- •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).
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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- Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain.Phys Ther. 2010; 90: 1345-1355
- Patient expectations and patient-reported outcomes in surgery: a systematic review.Surgery. 2014; 155: 799-808
- Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes.CMAJ. 2001; 165: 174-179
- Henn RF, 3rd. Patient expectations and satisfaction in Orthopedic surgery: A review of the literature.J Clin Orthop Trauma. 2019; 10: 755-760
- Patient expectations predict greater pain relief with joint arthroplasty.J Arthroplasty. 2009; 24: 716-721
- Fulfillment of patients' expectations for total hip arthroplasty.J Bone Joint Surg Am. 2009; 91: 2073-2078
- Patients' expectations of knee surgery.J Bone Joint Surg Am. 2001; 83: 1005-1012
- Patients' preoperative expectations predict the outcome of rotator cuff repair.J Bone Joint Surg Am. 2007; 89: 1913-1919
- A comparison of patient and surgeon preoperative expectations of spinal surgery.Spine (Phila Pa 1976). 2013; 38: 1040-1048
- Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study.Spine (Phila Pa 1976). 2012; 37: E103-E108
- The epidemiology of distal radius fractures.Hand Clin. 2012; 28: 113-125
- The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457
- Outcomes after volar plate fixation of low-grade open and closed distal radius fractures are similar.Clin Orthop Relat Res. 2013; 471: 2030-2035
- The American academy of Orthopedic surgeons outcomes instruments: normative values from the general population.J Bone Joint Surg Am. 2002; 84: 208-215
- Patient rating of wrist pain and disability: a reliable and valid measurement tool.J Orthop Trauma. 1998; 12: 577-586
- Fracture and dislocation classification compendium - 2007: Orthopedic Trauma Association classification, database and outcomes committee.J Orthop Trauma. 2007; 21: S1-133
- Self-efficacy corresponds to wrist function after combined plating of distal radius fractures.J Hand Ther. 2020; 33: 314-319
- Evaluation of expectations and expectation fulfillment in patients treated for trapeziometacarpal osteoarthritis.J Hand Surg Am. 2012; 40: 483-490
- Evaluation of preoperative expectations and patient satisfaction after carpal tunnel release.J Hand Surg Am. 2008; 33: 1783-1788
- The effect of diabetes on functional outcomes among individuals with distal radial fractures.J Hand Ther. 2019; 32: 476-482
- Early psychological and social factors explain the recovery trajectory after distal radial fracture.J Bone Joint Surg Am. 2020; 102: 788-795
- Randomized trials to modify patients' preoperative expectations of hip and knee arthroplasties.Clin Orthop Relat Res. 2008; 466: 424-431
- Patient expectations for outcomes of upper extremity total joint arthroplasty: a systematic review.Critical Reviews™ in Physical and Rehabilitation Medicine. 2020; 32: 205-220
- Could preoperative preferences and expectations influence surgical decision making? Rheumatoid arthritis patients contemplating metacarpophalangeal joint arthroplasty.Plast Reconstr Surg. 2008; 121: 175-180
- Relationship between patient expectations and clinical measures in patients undergoing rheumatoid hand surgery from the silicone arthroplasty in rheumatoid arthritis (SARA) study.Plast Reconstr Surg. 2015; 136: 775e-781e
- Patients With thumb-base osteoarthritis scheduled for surgery have more symptoms, worse psychological profile, and higher expectations than nonsurgical counterparts: a large cohort analysis.Clin Orthop Relat Res. 2019; 477: 2735-2746
- The effect of socioeconomic factors on outcomes of distal radius fractures: a systematic review.Hand (N Y). 2018; 13: 509-515
- Role of depression in outcomes of low-energy distal radius fractures in patients older than 55 years..J Orthop Trauma. 2016; 30: 228-233
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 JHTReadforCredit.com. 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
- c.ASHT Guideline Form
- d.LaStayo-MacDermid 3 prong approach
- # 5.Higher pre-treatment expectations had only moderate correlation to post-treatment fulfillment scores
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: May 12, 2021
Accepted: April 30, 2021
Received in revised form: April 18, 2021
Received: October 19, 2020
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