The impact of expectation on patient-rated global effectiveness of total hip arthroplasty

Abstract

Total Hip Arthroplasty (THA) is a standard elective surgery for hip osteoarthritis when reaching the limits of conservative medicine. Patient-based assessments are increasingly used for quality judgment after medical interventions. Identifying the biological and psychological characteristics that influence patients’ opinion is critical, in order to improve the efficiency and outcome of medical treatments. Emerging investigations underlines the role of expectation in predicting patient-based assessment after orthopedic interventions. The nature of the impact of expectations on patients’ perceived success of THA, however, remain conflicting. Using a sequential multiple regression model, the goal of this thesis was to determine the relative importance of preoperative expectations, expectation fulfillment and symptom improvements in predicting the patient-rated global effectiveness of THA. Ninety patients (49 female, 41 male ; mean age 63 ± 12.9 years) took part in the analysis and completed a detailed preoperative questionnaire assessing sociodemographic, clinical, functional and psychological characteristics. Expectations for eight domains hip pain, back pain, walking ability, independence, physical exercise, general function, social interactions and mental well-being) were measured using a 5-point scale. Twelve months following THA, patients reported progress changes and expectation fulfillments in each of these 8 domains. The outcome variable, i.e. the patient-rated global effectiveness of THA was evaluated on a 5-point scale. Finally, a sequential multiple regression analysis was conducted with the dependent variable being the patient-rated global effectiveness of THA. Walking ability before THA, hip pain expectation, expectation fulfillment in walking ability, independence and general function were found to predict the patient-rated global effectiveness of THA. Patients showed high expectations for improvement in all eight domains. Patients had the highest expectations for hip pain, walking ability and independence. For all eight domains, self-reported expectation fulfillment was higher than calculated expectation fulfillment. Compared to actual improvement at twelve months after surgery, 28% of patients were overoptimistic for hip pain, around 45% for walking ability and about 60% for back pain, physical exercise, general function, social interactions and mental well-being. Patients showed better physical, functional and psychological health after surgery. Indeed, patients showed high levels of surgery effectiveness ratings with only two patients stating only some to no improvement. Summary 51 In line with current investigations concerning the impact of expectations on postoperative outcome, the present thesis demonstrates the value of addressing explicitly patient expectations during the interaction between health-care provider and patient before a medical intervention. While to obtain postoperative success optimistic expectations appear to be helpful for emotional expectations such as hip pain, self-efficacy expectations and a more rational perspective should be encouraged for complex functional expectations such as for walking ability, independence in everyday life and general function to increase the likelihood of their fulfillment.