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

Lisa Hoogendam,Mark J.W Van Der Oest,Robbert M Wouters,Eleni-Rosalina Andrinopoulou,Guus M Vermeulen,Harm P Slijper,Jarry T Porsius,Ruud W Selles

doi:10.1016/j.apmr.2021.01.080

Abstract

ObjectiveTo 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). DesignCohort study SettingA total of 20 outpatient locations of a clinic for hand surgery and hand therapy in the Netherlands. ParticipantsPatients (N=308) receiving nonoperative treatment for CMC-1 OA, including exercise therapy, an orthosis, or both, between September 2017 and February 2019. InterventionsNonoperative treatment (ie, exercise therapy, an orthosis, or both) Main Outcome MeasuresSatisfaction 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. ResultsMore 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. ConclusionsThis 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.

Highlights

Nonoperative treatment consisted of immobilizing the CMC-1 using an orthosis and performing exercises to improve the active stability of the CMC-1 and strength of the thenar muscles
While several baseline variables were associated with satisfaction with outcome in the univariable analysis, higher Credibility and Expectancy Questionnaire (CEQ) Expectancy Score was the only significant variable associated with higher probability of being satisfied with treatment outcomes in the multivariable analysis (OR, 1.15; 95% confidence interval, 1.07-1.25)
We found that patients with more positive expectations of the treatment outcome are more likely to be satisfied with treatment outcomes after 3 months of nonoperative treatment for CMC-1 OA

Summary

Methods

Between September 2017 and February 2019, this cohort study was performed with routine outcome measurement data from Xpert Clinic and Handtherapie Nederland, comprising 20 outpatient locations for hand surgery and hand therapy in the Netherlands. Nonoperative treatment consisted of immobilizing the CMC-1 using an orthosis and performing exercises to improve the active stability of the CMC-1 and strength of the thenar muscles This treatment protocol has previously been described in more detail.[5] Nonoperative treatment was offered for at least 3 months before surgery was considered. Satisfaction with treatment outcomes was the primary outcome measure This was measured using a self-designed questionnaire administered 3 months after the start of nonoperative treatment. In this questionnaire, we asked patients, “To what extent are you satisfied with the treatment outcomes obtained so far?” (rated as poor, moderate, fair, good, or excellent). All questionnaires have been validated, and good reliability has been reported.[26,30,31,32,33,34,35]

Statistical methods

Results

Discussion

Study limitations

Conclusions