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Evaluating patients' expectations from a novel patient-centered perspective predicts knee arthroplasty outcome

Evaluating patients' expectations from a novel patient-centered perspective predicts knee arthroplasty outcome
Evaluating patients' expectations from a novel patient-centered perspective predicts knee arthroplasty outcome
BackgroundOne-in-five patients are dissatisfied following knee arthroplasty and <50% have fulfilled expectations. The relationship between knee-arthroplasty expectations and surgical outcome remains unclear.PurposeAre expectations regarding the impact of pain on postoperative life predictive of one-year outcome? Does the impact of pain on preoperative quality of life (QOL) influence this relationship?Methods Longitudinal cohort of 1044 uni-compartmental (43%) or total knee-arthroplasty (57%) (UKA or TKA) patients, aged mean 69 ± 9 years. Preoperatively, patients reported the impact of pain on QOL and expected impact of pain on life one-year post-arthroplasty. One-year postoperative outcomes: non-return to desired activity, surgical dissatisfaction, not achieving Oxford Knee Score minimal important change (OKS <MIC). Logistic regression including covariates was performed for all patients and subgroups (better vs worse pre-operative pain-related QOL; UKA vs TKA).ResultsExpecting moderate-to-extreme pain (vs no pain) predicted non-return to activity (odds ratio [95% confidence interval], 2.3 [1.3, 4.1]), dissatisfaction (4.0 [1.7, 9.3]), OKS <MIC (3.1 [1.5, 6.3]). Expecting mild pain (vs no pain) predicted worse outcomes for patients with better preoperative pain-related QOL (non-return to activity: 2.7 [1.5, 4.8], OKS <MIC: 2.5 [1.1, 5.5]). Expecting moderate-to-extreme pain (vs. no pain) predicted worse outcomes for patients with worse preoperative pain-related QOL (non-return to activity: 2.4 [1.1, 5.5], dissatisfaction: 5.0 [1.7, 14.8], OKS <MIC: 3.4 [1.4, 8.6]). The odds of a poor outcome in people with worse expectations was higher for UKA patients.ConclusionsExpecting a worse outcome predicted surgical dissatisfaction, less clinical improvement and non-return to desired activity. Patients expecting a more optimistic outcome relative to preoperative status achieved better surgical outcomes.
0883-5403
1-7
Filbay, Stephanie R.
0dad06f8-766f-4046-9bc9-4f29b61bdd5e
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Latham, J.
0577bade-f77c-4ae9-8bef-c95793180618
COASt Study Group
Filbay, Stephanie R.
0dad06f8-766f-4046-9bc9-4f29b61bdd5e
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Latham, J.
0577bade-f77c-4ae9-8bef-c95793180618

Filbay, Stephanie R., Judge, Andrew, Delmestri, Antonella, Arden, Nigel K., Cooper, Cyrus and Latham, J. , COASt Study Group (2018) Evaluating patients' expectations from a novel patient-centered perspective predicts knee arthroplasty outcome. Journal of Arthroplasty, 1-7. (doi:10.1016/j.arth.2018.02.026).

Record type: Article

Abstract

BackgroundOne-in-five patients are dissatisfied following knee arthroplasty and <50% have fulfilled expectations. The relationship between knee-arthroplasty expectations and surgical outcome remains unclear.PurposeAre expectations regarding the impact of pain on postoperative life predictive of one-year outcome? Does the impact of pain on preoperative quality of life (QOL) influence this relationship?Methods Longitudinal cohort of 1044 uni-compartmental (43%) or total knee-arthroplasty (57%) (UKA or TKA) patients, aged mean 69 ± 9 years. Preoperatively, patients reported the impact of pain on QOL and expected impact of pain on life one-year post-arthroplasty. One-year postoperative outcomes: non-return to desired activity, surgical dissatisfaction, not achieving Oxford Knee Score minimal important change (OKS <MIC). Logistic regression including covariates was performed for all patients and subgroups (better vs worse pre-operative pain-related QOL; UKA vs TKA).ResultsExpecting moderate-to-extreme pain (vs no pain) predicted non-return to activity (odds ratio [95% confidence interval], 2.3 [1.3, 4.1]), dissatisfaction (4.0 [1.7, 9.3]), OKS <MIC (3.1 [1.5, 6.3]). Expecting mild pain (vs no pain) predicted worse outcomes for patients with better preoperative pain-related QOL (non-return to activity: 2.7 [1.5, 4.8], OKS <MIC: 2.5 [1.1, 5.5]). Expecting moderate-to-extreme pain (vs. no pain) predicted worse outcomes for patients with worse preoperative pain-related QOL (non-return to activity: 2.4 [1.1, 5.5], dissatisfaction: 5.0 [1.7, 14.8], OKS <MIC: 3.4 [1.4, 8.6]). The odds of a poor outcome in people with worse expectations was higher for UKA patients.ConclusionsExpecting a worse outcome predicted surgical dissatisfaction, less clinical improvement and non-return to desired activity. Patients expecting a more optimistic outcome relative to preoperative status achieved better surgical outcomes.

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Accepted manuscript - Filbay et al. 2018 JoA - Accepted Manuscript
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Accepted/In Press date: 7 February 2018
e-pub ahead of print date: 15 February 2018

Identifiers

Local EPrints ID: 418685
URI: https://eprints.soton.ac.uk/id/eprint/418685
ISSN: 0883-5403
PURE UUID: 480d84dd-c3be-425b-b972-c6b30a90744c
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 19 Mar 2018 17:30
Last modified: 10 Dec 2019 05:29

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