Dissatisfied Patients Research Articles

Female Sex and Higher Infraspinatus Fatty Infiltration Are Linked to Dissatisfaction at a Minimum Follow-Up of 4 Years after Arthroscopic Repair of Massive Rotator Cuff Tears

PurposeTo evaluate patient satisfaction at a minimum of 4 years after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCT), to identify preoperative and intraoperative characteristics associated with satisfaction, and to compare clinical outcomes between satisfied and dissatisfied patients.MethodsA retrospective review on prospectively collected data was conducted on ARCRs of MRCTs performed at 2 institutions between January 2015 and December 2018. Patients with a minimum 4-year follow-up, preoperative and postoperative data, and primary ARCR of MRCTs were included for analysis. Patient satisfaction was analyzed according to patient demographics, patient-reported outcome measures (American Shoulder and Elbow Surgeons score [ASES], visual analog scale [VAS] for pain, Veteran Rands 12-item health survey [VR-12], and Subjective Shoulder Value [SSV]), range of motion (forward flexion [FF], external rotation [ER], and internal rotation [IR]), tear characteristics (fatty infiltration, tendon involvement, and tear size), and clinical significant measures (minimal clinical important difference [MCID], substantial clinical benefit [SCB], and patient-acceptable symptomatic state [PASS]) for ASES and SSV. Rotator cuff healing was also assessed with ultrasound in 38 patients at final follow-up.ResultsA total of 100 patients met the study’s criteria. Overall, 89% of patients were satisfied with ARCR of a MRCT. Female sex (P = .007) and increased preoperative infraspinatus fatty infiltration (P = .005) were negatively associated with satisfaction. Those in the dissatisfied cohort had significantly lower postoperative ASES (80.7 vs 55.7; P = .002), VR-12 (49 vs 37.1; P = .002), and SSV scores (88.1 vs 56; P = .003), higher VAS pain (1.1 vs 4.1; P = .002) and lower postoperative range of motion in FF (147° vs 117°; P = .04), ER (46° vs 26°; P = .003), and IR (L2 vs L4; P = .04). Rotator cuff healing did not have an influence on patient satisfaction (P = .306). Satisfied patients were more likely to return to work than dissatisfied patients (97% vs 55%; P < .001).ConclusionsNearly 90% of patients who undergo ARCR for MRCTs are satisfied at a minimum 4-year follow-up. Negative preoperative factors include female sex and increased preoperative infraspinatus fatty infiltration, but no association was observed with rotator cuff healing. Furthermore, dissatisfied patients were less likely to report a clinically important functional improvement.Level of EvidenceLevel IV, prognostic case series. To evaluate patient satisfaction at a minimum of 4 years after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCT), to identify preoperative and intraoperative characteristics associated with satisfaction, and to compare clinical outcomes between satisfied and dissatisfied patients. A retrospective review on prospectively collected data was conducted on ARCRs of MRCTs performed at 2 institutions between January 2015 and December 2018. Patients with a minimum 4-year follow-up, preoperative and postoperative data, and primary ARCR of MRCTs were included for analysis. Patient satisfaction was analyzed according to patient demographics, patient-reported outcome measures (American Shoulder and Elbow Surgeons score [ASES], visual analog scale [VAS] for pain, Veteran Rands 12-item health survey [VR-12], and Subjective Shoulder Value [SSV]), range of motion (forward flexion [FF], external rotation [ER], and internal rotation [IR]), tear characteristics (fatty infiltration, tendon involvement, and tear size), and clinical significant measures (minimal clinical important difference [MCID], substantial clinical benefit [SCB], and patient-acceptable symptomatic state [PASS]) for ASES and SSV. Rotator cuff healing was also assessed with ultrasound in 38 patients at final follow-up. A total of 100 patients met the study’s criteria. Overall, 89% of patients were satisfied with ARCR of a MRCT. Female sex (P = .007) and increased preoperative infraspinatus fatty infiltration (P = .005) were negatively associated with satisfaction. Those in the dissatisfied cohort had significantly lower postoperative ASES (80.7 vs 55.7; P = .002), VR-12 (49 vs 37.1; P = .002), and SSV scores (88.1 vs 56; P = .003), higher VAS pain (1.1 vs 4.1; P = .002) and lower postoperative range of motion in FF (147° vs 117°; P = .04), ER (46° vs 26°; P = .003), and IR (L2 vs L4; P = .04). Rotator cuff healing did not have an influence on patient satisfaction (P = .306). Satisfied patients were more likely to return to work than dissatisfied patients (97% vs 55%; P < .001). Nearly 90% of patients who undergo ARCR for MRCTs are satisfied at a minimum 4-year follow-up. Negative preoperative factors include female sex and increased preoperative infraspinatus fatty infiltration, but no association was observed with rotator cuff healing. Furthermore, dissatisfied patients were less likely to report a clinically important functional improvement.

