, the expanded application of the surgery has led expectations for outcomes to change dramatically.…”

“…Patient expectations can be viewed from two dimensions: "they can be probabilistic reflecting the perceived likelihood… alternatively, related to a particular outcome or event" (Zywiel et al, 2013). The assimilation of information by study participants resulted in a probabilistic view of expectations.…”

Graft tensioning in anterior cruciate ligament reconstruction

“…Thus, a focus on improving surgical technique is essential to achieving optimal patient outcomes (Irrgang, 2008;Paxton, Kymes, & Brophy, 2010;Zywiel, Mahomed, Gandhi, Perruccio, & Mahomed, 2013).…”