Kadzielski John, Malhotra Leah R, Zurakowski David, Lee Sang-Gil P, Jupiter Jesse B, Ring David
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114-2696, USA.
J Hand Surg Am. 2008 Dec;33(10):1783-8. doi: 10.1016/j.jhsa.2008.06.019.
We tested the hypothesis that preoperative expectations affect postoperative satisfaction and arm-specific, self-reported health status after elective carpal tunnel release.
Forty-nine patients having elective carpal tunnel release completed questionnaires evaluating self-rated upper extremity-specific disability using the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire, expectations regarding surgery (Preop Expectations Score), personal importance of upper-extremity function, measures of general optimism, the Life Orientation Test (LOT), as well as health-specific optimism, and the Multidimensional Health Locus of Control scale. Six months after surgery, patients completed a 10-point Likert scale to assess satisfaction, the DASH, and measures determining (1) fulfillment of expectations (Postop Met Expectations Score) and (2) relief of specific systems (Postop Help Score).
The DASH scores decreased significantly from an average of 37 points before surgery to an average of 15 points 6 months after carpal tunnel release (p<.001), and patients rated their satisfaction (mean +/- standard deviation) as 8 +/- 3. Preoperative expectations did not correlate with patient satisfaction or postoperative DASH scores. Multivariable analyses determined that patient satisfaction was best predicted by fulfillment of expectations (Postop Help Score alone, accounting for 41% of the variance in scores) and postoperative DASH scores were predicted by a combination of Postop Met Expectations Score and the LOT score (accounting for 31% of the variance in scores).
As measured in this study, the strongest predictor of satisfaction after carpal tunnel release was relief of symptoms, and the strongest predictors of postoperative disability were met expectations and optimism; however, the majority of the variance in postoperative satisfaction remains unexplained.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
我们检验了以下假设，即术前期望会影响择期腕管松解术后的满意度以及特定手臂的自我报告健康状况。
49例行择期腕管松解术的患者完成了问卷调查，使用手臂、肩部和手部功能障碍（DASH）问卷评估自我评定的上肢特定功能障碍、对手术的期望（术前期望评分）、上肢功能的个人重要性、一般乐观程度测量（生活取向测试，LOT）以及特定健康方面的乐观程度，还有多维健康控制点量表。术后6个月，患者完成一个10分的李克特量表以评估满意度、DASH问卷，以及确定（1）期望的达成情况（术后达成期望评分）和（2）特定症状的缓解情况（术后帮助评分）的测量。
DASH评分从术前平均37分显著降至腕管松解术后6个月的平均15分（p<0.001），患者对满意度的评分（均值±标准差）为8±3。术前期望与患者满意度或术后DASH评分无相关性。多变量分析确定，期望的达成情况（仅术后帮助评分，占评分方差的41%）最能预测患者满意度，术后DASH评分由术后达成期望评分和LOT评分共同预测（占评分方差的31%）。
在本研究中所测量的，腕管松解术后满意度的最强预测因素是症状缓解，术后功能障碍的最强预测因素是期望达成和乐观程度；然而，术后满意度的大部分方差仍无法解释。
研究类型/证据水平：预后性III级。