Patients report being satisfied with private musculoskeletal physical therapy when therapists educate effectively and facilitate shared decision making

BackgroundOverall satisfaction with physical therapy care can improve patient adherence and active involvement in their management. However, which individual factors most influence satisfaction with private practice physical therapy care is not well established. ObjectiveTo identify which aspects of the private practice musculoskeletal physical therapy experience best delineated “completely satisfied” and “dissatisfied patients”. MethodsThe MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) was used in a cross-sectional design within 18 Australian private musculoskeletal physical therapy practices. The area under the curve (AUC) of receiver operator characteristic curves (ROC) was used to quantify the ability of the individual patient experience questions to classify the global impressions of satisfaction and likelihood to recommend to others. Results1712 patients completed the survey (out of 7320 survey recipients - response rate 23%). High scores were identified for overall satisfaction (4.8/5 ± 0.61) and likelihood to recommend (4.78/5 ± 0.67). Individual items relating to education (AUC = 0.839 and 0.838) and shared decision making (AUC = 0.832 and 0.811) were the most accurate indicators of satisfaction and likelihood to recommend to others, respectively. ConclusionIndividual questionnaire items relating to education and shared decision making were the most accurate indicators of satisfaction and likelihood to recommend in patients attending private practice musculoskeletal physical therapy in Australia. Clinicians and educators should focus on developing these skills to encourage an effective therapeutic alliance and promote greater levels of patient satisfaction.

Dissatisfaction With Total Knee Arthroplasty at 1 Year Post Surgery Can be Predicted Using a Short Questionnaire Early in the Recovery Process

BackgroundApproximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA). Identifying patients likely to be dissatisfied early in the recovery process could help reduce the number of dissatisfied patients. The purpose of this study was to create an easily administered short questionnaire to identify patients likely to be dissatisfied at 1 year post surgery early in the recovery process. MethodsThe study included 275 patients who underwent primary TKA for osteoarthritis. Individual 3-month postsurgery questionnaire items from the Knee Injury and Osteoarthritis Outcome Score and Knee Society Knee Scoring System were pooled together and used as candidate items to create 3 different short questionnaires. Items included in each questionnaire were selected using least absolute shrinkage and selection operator logistic regressions, a backward elimination method, and theory-based approaches. The area under the curve for each short questionnaire was calculated to evaluate predictive performances. ResultsAll 3 questionnaires contained a small number of items and appeared to successfully predict 1-year postsurgery dissatisfaction early in the recovery process. The least absolute shrinkage and selection operator logistic regression, backward elimination, and theory-based questionnaires were comprised of 4, 7, and 5 items and had the area under the curve scores of 0.893, 0.902, and 0.890, respectively. A question evaluating rising from sitting and activities of daily living appeared in all of the created questionnaires. ConclusionA short questionnaire that is easy to administer and interpret can effectively predict TKA patient dissatisfaction at 1 year post surgery early in the recovery process.

Multifocal intraocular lens exchange to monofocal for the management of neuroadaptation failure

