Full Length Article| Volume 36, ISSUE 1, P97-102, January 2023

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Effect of pre-treatment expectations on post-treatment expectation fulfillment or outcomes in patients with distal radius fracture


      • The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group.
      • The pre-treatment expectation score was a predictor of the post-treatment expectation fulfillment and PRWE scores only in the surgical group.



      The influence of patient expectations on patient-rated outcomes (PRO) after elective orthopedic procedures has been addressed in previous studies. However, the influence of pre-treatment expectations on post-treatment PRO was rarely examined in patients with extremity fractures.


      The purpose of this study was to determine if pre-treatment expectations have an effect on post-treatment expectation fulfillment or PRO in patients surgically and conservatively managed for distal radius fractures (DRFs).

      Study design

      Prospective cohort study


      For this study, 114 consecutive patients treated for DRF between January 2017 and February 2018 were enrolled. Of the 114 patients, 81 underwent surgical treatment (surgical group), and 33 were managed conservatively (conservative group). All patients completed a 7-item pre-treatment expectation questionnaire initially. There were 66 patients in the surgical group and 25 patients in the conservative group available at the 1-year follow-up and completed a 6-item post-treatment expectation fulfillment questionnaire and patient-reported wrist evaluation (PRWE) questionnaire.


      The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group. However, no significant differences in post-treatment expectation fulfillment scores and PRWE scores were observed between groups. Higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score (r = 0.36, P = 0.003) and lower PRWE score (r = -0.3, P = 0.02) in the surgical group. However, the pre-treatment expectation score was not significantly correlated with the post-treatment expectation fulfillment score (r = -0.09, P = 0.65) or PRWE score (r = -0.02, P = 0.93) in conservative group. In the surgical group, multivariable linear regression analysis showed that post-treatment expectation fulfilment score could be explained by the pre-treatment expectation score (Beta = 0.41, P = 0.001), accounting for 15% of the variance, and PRWE score was also explained by the pre-treatment expectation score (Beta = 0.39, P = 0.001), accounting for 14% of the variance.


      In conclusion, higher pre-treatment expectation score was moderately correlated with higher the post-treatment expectation fulfillment score and lower PRWE score, and the pre-treatment expectation score could only explain a small amount of variance seen in the post-treatment expectation fulfillment and PRWE scores in the surgical group. However, there was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment score or the PRWE score in the conservative group.

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      JHT Read for Credit

      Quiz: # 927

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The of the 114 patients, approximately
        • a.
          70% were managed conservatively
        • b.
          70% underwent surgery
        • c.
          90 % underwent surgery
        • d.
          90% were managed conservatively
      • # 2.
        During pre-treatment expectation evaluation
        • a.
          all questions were open-ended
        • b.
          both groups had essentially equal expectations
        • c.
          the conservative group had higher expectations than the surgical group
        • d.
          the surgical group had higher expectations than the conservative group
      • # 3.
        Pre-treatment expectations were evaluated by
        • a.
          the staff's PA
        • b.
          Zoom patient interviews
        • c.
          written questionnaires
        • d.
          live patient interviews
      • # 4.
        A primary post-treatment fulfillment outcome measure was the
        • a.
          Mayo Wrist Result Survey
        • b.
        • c.
          ASHT Guideline Form
        • d.
          LaStayo-MacDermid 3 prong approach
      • # 5.
        Higher pre-treatment expectations had only moderate correlation to post-treatment fulfillment scores
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.