Differences between Patientsʼ and Physiciansʼ Evaluations of Outcome after Total Hip Arthroplasty*

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

“…This was true regardless of whether the status was expressed as global outcome, the COMI multidimensional outcome score, or satisfaction with treatment for the back problem. This confirms the findings of previous studies in patients after hip arthroplasty, in which the discrepancy between patient and physician assessments (physician better rating than patient) was even greater when the patient was not completely satisfied with the result [1,6]. These authors considered various potential explanations for this phenomenon, most notably concerning the notion of the patient and surgeon having different expectations regarding what could be achieved by the surgery, and different opinions as to what constitutes success.…”

“…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.…”

“…Work disability: 1 (none) to 5 (max) 2.9 ± 1.8 2.2 ± 1.6 2.4 ± 1.7 \0.0001 COMI composite score: 0 (best status) to 10 (worst status) 5.8 ± 2.4 3.8 ± 2. notable difference of opinion or misunderstanding between patient and surgeon, especially when compared with the reported discrepancies in outcome ratings between patient and physician of only 13% after hip arthroplasty [6] or 31% after shoulder arthroplasty [16]. One explanation that immediately comes to mind relates to the fact that arthroplasty surgery has a long history of successful development, and is well standardised, worldwide.…”

“…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]. To the authors' knowledge, no study has investigated this issue in any depth in patients undergoing spine surgery.…”

Do Psychological Factors Predict Poor Outcome in Patients Undergoing TKA? A Systematic Review

“…Surgeon rating and patient rating of success after surgery differ and may not correlate [10]. The divergence becomes more pronounced in patients who are dissatisfied with the outcome of their procedure [32]. Our systematic review showed that preoperative psychological factors influence patients' postsurgical outcomes, including persistent pain, reduced level of function, and overall satisfaction with the procedure.…”