BackgroundThe aim of this study was to evaluate visual, refractive, quality of vision, visual function and satisfaction of multifocal intraocular lens (MF-IOL) exchange with a monofocal IOL (MNF-IOL) in dissatisfied patients following MF-IOL implantation.MethodsThis was a retrospective case series. Bilateral IOL exchange (MF-IOL to MNF-IOL) was performed in 13 patients (26 eyes) with neuroadaptation failure. Questionnaires including the Quality of Vision (QoV), Visual Function Index (VF-14 and Rasch-revised VF-8R version), and a satisfaction questionnaire were used.ResultsThe mean time for IOL exchange was 15 months. The corrected distance visual acuity (CDVA) improved from 20/26 to 20/23 (P = 0.028). The uncorrected near visual acuity (UNVA) worsened after exchange from 20/47 to 20/62 (P = 0.024). QoV scores improved significantly across all three subscales after exchange. Visual function for far distance improved with a change in VF-14 score from 74.2 ± 24.8 to 90.9 ± 9.1 (P = 0.03). The VF-8R score showed worsening although not statistically significant. Near vision spectacle independence was totally or partially lost in all cases. Ten patients (77%) reported they would not repeat the lens exchange. Safety and efficacy indices changed from 1.23 to 0.85, respectively, at three months to 1.24 (P = 0.871) and 0.89 (P = 0.568), respectively, at one year.ConclusionIOL exchange (multifocal to monofocal) to solve neuroadaptation failure in this case series resulted in significant improvements in dysphotopsia and improved distance visual function. However, UNVA worsened and patient satisfaction after exchange remained suboptimal with 77% claiming they would not repeat the lens exchange, suggesting the value of near vision spectacle independence for these patients.

Clinical and Radiological Outcomes of Revision Total Hip Arthroplasty for Patients with Prior Hartofilakidis Type C Hip Dysplasia.

ObjectiveTo investigate the clinical and radiological results of revision total hip arthroplasty (THA) for patients with previously diagnosed Hartofilakidis type C hip dysplasia, which is technically challenging and lacks literature.MethodsWe enrolled 20 patients with previously diagnosed Hartofilakidis type C hip dysplasia who underwent revision THA between November 2008 and July 2015 at our hospital. Patients were followed up for an average of 87 months. Data pertaining to the Harris hip score (HHS), modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), general satisfaction, and the level of satisfaction related to 16 hip functions or issues experienced after revision THA were collected. The vertical and horizontal center of rotation (COR) of the hips were measured bilaterally based on preoperative and postoperative anteroposterior radiographs. Categorical variables were analyzed by the chi‐square test. Continuous variables were analyzed using the student's t test or non‐parametric Wilcoxon Rank Sum test.ResultsThere were significant postoperative improvements in the HHS (47.4 ± 31.6 vs 70.1 ± 39.0), modified WOMAC (48.5 ± 27.9 vs 75.7 ± 36.8), and the vertical (45.7 ± 33.7 mm vs 21.6 ± 21.8 mm) and horizontal (41.8 ± 17.0 mm vs 31.4 ± 14.7 mm) offset of the COR after revision THA (P < 0.05). Fifteen (75.0%) patients were satisfied with the procedure. The satisfaction rate for each of the 16 items ranged from 45% to 100%. The top three dissatisfactory items were squatting, getting into/out of cars, and leg‐length discrepancy. Postoperatively, dissatisfied patients had a significantly higher visual analogue scale pain score and lower WOMAC pain, HHS pain, WOMAC total, and HHS total scores, a lower satisfaction rate for pain relief, and a higher vertical COR.ConclusionThere is a high rate (25%) of dissatisfaction with the outcome after revision THA for patients with prior Hartofilakidis type C hip dysplasia. The most likely reasons for dissatisfaction were inadequate pain relief and a higher vertical COR measured on radiography.

Динамика лояльности представителей пациентов до и в период эпидемии COVID‑19 на примере московской детской поликлиники организациям

The COVID-19 has had an enormous impact on the entire Russian health care system, including a significant impact on both the provision of medical services and the relationship between the doctor, the patient, and patient’s legal representatives. On this basis, the research is interested in issues related to the adaptation of medical organizations to the new working conditions with patients and their legal representatives. Aim of the study: to test long-term monitoring of the NPS Loyalty Index by a simplified methodology in patient’s legal representatives of pediatric polyclinic patients before and during the COVID-19 epidemic. Materials and Methods. The empirical material based on patient legal representative scores (n=22098) collected using the simplified NPS (Net Promoter Score) methodology during the two periods: 14.05.2019 -13.06.2020 and 18.06.2021 – 23.08.2021, as well as comments and predictions from lead outpatient clinic staff (n=19) collected by brainstorming to obtain additional interpretations of dynamics of patient legal representative loyalty index during the periods. The Results. According to the results of the study, the NPS patient legal representatives in pediatric polyclinics has increased significantly since the beginning of the coronavirus epidemic and after a year was fixed at a level almost one and a half times higher than the values from the first measurement. According to the initiative group, this growth was due not only to measures taken by the management of polyclinics, but also to cultural and psychological characteristics of the population; when the epidemic is over, the loyalty index of legal representatives of pediatric polyclinic patients is likely to return to its initial values. Conclusions. The use of a simplified method to measure the loyalty level (NPS) of patients and their legal representatives is a rather effective tool. An important condition in this case is to provide feedback to dissatisfied patients and their legal representatives. The professionalism and dedication of the medical staff play and will play a role in ensuring a high level of loyalty regardless of the epidemiological situation.

