Satisfaction With the Process vs Outcome of Care in Total Hip and Knee Arthroplasty

Kahlenberg, Cynthia A.; Gibbons, John A.; Mehta, Bella; Antao, Vinicius C.; Lai, Emily Ying; Hương, Trần Thu; Russell, Linda; Sculco, Peter K.; Figgie, Mark P.; Goodman, Susan M.

doi:10.1016/j.arth.2021.11.010

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…Our results regarding patient satisfaction are within the spectrum of current TKA studies or registry reports [4, 10, 34, 35]. The results are also consistent with other CIM TKA studies.…”

Section: Discussionsupporting

confidence: 90%

Satisfaction after total knee arthroplasty: a prospective matched‐pair analysis of patients with customised individually made and off‐the‐shelf implants

Vogel,

Kaelin,

Rychen

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Customised individually made (CIM) total knee arthroplasty (TKA) was introduced to potentially improve patient satisfaction and other patient-reported outcome measures (PROMs). The purpose of this study was to compare PROMs, especially patient satisfaction, of patients with CIM and OTS TKA in a matched-pair analysis with a 2-year follow-up. Methods This is a prospective cohort study with a propensity score matching of 85 CIM and 85 off-the-shelf (OTS) TKA. Follow-up was at 4 months, 1 year and 2 years. The primary outcome was patient satisfaction. Secondary outcomes were as follows: overall improvement, willingness to undergo the surgery again, Knee injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score (FJS-12), High-Activity Arthroplasty Score (HAAS), EQ-5D-3L, EQ-VAS, Knee Society Score (KSS) and surgeon satisfaction. Results Patient satisfaction ranged from 86 to 90% and did not differ between CIM and OTS TKA. The EQ-VAS after 4 months and the HAAS after 1 year and 2 years were higher for CIM TKA. KOOS, FJS-12 and EQ-5D-3L were not different at follow-up. The changes in KOOS symptoms, pain and daily living were higher for OTS TKA. The KSS was higher for patients with CIM TKA. Surgeon satisfaction was high throughout both groups. Patients who were satisfied after 2 years did not differ preoperatively from those who were not satisfied. Postoperatively, all PROMs were better for satisfied patients. Patient satisfaction was not correlated with patient characteristics, implant or preoperative PROMs, and medium to strongly correlated with postoperative PROMs. Conclusion Patient satisfaction was high with no differences between patients with CIM and OTS TKA. Both implant systems improved function, pain and health-related quality of life. Patients with CIM TKA showed superior results in demanding activities as measured by the HAAS. Level of evidence II, prospective cohort study.

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“…Our results regarding patient satisfaction are within the spectrum of current TKA studies or registry reports [4, 10, 34, 35]. The results are also consistent with other CIM TKA studies.…”

Section: Discussionsupporting

confidence: 90%

Satisfaction after total knee arthroplasty: a prospective matched‐pair analysis of patients with customised individually made and off‐the‐shelf implants

Vogel,

Kaelin,

Rychen

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…53 However, while satisfaction is often discussed as a global construct, satisfaction with the process and outcome of care may not be associated and should be measured separately for more targeted quality improvement. 54 Similar to our work, a 2012 paper presented a theory of change model for overarching TJR care (including 'joint class'), which the authors used to guide a qualitative evaluation of patients' perioperative experiences. 43 While that model included similar concepts of health literacy, anxiety and satisfaction, the authors did not specify how they developed their model.…”

Section: Logisticsmentioning

confidence: 88%

“…Assessment of patient satisfaction has been specifically advocated as a meaningful TJR metric since it can encompass a wide range of multidimensional outcomes 53 . However, while satisfaction is often discussed as a global construct, satisfaction with the process and outcome of care may not be associated and should be measured separately for more targeted quality improvement 54 …”

