Abstract
ObjectiveThis systematic review aims to summarise all the available evidence related to the association between pre-operative patient expectations (outcome expectations, process expectations and self efficacy expectations) and 5 different treatment outcomes (overall improvement, pain, function, stiffness and satisfaction) in patients with total knee or total hip arthroplasty at three different follow-op periods (>6 weeks; >6 weeks- ≤6 months; >6 months).MethodsEnglish and Dutch language articles were identified through PubMed, EMBASE.com, PsycINFO, CINAHL and The Cochrane Library from inception to September 2012. Articles assessing the association between pre-operative patient expectations and treatment outcomes for TKA/THA in either adjusted or unadjusted analysis were included. Two reviewers, working independently, determined eligibility, rated methodological quality and extracted data on study design, population, expectation measurements, outcome measurements and strength of the associations. Methodological quality was rated by the same reviewers on a 19 item scale. The scores on the quality assessment were taken into account when drawing final conclusions.ResultsThe search strategy generated 2252 unique references, 18 articles met inclusion criteria. Scores on the methodological quality assessment ranged between 6% and 79%. Great variety was seen in definitions and measurement methods of expectations. No significant associations were found between patient expectations and overall improvement, satisfaction and stiffness. Both significant positive and non-significant associations were found for the association between expectations and pain and function.ConclusionsThere was no consistency in the association between patients’ pre-operative expectations and treatment outcomes for TKA and THA indentified in this systematic review. There exists a need for a sound theoretical framework underlying the construct of ‘patient expectations’ and consistent use of valid measurement instruments to measure that construct in order to facilitate future research synthesis.
Highlights
Total hip and total knee arthroplasty (THA and Total knee arthroplasty (TKA)) are amongst the most cost-effective treatments within the field of orthopaedics [1,2]
It is important for clinicians to know which factors, apart from technical factors, could possibly have an influence on the outcome after TKA or Total hip arthroplasty (THA) to improve their decision making and recommendations to patients opting for TKA or THA
Constantino et al [13] concluded in their systematic review that there was a small significant effect of outcome expectations on outcomes in psychotherapy
Summary
Total hip and total knee arthroplasty (THA and TKA) are amongst the most cost-effective treatments within the field of orthopaedics [1,2]. Even after technically well performed surgery patients may have residual complaints. In these cases post-operative imaging shows no abnormalities and low-grade infection or loosening is ruled out; but patients may still have impaired function and pain, resulting in a low quality of life and high health care costs [11]. It is important for clinicians to know which factors, apart from technical factors, could possibly have an influence on the outcome after TKA or THA to improve their decision making and recommendations to patients opting for TKA or THA. Constantino et al [13] concluded in their systematic review that there was a small significant effect of outcome expectations on outcomes in psychotherapy
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