Postoperative outcomes and survival rates after aseptic revision total hip arthroplasty : What can patients expect from revision surgery?

In 2020, more than 14,000 aseptic revision procedures for total hip arthroplasty (THA) were registered in Germany. Patient expectations of revision hip arthroplasty are not substantially different from expectations of primary hip replacement. However, revision surgery is associated with increased complication rates and ahigher proportion of dissatisfied patients. In particular, poorer postoperative function and mobility as well as increased pain levels following revision THA have been described compared to the outcome after primary THA. Quality of life and return-to-work can also be impaired. Implant survival is influenced by age, BMI, and comorbidities of the patients, but also by the size and complexity of bone defects, the extent of periprosthetic soft tissue compromise and the choice of revision implant(s). In addition, the number of previous revision surgeries inversely correlates with the survival rates. Previous revisions have been shown to be associated with increased risks of aseptic loosening, instability and periprosthetic infection.

Patient and Implant Performance of Satisfied and Dissatisfied Total Knee Arthroplasty Patients.

Implant migration and altered kinematics have been thought to impact patient-reported outcome measures (PROMs) and postoperative patient satisfaction. In this study comparing satisfied and dissatisfied total knee arthroplasty (TKA) patients, we hypothesized that dissatisfied patients will have greater continuous implant migration and that there will be differences in joint kinematics, objective functional measurements, and PROMs between satisfied and dissatisfied patients. The Knee Society Score Satisfaction Subsection questions regarding satisfaction with function were used at least 6 months postoperation to split 50 patients into satisfied and dissatisfied groups. Patients underwent radiostereometric analysis to evaluate migration and kinematics. A wearable sensor system obtained objective measurements of patient function during timed up and go tests. PROMs were recorded preoperation and postoperation. No statisticallysignificant differences were found in migration between satisfied and dissatisfied groups. Statistical kinematic differences existed in lateral anteroposterior contact location at 20° and 40° of flexion at 1 year, where the dissatisfied group had more anteriorly located lateral contact. No statisticallysignificant differences were present in objective functional measurements. Satisfied and dissatisfied groups had differing PROMs at 4 timepoints or greater for each questionnaire. No differences were found in tibial component migration or objectively measured function between satisfied and dissatisfied patients. Functionally dissatisfied patients had more anteriorly positioned contact on the lateral condyle in early flexion and reported more pain and unmet expectations. These findings suggest that improving the functional satisfaction of TKA requires restoration of kinematics in early flexion and management of patient's pain and expectations.

Directions of Modification of the Model of Perception of the Thermal Environment by Patients of Selected Hospital Wards

Patients are different regarding their health conditions, illnesses and ailments, and mobility. These and other factors could affect their specific feelings about the thermal environment. Current methods of predicting thermal sensations were developed based on research on a group of healthy people. Therefore, the use of these methods with patients should be verified. This paper aimed to verify selected thermal comfort models in terms of their reliability to predict the average assessment of thermal conditions in the patient rooms and the percentage of dissatisfied patients. Thermal condition analyses were based on microclimate parameter measurements and extensive questionnaires among patients, done in parallel in the hospital’s patient rooms. The research was carried out in 23 hospitals located in the following provinces in Poland: (Warmińsko-Mazurskie, Kujawsko-Pomorskie, Mazowieckie, Wielkopolskie, Łódzkie, Świętokrzyskie, Lubelskie and Dolnośląskie). Overall, 890 patients from 14 different specialities participated in the research. Actual thermal sensations of patients differed from predictions obtained from selected thermal comfort models. A comparison of the actual thermal sensations with the PMV model indicates the shift of the comfort curve towards cooler rather than neutral conditions. A comparison of the same to the adaptive model predictions indicates that patients had a higher dissatisfaction rate and preferred cooler thermal conditions than predicted. Research findings show that normative models are not fully reliable in predicting patients’ thermal sensations.