Section: Discussionmentioning

confidence: 99%

Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

Herrera

Stern

Russo

et al. 2023

Evaluation Clinical Practice

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RationalePreoperative patient education through ‘joint class’ has potential to improve quality of care for total joint replacement (TJR). However, no formal guidance exists regarding curriculum content, potentially resulting in inter‐institutional variation.ObjectiveWe aimed to (a) synthesize curriculum components of ‘joint classes’ across high‐volume institutions and (b) develop a preliminary theory of change model for development and evaluation guided by the existing curricula and related literature.MethodsWe reviewed ‘joint class’ curricula from the websites of the 10 highest‐volume TJR centres (by average annual 2017–2019 volume) that publicly disclosed this information. Two reviewers qualitatively compared available content and noted common categories, which were synthesized into key domains across institutions. We then reviewed the PubMed database for literature on pre‐TJR patient education and education needs in the past 10 years. Drawing on our curriculum synthesis and related literature, we proposed a theory of change model: hypothesized mechanisms through which ‘joint class’ confers benefits to patients and health systems.ResultsWe identified 30 categories in our review of existing class content, which we synthesized into seven key domains: (I) Practical Elements, (II) Logistics, (III) Medical Information, (IV) Modifiable Risk Factors, (V) Expected Outcomes, (VI) Patient Role in Recovery and (VII) Enhanced Education. Variation across institutions was noted. Our preliminary model based on the curriculum synthesis and related literature on the impact of ‘joint class’ includes three levels: (1) Practical Elements (‘joint class’ accessibility and information quality), (2) Class Goals (increased health literacy, increased adherence, risk mitigation, realistic expectations, and reduced anxiety) and (3) Target Outcomes (improved clinical outcomes, positive patient experience and increased patient satisfaction).ConclusionOur synthesis identified core common topics included in pre‐TJR education but also highlighted variation across institutions, supporting opportunities for standardization. Clinicians and researchers can use our preliminary model to systematically develop and evaluate ‘joint classes,’ with the goal of establishing a standard of care for TJR preoperative education.

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“…Quality care assessments meant to evaluate physician performance may be biased against practices that have this kind of high-risk patients. Previous research is limited but has indicated that patients’ perception of care may be more connected to interpersonal communication than quality 26 , 27 . In a clinical setting, being a repeat patient appears to be the strongest known predictor of satisfaction.…”

Section: Discussionmentioning

confidence: 99%

The obesity challenge in joint replacement: a multifaceted analysis of self-reported health status and exercise capacity using NHANES data: a population-based study

Zhang,

Shen,

Bai

et al. 2024

International Journal of Surgery

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Background: Joint replacement is successful for end-stage osteopathy, with obesity linked to evaluated risk. But the impact of obesity on self-reported health and exercise capacity among joint replacement patients remains complex and requires investigation. Methods: This study utilizes data from the National Health and Nutrition Examination Survey (NHANES) to examine the relationship between obesity severity, demographic factors, medical comorbidities, and self-reported health status. The relationship between general health status and BMI was analyzed using multivariable regression, and further illustrated using a restricted cubic spline. Additionally, a bibliometric analysis and systemic review was done to frame the research within the broader context of existing knowledge and demographic specifics. Results: Analysis of NHANES data involving 327 joint replacement patients yielded intriguing insights. The difference in self-reported health between BMI groups did not achieve conventional statistical significance (P=0.06), and multivariable analysis showed that even severely obese patients did not exhibit significantly elevated risk of poor/fair self-reported health compared to normal weight subjects. Among severely obese individuals (BMI>40), 40.63% still rated their health positively. However, stratified analyses indicated that obesity correlated with negative health reports across gender, age, and education strata. Notably, physical functioning emerged as a robust predictor of self-reported health, with those reporting no walking difficulties having significantly lower odds of poor/fair health (Odds Ratio=0.37, P=0.01). Conclusion: The study highlights the need for healthcare providers to consider individual physical abilities and comorbidities alongside obesity severity when discussing treatment options with joint replacement patients. It supports tailored interventions and informed shared decision-making. Future research could explore effective weight management strategies for obese individuals undergoing joint replacement.

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Satisfaction With the Process vs Outcome of Care in Total Hip and Knee Arthroplasty

Cited by 7 publications

References 17 publications

Satisfaction after total knee arthroplasty: a prospective matched‐pair analysis of patients with customised individually made and off‐the‐shelf implants

Satisfaction after total knee arthroplasty: a prospective matched‐pair analysis of patients with customised individually made and off‐the‐shelf implants

Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

The obesity challenge in joint replacement: a multifaceted analysis of self-reported health status and exercise capacity using NHANES data: a population-based study

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