Relationship between Patient Expectations and Clinical Measures in Patients Undergoing Rheumatoid Hand Surgery from the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) Study.

Abstract

The purpose of this study was to evaluate the relationship between preoperative patient expectations and clinical measures in patients undergoing rheumatoid hand surgery. Patients were recruited as a part of a larger prospective multicenter study to evaluate outcomes of silicone metacarpophalangeal joint arthroplasty (SMPA). Patients in the surgical cohort completed a baseline expectation questionnaire asking about expectations for function, work, pain, and aesthetics after SMPA. Responses were categorized into groups of low, middle, and high expectations for each domain and for cumulative expectations across all domains. Other study measurements were taken at baseline and 1 year, including the Michigan Hand Outcomes Questionnaire (MHQ) and objective clinical measurements (i.e., grip strength, pinch strength, the Jebsen-Taylor Hand Function Test, ulnar drift, and extensor lag). Preoperative expectations and clinical measures were complete for 59 patients at baseline and 45 patients at 1-year follow-up. Preoperative expectation level was related to baseline patient-reported domains of activities of daily living and hand satisfaction measured by the MHQ (p = 0.04 and p = 0.07, respectively). Patients had relatively similar satisfaction with hand function postoperatively regardless of preoperative expectation level. No consistent relationship was seen between preoperative expectations and objective measures at baseline and 1-year follow-up. High preoperative expectations were not a risk factor for dissatisfaction postoperatively. Preoperative expectation level may be considered for stratifying baseline patient-reported hand function in patients with similar objective hand function.