Expectations of recovery from revision knee replacement

Abstract

Objective. To evaluate outcome expectations of patients undergoing revision total knee replacement (TKR) and to examine personal factors, patient functioning, previous experiences with knee replacement surgery, concerns about surgery, and general health as predictors of expectations. Methods. Revision TKR patients (n ‫؍‬ 184, 54% women; mean age 69 years) completed a questionnaire up to 2 weeks before surgery. This included demographics, experience with previous knee surgery, concerns about surgery, the Life Orientation Test (LOT), the Arthritis Helplessness Scale, the Western Ontario and McMaster Universities Osteoarthritis Index, and a rating of overall health. Outcome expectations were evaluated as 5 questions assessing global benefit; relief of pain; ease of disability; expectations of having complications; and whether the person expected to be fully recovered from surgery in <6 months, 6 -12 months, >12 months, or did not expect to recover. Predictors of each of the 5 outcome expectations were evaluated using univariable and multivariable regression analyses. Results. Expectations are a multidimensional construct (Cronbach's ␣ ‫؍‬ 0.63). Expectation of global benefit of surgery was high, but was lower for benefits related to ease of pain and improved function. Concerns about surgery were a consistent predictor of all expectation outcomes in multivariable modeling. When concerns about surgery and general health were entered into the model as an interaction with expectation of recovery time as the outcome, past experience (P ‫؍‬ 0.05), pain (P ‫؍‬ 0.03), LOT (P ‫؍‬ 0.03), and interaction between concerns about surgery and general health were significant predictors. Conclusion. Clinicians need to understand and help patients shape appropriate expectations for recovery from revision TKR.

Patient expectations for surgical outcome in extremity soft tissue sarcoma

“…Similar to what has been reported in Journal of Surgical Oncology Defined as patients having an incomplete primary excision at a peripheral hospital prior to their definitive surgery at a study center. other surgical populations, patients' expectations were generally high, with almost 50% of our cohort expecting a short, uncomplicated recovery and no difficulty performing daily activities post-operatively [19,28,29,33,34]. However, we also found that a significant percentage of our patients did not know what to expect regarding their postoperative recovery.…”

“…Outcome expectations have been defined as the ''physical, social and self-evaluative expectations one holds for the outcome of one's behaviors'' [18], and have been linked to post-operative analgesic use, rehabilitation compliance, functional recovery, and satisfaction with outcomes [16,19]. In general, patients achieve better health outcomes when they have positive, realistic outcome expectations (high outcome expectancy) and when they believe they can successfully execute the behaviors needed to generate these outcomes (high self-efficacy) [16][17][18][19][20][21].…”

Measuring Expectations in Orthopaedic Surgery: A Systematic Review

“…Thirteen different clinical assessment tools modified for the evaluation of expectations were identified (Table 3) [2, 13,15,19,23,25,33,39,40,43,44,46,61,65]. All of the modified instruments were designed for self-administration by patients.…”

“…All of the modified instruments were designed for self-administration by patients. Excluding the modified Total Hip Arthroplasty Outcome Evaluation Questionnaire [13,33,40,65], all of the instruments were only used in a single study identified in our review. Twenty studies used custom questionnaires developed by the authors to assess patient expectations without any explicit description of the methodology, rationale, or source instrument behind their development [3, 5, 10, 12, 14, 16, 20, 22, 27, 28, 30-32, 45, 52, 53, 57, 64, 66, 68].…”

Patient expectations of second primary joint replacement surgery

“…9 Few studies have been directed towards identifying the patient level predictors of higher expectations with surgery. 20 Factors such as geographic location, 21 older age, 22 and male gender 22 have been identified as predictors of higher patient expectations. We found no relationship between patient demographic data such as age, gender, body mass index, and comorbidity and expectations of contralateral TJR.…”