The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is an effective treatment option for many patients, but a small group of patients are dissatisfied following TKA. Alignment, in combination with balance, stability, and knee kinematics, is an important modifiable surgical factor that can affect patient outcomes. Driven by the subset of dissatisfied patients after TKA, new techniques have evolved in the search for a more anatomic reconstruction of individual knee morphology and a more accurate approximation of the individual lower-extremity alignment. There is a need to optimize 3 aspects of TKA to improve patient outcomes-mechanical tooling processes, implants that resurface the epiphysis, and techniques that respect the variable anatomy of patients.

Patients\u2019 dissatisfaction with multifocal intraocular lenses managed by exchange with other multifocal lenses of different optical profiles

BackgroundThe aim of the study was to evaluate the outcomes of dissatisfied patients reporting poor visual quality following implantation of multifocal intraocular lenses (MF-IOLs), managed by IOL exchange with another multifocal optical profile.MethodsThis is a retrospective series of cases. MF-IOL exchange was done in 15 dissatisfied patients (30 eyes) with the perception of poor visual quality for far distance affected by neuroadaptation failure. Patients underwent a bilateral exchange of a MF-IOL with another MF-IOL of a different optical profile. Visual outcomes and complications were analyzed. Questionnaires including Quality of Vision (QoV), Visual Function Index-14 (VF-14) and its Rasch-revised version (VF-8R) and a satisfaction questionnaire were also used for outcome evaluation.ResultsThe mean elapsed time from implantation to explantation-reimplantation was 11.8 months. The QoV scores improved significantly across all the three subscales. Visual function improved with a change in VF-14 score from 60.41 ± 24.81 to 90.16 ± 10.91 (P < 0.001). The VF-8R score improved as well. The uncorrected distance visual acuity improved from 0.24 to 0.12 logMAR after exchange (P < 0.001) and corrected distance visual acuity improved from 0.15 to 0.04 logMAR (P < 0.001). Safety and efficacy indexes reached 1.46 and 1.16, respectively. Concerning patients’ satisfaction following MF-IOL exchange, 80% of the patients reported they would have the MF-IOL reimplantation procedure again.ConclusionsPatient dissatisfaction with neuroadaptation failure following MF-IOL implantation can be managed in 80% of our cases by MF-IOL exchange with a different MF-IOL optical profile.

Evaluating Patient Preferences in Benign Prostatic Hyperplasia Treatment Using Conjoint Analysis

ObjectiveTo quantify benign prostatic hyperplasia (BPH) patient preferences to promote guidelines-compliant, patient-centered care. Discordance between patient and urologist priorities for the treatment of BPH hinders patient-centered care. Physician assumptions regarding patient preferences lead to dissatisfied patients; a poor outcome in any quality of life surgery. American Urologic Association guidelines urge urologists to consider patient preferences when recommending a BPH treatment. MethodsIn this cross-sectional, online survey study using researchmatch.org, participants were required to decide between theoretical BPH treatments in a balanced, choice-based conjoint analysis. The treatments had varying levels of four attributes: efficacy, recovery difficulty, risk of complications (Clavien-Dindo 2+), and risk of de novo ejaculatory dysfunction. Demographic information and International Prostate Symptom Score were collected and analyzed using comparative statistics. Each attribute was analyzed using a conditional logit model, and attribute importance (range in utility between attribute-levels) was calculated. ResultsOut of 1235 recruited participants, 812 (66%) completed the study. Median International Prostate Symptom Score and age was 6 (IQR 3-12) and 56 (IQR 38-67), respectively. Complication risk was the most important attribute, followed by efficacy, recovery difficulty, and risk of ejaculatory dysfunction. In a subgroup analysis of age quartiles, participants age <38 and >67 held efficacy (31%) and complication risk (47%) to the highest relative importance, respectively. ConclusionMales valued BPH treatments that minimize complication risks, while ejaculatory dysfunction was least impactful. Variation in results between age subgroups emphasizes the need for individualized care to maximize patient satisfaction.

CLINICAL RESULTS OF MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION.

