Associations between positive treatment outcome expectations, illness understanding, and outcomes: a cohort study on non-operative treatment of first carpometacarpal osteoarthritis

Abstract

Purpose: More positive outcome expectations and illness perceptions are associated with better outcomes for patients with several osteoarthritic orthopedic conditions. However, it is unknown whether these factors also influence outcomes of non-operative treatment for first carpometacarpal osteoarthritis (CMC-1 OA). Therefore, we assess the role of pre-treatment outcome expectations and illness perceptions in reports of pain and hand function 3 months after non-operative treatment for CMC-1 OA. Materials and methods: We conducted a cohort study with 219 patients treated non-operatively for CMC-1 OA between September 2017 and October 2018. Patients were included in the study if they completed measures of pain and hand function, illness perceptions (scale: 0-10), and expectations (scale: 3-27) as part of routine outcome measurements. Pain and hand function were measured before treatment and 3 months after starting treatment using the Dutch version of the Michigan Hand Outcomes Questionnaire. Multivariable linear regression analysis was used to assess the influence of outcome expectations and illness perceptions on pain and hand function. Results: Both positive outcome expectations (B ¼ 0.64; 95% CI [0.1-1.2]) and a better illness understanding (an illness perception subdomain; B ¼ 1.53; 95% CI [0.2-2.9]) at baseline were associated with less pain at 3 months. For hand function, similar estimates were found. Conclusions: We found that positive outcome expectations and a better illness understanding, were associated with a better outcome of non-operative treatment for CMC-1 OA. ä IMPLICATIONS FOR REHABILITATIONNon-operative treatment can often be successful for patients with arthritis of the thumb. Outcome expectations and illness perceptions are associated with pain and hand function 3 months after non-operative treatment for thumb base osteoarthritis. Improving the outcome expectations and illness perceptions of patients through better education could improve the outcome of non-operative treatment.

The Ultrashort Mental Health Screening Tool Is a Valid and Reliable Measure With Added Value to Support Decision-making

“…The mental health screening tool explained a substantial part of the variance in pain and hand function at baseline and 3 months. This highlights, in line with other studies [3-5, 8, 9, 12, 14-16, 18, 19, 25, 28, 30, 31, 33, 35, 36], the importance of mental health and its relation to treatment decisions and outcomes. The models with only the screening tool items performed nearly as well as the models using the full mental health measures (that is, the entire PCS, PHQ-4, and B-IPQ), which further substantiates the validity of our tool.…”

“…In musculoskeletal healthcare, patient mental health has gained attention in recent years. Numerous studies have demonstrated that mental health factors influence symptoms, outcomes, and treatment choices [3-5, 8, 9, 12, 14-16, 18, 19, 25, 28, 30, 31, 33, 35, 36]. For example, patients with thumb-base osteoarthritis scheduled for surgery have worse psychologic profiles than their nonsurgical counterparts [37], suggesting that domains of mental health play an important role in choosing between surgical and nonsurgical treatment.…”

Treatment Invasiveness and Illness Perceptions Are Strongly Associated With Outcome Expectations in Patients Treated for Hand or Wrist Conditions: A Cross-sectional Study

“…Multiple studies have shown that more-positive outcome expectations are associated with better treatment outcomes [ 1 , 5 , 6 , 8 , 23 , 27 , 33 ], and there is an interest in positively modifying outcome expectations to improve treatment outcomes. However, little was known about factors independently associated with outcome expectations.…”

“…Although some studies suggested expectations of medical treatments are already too high and should be tempered by the clinician to cultivate realistic expectations for the patient [ 13 , 19 , 24 , 35 ], several meta-analyses have found that patients with more-positive pretreatment expectations achieve better outcomes [ 1 , 5 , 6 , 27 ]. Additionally, in patients treated for hand or wrist conditions, more-positive expectations have been reported to be associated with better outcomes [ 8 , 23 , 33 ]. In addition, positive expectations of the treatment outcomes are considered a key mechanism of placebo effects [ 20 , 30 ].…”

Reply to the Letter to the Editor: Machine Learning Can be Used to Predict Function but Not Pain After Surgery for Thumb Carpometacarpal Osteoarthritis

“…We fully agree with the letter authors on the importance of considering the psychological profiles of patients when predicting outcomes after surgical treatment of the first carpometacarpal with osteoarthritis (CMC-1 OA). Our research group previously published on the association between psychological profile and patientreported outcome measures before and after nonsurgical treatment for CMC-1 OA [3,9,10]. We therefore included several psychological variables as possible predictors for our models, including the PHQ-4 for depression and anxiety.…”