Patients With Higher Treatment Outcome Expectations Are More Satisfied With the Results of Nonoperative Treatment for Thumb Base Osteoarthritis: A Cohort Study

Abstract

To investigate how satisfaction with treatment outcome is associated with patient mindset and Michigan Hand Outcome Questionnaire (MHQ) scores at baseline and 3 months in patients receiving nonoperative treatment for first carpometacarpal joint (CMC-1) osteoarthritis (OA). Design: Cohort study Setting: A total of 20 outpatient locations of a clinic for hand surgery and hand therapy in the Netherlands. Participants: Patients (NZ308) receiving nonoperative treatment for CMC-1 OA, including exercise therapy, an orthosis, or both, between September 2017 and February 2019. Interventions: Nonoperative treatment (ie, exercise therapy, an orthosis, or both) Main Outcome Measures: Satisfaction with treatment outcomes was measured after 3 months of treatment. We measured total MHQ score at baseline and at 3 months. As baseline mindset factors, patients completed questionnaires on treatment outcome expectations, illness perceptions, pain catastrophizing, and psychological distress. We used multivariable logistic regression analysis and mediation analysis to identify factors associated with satisfaction with treatment outcomes. Results: More positive pretreatment outcome expectations were associated with a higher probability of being satisfied with treatment outcomes at 3 months (odds ratio, 1.15; 95% confidence interval, 1.07-1.25). Only a relatively small part (33%) of this association was because of a higher total MHQ score at 3 months. None of the other mindset and hand function variables at baseline were associated with satisfaction with treatment outcomes. Conclusions: This study demonstrates that patients with higher pretreatment outcome expectations are more likely to be satisfied with treatment outcomes after 3 months of nonoperative treatment for CMC-1 OA. This association could only partially be explained by a better functional outcome at 3 months for patients who were satisfied. Health care providers treating patients nonoperatively for CMC-1 OA should be aware of the importance of expectations and may take this into account in pretreatment counseling.

Which Factors Are Associated With Satisfaction With Treatment Results in Patients With Hand and Wrist Conditions? A Large Cohort Analysis

“…This is especially noteworthy because several studies have suggested that clinicians ought to try to temper patients’ expectations [14, 20, 30, 52], and many surgeons believe that it is important to help patients to cultivate reasonable expectations before surgery. By contrast, several other studies have suggested that boosting expectations is associated with better outcomes [12, 17, 28, 36, 37, 47]. Our findings support the latter suggestion.…”

Mobilisation or immobilisation-based treatments for first carpometacarpal joint osteoarthritis: A systematic review and meta-analysis with subgroup analyses

“…47,49 Overall, improvements noted in clinical practice are likely mediated by positive treatment expectations rather than the type of intervention. 53 Therefore, providing patients with a positive outlook on their pathology, and avoiding inducing fear avoidance and catastrophising thoughts in our clients, is likely going to benefit them. This review presents several limitations.…”

What’s New in Rehabilitation Post Orthopaedic Trauma?

“…But satisfaction after nonoperative treatment of first CMC osteoarthritis is not yet optimal, positive expectations of treatment outcomes are associated with higher satisfaction. Therefore, optimizing patient expectations may further improve treatment expectations and outcomes [5,6]. In another systematic review and meta-analysis which included 11 RCTs, Marotta et al compared the effectiveness of 4 different orthoses (short thermoplastic CMC splint, long thermoplastic CMC-metacarpophalangeal [MCP] splint, short neoprene CMC splint, and long neoprene CMC-MCP splint) with that of no splinting for first CMC osteoarthritis.…”