ABSTRACTObjective: To assess clinical results of patients who underwent medial patellofemoral ligament (MPFL) reconstruction after a minimum of two years of follow-up.Methods: Patients’ medical records were assessed for residual instability, patient satisfaction, and post-operative functional outcomes.Results: Fifty-one patients were analyzed, out of which 56.87% were women. Patients’ mean age was 30.8 years (16 to 57 years). The mean follow-up time was 68.7 months (37 to 120 months). Length between first dislocation and surgery was less than 1 year for 58.82% of patients, between 1 and 5 years for 37.25%, and over 5 years for 3.93%. Patients showed a high degree of satisfaction (96.08% would undergo surgery again), with recurrence rate of 11.76%. Twenty-two patients reported knee symptoms, including pain from movements (72.72%), weakness (18.18%), constant pain (13.63%), and crepitus (4.54%). Considering dissatisfied patients, patients with dislocation recurrence, and patients with symptoms, five cannot practice physical activity, out of which only three blame their knee.Conclusion: MPFL reconstruction showed a recurrence rate of 11.7%, with high patient satisfaction, good functional results, and high rate of return to sports, after a minimum of two years of follow-up. Level of Evidence IV, Case Series.

Ocular surface optimization before cataract surgery.

The evolution of refractive cataract surgery has increased patient expectations for visual outcomes following cataract surgery. Precise biometry and keratometry are critical for accurate intraocular lens (IOL) selection and favorable surgical outcomes. In patients with the ocular surface disease and corneal pathologies, preoperative measurements can often be erroneous, leading to postoperative refractive surprises and dissatisfied patients. Conditions such as dry eye disease, epithelial basement membrane dystrophy, Salzmann's nodular dystrophy, and pterygia need to be addressed thoroughly before performing cataract surgery to optimize the ocular surface, obtain high-quality preoperative measurements, and ultimately determine the appropriate IOLs. In this review, the various ocular surface pathologies affecting cataract surgery outcomes and options for treatment are discussed and the importance of optimization of the ocular surface before cataract surgery is reviewed.

The Online Patient Satisfaction Index for Patients With Low Back Pain: Development, Reliability, and Validation Study.

BackgroundLow back pain is highly prevalent, and most often, a specific causative factor cannot be identified. Therefore, for most patients, their low back pain is labeled as nonspecific. Patient education and information are recommended for all these patients. The internet is an accessible source of medical information on low back pain. Approximately 50% of patients with low back pain search the internet for health and medical advice. Patient satisfaction with education and information is important in relation to patients’ levels of inclination to use web-based information and their trust in the information they find. Although patients who are satisfied with the information they retrieve use the internet as a supplementary source of information, dissatisfied patients tend to avoid using the internet. Consumers’ loyalty to a product is often applied to evaluate their satisfaction. Consumers have been shown to be good ambassadors for a service when they are willing to recommend the service to a friend or colleague. When consumers are willing to recommend a service to a friend or colleague, they are also likely to be future users of the service. To the best of our knowledge, no multi-item instrument exists to specifically evaluate satisfaction with information delivered on the web for people with low back pain.ObjectiveThis study aims to report on the development, reliability testing, and construct validity testing of the Online Patient Satisfaction Index to measure patients’ satisfaction with web-based information for low back pain.MethodsThis is a cross-sectional validation study of the Online Patient Satisfaction Index. The index was developed with experts and assessed for face validity. It was subsequently administered to 150 adults with nonspecific low back pain. Of these, 46% (70/150) were randomly assigned to participate in a reliability test using an intraclass correlation coefficient of agreement. Construct validity was evaluated by hypothesis testing based on a web app (MyBack) and Wikipedia on low back pain.ResultsThe index includes 8 items. The median score (range 0-24) based on the MyBack website was 20 (IQR 18-22), and the median score for Wikipedia was 12 (IQR 8-15). The entire score range was used. Overall, 53 participants completed a retest, of which 39 (74%) were stable in their satisfaction with the home page and were included in the analysis for reliability. Intraclass correlation coefficient of agreement was estimated to be 0.82 (95% CI 0.68-0.90). Two hypothesized correlations for construct validity were confirmed through an analysis using complete data.ConclusionsThe index had good face validity, excellent reliability, and good construct validity and can be used to measure satisfaction with the provision of web-based information regarding nonspecific low back pain among people willing to access the internet to obtain health information.Trial RegistrationClinicalTrials.gov NCT03449004; https://clinicaltrials.gov/ct2/show/NCT03449004

