Patient expectations, outcomes and satisfaction: related, relevant or redundant?

Abstract

Study design: A prospective case series of patients undergoing lumbar spine surgery.Objective: Is there a correlation between patients' expectations before lumbar surgery, postoperative outcomes, and satisfaction levels?Methods: A prospective study of 145 patients undergoing primary, single-level surgery for degenerative lumbar conditions was conducted. Oswestry Disability Index, back Visual Analog Scale (VAS), and leg VAS were assessed preoperatively and at 6 weeks and 6 months after surgery. Patients' expectations were measured preoperatively by asking them to score the level of pain and disability that would be least acceptable for them to undergo surgery and be satisfied. Satisfaction was assessed 6 weeks postoperatively with a Likert scale. Differences in patient expectations between actual and expected improvements were quantified.Results: Most patients had a clinically relevant improvement, but only about half achieved their expectations. Satisfaction did not correlate with preoperative pain or disability, or with patient expectation of improvement. Instead, satisfaction correlated with positive outcomes.Conclusions: Patient expectations have little bearing on final outcome and satisfaction.Final class of evidence-treatmentStudy design RCT Cohort Case control Case series•Methods Concealed allocation (RCT) Intention to treat (RCT) Blinded/independent evaluation of primary outcome F/U ≥ 85%• Adequate sample size• Control for confoundingOverall class of evidenceIVThe definiton of the different classes of evidence is available on page 67.

Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis

“…8,13 Patient expectations have been studied for lumbar stenosis. 9,10,21 Lutz et al reported that patients with better expectations from their surgery had better outcomes after discectomy for disc herniation. 11 In contrast, McGregor and colleagues reported that patients undergoing spinal stenosis surgery frequently had unrealistically high expectations from their surgery and tended to have lower levels of satisfaction; 14,15 similarly, Toyone et al reported that patients with spinal stenosis tend to have more unrealistic and, consequently, unfulfilled expectations.…”

Instruments used in the assessment of expectation toward a spine surgery: an integrative review

“…The methodological characteristics of the articles found are similar, with 16 observational studies (9)(10)(13)(14)(18)(19)(20)(21)(22)24,26,(30)(31)(32)(33)(34) ; six prospective cohorts (25,(27)(28)34,(36)(37) ; one retrospective cohort (38) , one quasi-experimental study (35) , and one experimental study (29) . The use of instruments occurred in the immediate preoperative period in 21 studies that assessed patients' expectations (10,14,(18)(19)(20)(21)(22)(23)(24)(25)(26)(28)(29)(30)(31)(32)(33) , whereas in two studies it occurred when the patient received the indication of surgical treatment (9,27) , one study used them in the intermediate preoperative period (13) ; finally, one study completed the instrument after the patient underwent a spine surgery (34) . Three catego...…”

“…The studies were published between 1998 and 2015 and, in general, publications on this subject increased in the last five years (9)(10)14,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) . The methodological characteristics of the articles found are similar, with 16 observational studies (9)(10)(13)(14)(18)(19)(20)(21)(22)24,26,(30)(31)(32)(33)(34) ; six prospective cohorts (25,(27)(28)34,(36)(37) ; one retrospective cohort (38) , one quasi-experimental study (35) , and one experimental study (29) . The use of instruments occurred in the immediate preoperative period in 21 studies that assessed patients' expectations (10,14,(18)(19)(20)(21)(22)…”

“…After all, when patients are realistically questioned about their expectations, it is possible to avoid utopic results, to narrow the gaps between the preoperative and postoperative periods, and to contribute to a better management of health status and each patient's needs (9,38) . Researchers from countries that do not have instruments available to assess expectations have opted for the use of the VAS to measure how much the patient hopes to improve after spine surgery (21)(22)(23)36) . The use of the VAS has been shown to detect small changes over time, and clinically significant changes.…”

“…In four of the 17 articles in this category, the researchers used the VAS as a way to measure expectation (21)(22)(23)36) , seven studies used a Likert scale (24,(26)(27)32,(34)(35)37) , and finally, in six studies the researchers created closed-ended questions addressing patients' expectations toward surgery (18,25,29,31,33,38) . Of these studies, in most cases, patients' expectation facing their main symptoms, such as pain, muscle function, and sensitivity (18, Instruments used in the assessment of expectation toward a spine surgery: an integrative review the general state of health, overall success of the surgery and recovery (23,29,31,33,35,36) ; two studies evaluated return to work (24,31) , and one assessed the social role (18) .…”