Comparison of Patient and Doctor Responses to a Total Hip Arthroplasty Clinical Evaluation Questionnaire

Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree?

“…A further difference between the present study and others [12,16], that would explain our more pronounced surgeon-patient discrepancies, is the fact that the patients and surgeons conducted their appraisals completely independently of each other. This contrasts with three previous studies, in which the patient completed the questionnaire in the waiting room immediately prior to the consultation [6,12,16].…”

“…This contrasts with three previous studies, in which the patient completed the questionnaire in the waiting room immediately prior to the consultation [6,12,16]. In some of these studies, the doctor then discussed an identical questionnaire with the patient [16] and/or completed it in the patient's presence [12,16]; in others, even if the patient's evaluation was not available for the physician to review and the physician completed his/her questionnaire after the patient's visit, he/she was still aware that the patient had just evaluated the result of the operation [6]. These factors, and the acute awareness that the ''accuracy'' of the ratings was being subject to investigation, may-whether consciously or otherwise-have biased the outcome ratings given by the surgeons, leading them to proffer less ''enthusiastic'' ratings than normal.…”

“…McGee et al [12] found that, in relation to hip arthroplasty, agreement was less good in older patients, for whom the outcome tended to be overestimated by the surgeon. Another study, however, has shown that surgeons feel more warmth and enthusiasm for older patients [5], and this greater empathy might be expected to lead to better agreement, not to an underestimation of an individual's health problems.…”

“…Despite this, a number of studies in the area of hip, knee and shoulder arthroplasty have shown a substantial degree of agreement between patient and physician assessments of outcome [1,12,13,16], although not without fail [14]. Smith et al [16] reported a high level of agreement between patients' and surgeons' ratings of pain, function and satisfaction in a group of patients who were followedup at least 6 months after shoulder arthroplasty.…”

“…Smith et al [16] reported a high level of agreement between patients' and surgeons' ratings of pain, function and satisfaction in a group of patients who were followedup at least 6 months after shoulder arthroplasty. Another study compared the results from a 16-item clinical evaluation questionnaire after hip arthroplasty: for 12 items, acceptable consensus was found, although for patients with other health problems, revision surgery or mild to moderate pain there was a greater likelihood of disagreement [12]. Generally, where disagreement has been recorded in these studies, it is the case that the clinician systematically overrates outcome or underrates symptoms compared with the patient [11,12,16] and the discrepancy is more marked the more senior the clinician [11] and the poorer the patients' outcome [1,6].…”