Satisfacción del servicio de telemedicina en pacientes con artritis reumatoide

IntroductionInformation and communication technologies (ICT) have made it possible to provide the population with accessible, profitable, and high-quality healthcare services in different pathologies. It is important to conduct an evaluation of the satisfaction of users who use telemedicine who require frequent monitoring as in the case of chronic diseases such as rheumatoid arthritis; this is also important for insurers. ObjectiveThe objective of the study was to evaluate the degree of satisfaction with telemedicine care among patients with rheumatoid arthritis from a health provider entity in Colombia. Materials and methodsAn observational, descriptive cross-sectional study was carried out, patients older than 18 years with a diagnosis of rheumatoid arthritis who received telemedicine care on more than one occasion were included, telephone surveys were carried out in which the SERVQHOS questionnaire was applied to evaluate the quality of the health service; A dissatisfied patient was defined as one with an average response of 3 or less in the questions of the questionnaire, and a very satisfied patient when the average was 4 or more. The primary objective was to determine the degree of satisfaction of a cohort and the number of highly satisfied patients. We also evaluated whether there was an association between sex, age, origin, number of consultations, socio-economic status, and educational level with a high rating by very satisfied patients. ResultsA total of 243 patients were evaluated. Evaluation of satisfaction with the telemedicine service in rheumatology showed that 92.2% of the patients were satisfied and 49% very satisfied. In the subsequent analysis, an association was found between very high satisfaction and a greater number of consultations (P=.001), people living in rural areas (P=.03), and a higher level of schooling with a greater difference in secondary education (P=.017). ConclusionsWe found that the vast majority of patients surveyed were satisfied with the quality of telemedicine care and half were very satisfied which increases with the number of consultations, in people from rural areas and in some educational levels.

The value of an integrated approach to assessing the availability of primary health care, taking into account public opinion and EMIAS data

Introduction. The study of public opinion as the basis for strategic planning of the activities of medical institutions is more relevant than ever, as it allows finding ways to solve the problems of ensuring the availability and satisfaction of citizens with medical care. Purpose. Comparative assessment of the availability of primary health care based on the results of a sociological study of public opinion and data from the Unified Medical Information and Analytical System of the City of Moscow (UMIAS). Material and methods. To study public opinion, the practice of population survey was used, which was conducted through direct interviewing with filling out questionnaires of visitors to Moscow polyclinics and the method of questioning doctors based on a questionnaire developed by researchers. To analyze the data, the authors used general scientific methods of cognition, including the dialectical method, a systematic approach, logical correspondence and harmonization, detailing and generalization. As part of the study, the index value of the patient loyalty to the medical institution (MI) was calculated according to Net Promoter Score (NPS) method as the difference between the share of the “Promoters” group and the share of the “Critics” group in the total number of responses. Results and discussion. The established correlations indicate the opinions of doctors and citizens to coincide and the UMIAS data on the issue of assessing the accessibility of admission of level 1 doctors for citizens. Based on the results of a sociological survey, the number of dissatisfied patients is mainly affected by managing medical care and its availability. The study confirmed that the higher the availability of an appointment with a level 1 doctor, the lower the number of visits the doctor on duty. Conclusion. The conducted research has shown the practicality of an integrated approach to evaluating the activities of medical organizations based on the results of public opinion research and UMIAS data.

Patients’ satisfaction after total knee arthroplasty: Tashkent Medical Academy experience

