Higher Patient Expectations Predict Higher Patient-Reported Outcomes, But Not Satisfaction, in Total Knee Arthroplasty Patients: A Prospective Multicenter Study

Jain, Deeptee; Nguyen, Long Co L.; Bendich, Ilya; Nguyen, Long L.; Lewis, Courtland G.; Huddleston, James I.; Duwelius, Paul J.; Feeley, Brian T.; Bozic, Kevin J.

doi:10.1016/j.arth.2017.01.008

Cited by 83 publications

(88 citation statements)

References 27 publications

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“…Specifically, for every 10‐unit increase in the HSS expectations score, the risk of TKR failure declined 16%. A recent study showed an association between HSS expectations scores and patient‐reported outcome measures and activity levels in the year after surgery , and prior studies have suggested that blacks have lower preoperative expectations . Patient expectations have been shown to correlate with health literacy , but the relationship between health literacy and health disparities has not yet been well established .…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

Bass

Mehta

Szymonifka

et al. 2019

Arthritis Care & Research

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Objective To determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Methods Black and white New York state residents, enrolled in a prospective single‐institution TKR registry January 1, 2008 to February 6, 2012, who underwent primary unilateral TKR (n = 4,062) were linked to the New York Statewide Planning and Research Cooperative System database (January 1, 2008 to December 31, 2014) to capture revisions performed at outside institutions. Patients were linked by geocoded addresses to residential census tracts. Multivariable Cox regression was used to assess predictors of TKR revision. Multivariable logistic regression was used to analyze predictors of TKR failure, defined as TKR revision in New York state ≤2 years after surgery, or as Hospital for Special Surgery (HSS) TKR quality of life score “not improved” or “worsened” 2 years after surgery. Results The mean ± SD age was 68.4 ± 10 years, 64% of patients were female, 8% lived in census tracts with >20% of the population under the poverty line, and 9% were black. Median follow‐up time was 5.3 years. A total of 3% of patients (122 of 4,062) required revision a median 454 days (interquartile range 215–829) after surgery. TKR revision risk was higher in blacks than whites, with a hazard ratio of 1.69 (95% confidence interval 1.01–2.81), but in multivariable analysis, only younger age, male sex, and constrained prosthesis were predictors of TKR revision. TKR failure occurred in 200 of 2,832 cases (7%) with 2‐year surveys. Risk factors for TKR failure were non‐osteoarthritis TKR indication, low surgeon volume, and low HSS Expectations Survey score, but not black race. Community poverty was not associated with TKR revision or failure. Conclusion There was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

Bass

Mehta

Szymonifka

et al. 2019

Arthritis Care & Research

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“…Patients' expectations have previously been shown to play an important role in postoperative satisfaction [8,9,19,22,24,28,29,31,37,43], but these studies do not define the patients' expectations, nor do they explain how to address them. The studies do agree about using individualized enquiry regarding patient expectations.…”

Section: Discussionmentioning

confidence: 99%

“…Quantitative designs have been used to assess patient satisfaction after TKA in previous studies [3, [6][7][8][9][10][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], but to our knowledge no qualitative studies have examined patient´s experience of discontentment after TKA. The few studies addressing patient satisfaction have focused on the importance of patient education and information before and after surgery [23,[32][33][34][35][36][37].…”

Section: Introductionmentioning

confidence: 99%

Patients’ experiences of discontentment one year after total knee arthroplasty- A qualitative study

Mahdi

Svantesson

Wretenberg

et al. 2019

Preprint

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Background Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are discontented without known explanation. Contentment and discontentment have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the discontentment rate. Methods Of the 348 patients who responded to a letter asking if they were contented or discontented with their surgery, 61 (18%) reported discontentment. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment one year after total knee arthroplasty. Results The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and need for buttresses. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a need for buttresses, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient contentment after surgery.

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Section: Introductionmentioning

confidence: 99%

Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study

Mahdi

Svantesson

Wretenberg

et al. 2020

BMC Musculoskelet Disord

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Background: Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients' experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate. Methods: Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients' experiences of discontentment 1 year after total knee arthroplasty. Results: The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion: Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.

show abstract

Higher Patient Expectations Predict Higher Patient-Reported Outcomes, But Not Satisfaction, in Total Knee Arthroplasty Patients: A Prospective Multicenter Study

Cited by 83 publications

References 27 publications

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

Patients’ experiences of discontentment one year after total knee arthroplasty- A qualitative study

Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study

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