Marks Miriam, Audigé Laurent, Reissner Lisa, Herren Daniel B, Schindele Stephan, Vliet Vlieland Thea P M
Department of Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland,
Arch Orthop Trauma Surg. 2015 Jan;135(1):141-7. doi: 10.1007/s00402-014-2119-0. Epub 2014 Nov 21.
The evaluation of patient satisfaction is becoming increasingly important in assessing treatment outcomes. The objective of this study was to analyze the determinants of treatment satisfaction in patients with trapeziometacarpal osteoarthritis (TMC OA) after surgery or corticosteroid injection.
Prospective cohort study of patients with TMC OA who received surgery or corticosteroid injection was carried out. Socio-demographic and clinical data were recorded at baseline and 1 year after the intervention, and patients filled out the Michigan Hand Outcomes Questionnaire (MHQ). On a 5-point Likert scale, patients reported baseline expectations, expectation fulfillment at 1 year, as well as satisfaction with the treatment result. To identify determinants of satisfaction, we entered these variables into one ordered logistic regression model for surgical patients and another for patients with injection.
We included 146 patients, 88 of whom were treated surgically. With respect to satisfaction at 1 year, 87 % of the surgical patients were somewhat or very satisfied with the treatment result, whereas only 49 % of the patients with injection were satisfied. Expectations being fulfilled was the only determinant of treatment satisfaction in the surgical group. In the injection group, a more advanced Eaton stage of TMC OA and greater pain at 1 year were associated with reduced satisfaction.
Surgery for TMC OA leads to high patient satisfaction, whereas only half of the patients treated with corticosteroid injection were satisfied with the treatment result. An advanced stage of TMC OA and higher pain lead to reduced treatment satisfaction in the latter group, indicating that corticosteroid injection is only effective for patients in a lower stage of disease. As fulfillment of expectations was an important determinant of satisfaction in the surgical group, we emphasize the need to provide comprehensive information prior to surgery, so that the patient's expectations of treatment outcome are realistic.
在评估治疗效果时，患者满意度的评估变得越来越重要。本研究的目的是分析手术或皮质类固醇注射治疗后，第一掌腕关节骨关节炎（TMC OA）患者治疗满意度的决定因素。
对接受手术或皮质类固醇注射的TMC OA患者进行前瞻性队列研究。在基线和干预后1年记录社会人口统计学和临床数据，患者填写密歇根手部结果问卷（MHQ）。患者采用5点李克特量表报告基线期望、1年时期望的达成情况以及对治疗结果的满意度。为了确定满意度的决定因素，我们将这些变量纳入一个针对手术患者的有序逻辑回归模型和另一个针对注射患者的模型。
我们纳入了146例患者，其中88例接受了手术治疗。关于1年时的满意度，87%的手术患者对治疗结果有些满意或非常满意，而只有49%的注射患者满意。期望的达成是手术组治疗满意度的唯一决定因素。在注射组中，TMC OA的伊顿分期更高级以及1年时疼痛更严重与满意度降低相关。
TMC OA手术导致患者满意度较高，而接受皮质类固醇注射治疗的患者中只有一半对治疗结果满意。TMC OA的晚期和更高的疼痛导致后一组患者的治疗满意度降低，表明皮质类固醇注射仅对疾病处于较低阶段的患者有效。由于期望的达成是手术组满意度的一个重要决定因素，我们强调在手术前需要提供全面的信息，以便患者对治疗结果的期望是现实的。
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