Objectives:The aim of the study was to assess satisfaction of our patients after primary total knee arthroplasty (TKA) at various intervals of follow-up.Methods:This prospective study was performed in the Multidisciplinary clinic of the Tashkent Medical Academy in the Department of orthopedics from November 2018 to October 2020 performed 88 unilateral TKAs in patients with confirmed diagnosis of primary knee osteoarthritis III-IV grade (Kellgrene-Lawrence, 1978). Among them, 32 males and 54 females aged from 56 to 83 years old with an average of 65.1 years old. The follow up period ranged from 1 month to 1 year. On each follow-up examination (3, 6, 12 month period), every patient received UCLA activity score and VAS score. The patients assessed the degree of satisfaction after TKA on a scale ranging from "fully satisfied" to "dissatisfied" and expressed their overall satisfaction in percent.Results:The mean length of stay in the obese group was 11.3 days (±6.3). There were no 30-day re-admisison cases. At the final follow-up, 4.54% of the patients were not satisfied with the outcome. Of 56 patients (63.6%) who were working before TKA, 42 (75%) returned to any job at a mean of 12 weeks post-operatively. Mean UCLA scores improved in 61 patients (69%) from 4 (mild activity) to 6 (moderate activity). The patients’ overall satisfaction was 82.2 % (i.e., responses to the question of how you were satisfied with surgery). Significantly, more satisfied patients were among those with primary osteoarthritis without any fixed deformities. Their satisfaction was related to the level of the UCLA activity rating. However, there was slight relation between VAS-evaluated pain intensity before TKA and patient satisfaction after arthroplasty.Conclusion:An analysis of patient responses shows that the level of satisfaction is high in the short period after surgery. Overall, patient satisfaction is slightly changed approximately 12 months after surgery. The number of dissatisfied patients or those who reported regular pain after TKA in our study is consistent with the results presented in the relevant literature, number of patients could be the cause of this. Furthermore, preoperative discussion of functional properties after TKA could help reduce dissatisfaction after TKA. In addition, multicenter studies are needed for a more in-depth analysis of patient satisfaction after TKA.

Overground Walking Biomechanics of Dissatisfied Persons With Total Knee Replacements.

Patient dissatisfaction following total knee replacement (TKR) procedures is likely influenced by both subjective and objective aspects. Increased pain and reduced performance on clinical tests have been shown in persons who are dissatisfied with the outcome of their surgery. However, it is unknown how overground walking kinematics and kinetics might differ in the dissatisfied versus satisfied patients following TKR surgery. This study compared the lower-extremity walking kinematics and kinetics of patients dissatisfied with their TKR to that of satisfied patients and healthy controls. Thirty nine subjects completed walking trials, including nine dissatisfied and 15 satisfied TKR patients and 15 healthy controls. A 2 × 3 repeated -measures analysis of variance was used to assess differences between groups and limbs (P < .05). Dissatisfied persons showed significantly reduced loading-response and push-off peak vertical ground reaction forces, flexion range of motion, loading-response extension moments, and loading-response abduction moments compared to the controls. Peak loading-response and push-off vertical ground reaction forces and flexion range of motion were reduced in the replaced limb of dissatisfied patients compared with their nonreplaced limb. Push-off plantar flexion moments were reduced in the dissatisfied patients compared with the satisfied and healthy controls. Dissatisfied patients also reported increased knee joint pain and reduced preferred gait speed. Moreover, dissatisfied patients experienced mechanical limb asymmetries not present in those satisfied with their surgery result. Thus, patients dissatisfied with their total knee replacement outcome were found to be experiencing significant negative physiological changes.

The Effect of Personalized Patient Videos on Patient Satisfaction After Arthroscopic Shoulder Surgery.

Dissatisfaction after shoulder arthroscopy may be influenced by the information that patients receive. Multimedia is an emerging modality of information delivery. The goal of this study was to evaluate whether providing patients with a personalized video of their arthroscopic shoulder surgery improved satisfaction through a multisurgeon randomized controlled study. Patients undergoing arthroscopic shoulder decompression, rotator cuff repair, or labral repair were randomized to either the intervention group, receiving a video recording of their surgery, or the control group, not receiving a video. Patients who had previous ipsilateral shoulder arthroscopy or who could not participate in follow-up were excluded. Patient satisfaction was assessed at 3 months with a visual analog scale (VAS), Likert scale, and Quick Disabilities of the Arm, Hand and Shoulder (QuickDASH) score. The intervention group included 50 participants, and the control group included 47 participants, with 18% loss to follow-up. Mean control group VAS score was 8.5±2.2 and intervention group VAS score was 9.0±1.5, a difference that was not significantly different (P=.27). No statistically significant differences were noted for Likert scale scores and QuickDASH scores. A subgroup analysis of age group, sex, surgeon, and surgical procedure showed no significant differences. Based on these findings, personalized patient videos do not appear to improve satisfaction with surgery. Surgeons should investigate other means to improve patient satisfaction in the small group of dissatisfied patients. [Orthopedics. 2021;44(3):e331-e336.].