Frouzakis Regula, Herren Daniel B, Marks Miriam
Department of Research and Development, Schulthess Clinic, Zurich, Switzerland; Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland; Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
Department of Research and Development, Schulthess Clinic, Zurich, Switzerland; Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland; Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
J Hand Surg Am. 2015 Mar;40(3):483-90. doi: 10.1016/j.jhsa.2014.10.066. Epub 2015 Jan 21.
To determine the main reasons why patients with trapeziometacarpal osteoarthritis (TMC OA) seek treatment, their pretreatment expectations for the final outcome, fulfillment after one year, and predictors of fulfillment of the expectation.
We included 163 patients with TMC OA. They filled out questionnaires assessing expectations and functional status before and at 3, 6, and 12 months after treatment.
Pain reduction was the most important reason why 65% of all patients sought treatment, whereas 17% and 13% requested treatment to improve hand function and activities of daily living, respectively. No patients considered improved appearance of the hand to be the main reason for undertaking treatment. Expectations before treatment were anticipated to be totally or mostly fulfilled by 93% of surgically treated patients and 59% of patients treated with corticosteroid injection. After one year, 77% of surgically treated patients rated their expectations as completely or mostly fulfilled, compared with 24% of patients treated with corticosteroid injections. Including all variables before treatment in a best-fit regression model, fulfillment of patients' expectations could not be sufficiently predicted. However, with addition to the model of the outcome of pain at one year, 48% of the variance of fulfilled expectations could be accounted for.
Patients with TMC OA predominantly visit hand surgeons seeking treatment to reduce pain, whereas function and aesthetics have minor roles. Based on variables before treatment, no prediction can be made regarding whether expectations will be fulfilled after treatment because residual pain at one year contributes considerably to the variance in fulfilled expectations. Clinicians should assess patients' expectations before treatment and explain realistic treatment outcomes to obtain best treatment results.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
确定大多角骨-第一掌骨骨关节炎（TMC OA）患者寻求治疗的主要原因、治疗前对最终结果的期望、治疗一年后的期望达成情况以及期望达成的预测因素。
我们纳入了163例TMC OA患者。他们在治疗前以及治疗后3、6和12个月填写了评估期望和功能状态的问卷。
疼痛减轻是65%的患者寻求治疗的最重要原因，而分别有17%和13%的患者要求治疗以改善手部功能和日常生活活动能力。没有患者认为手部外观改善是接受治疗的主要原因。93%接受手术治疗的患者和59%接受皮质类固醇注射治疗的患者预计治疗前的期望将完全或大部分得到满足。一年后，77%接受手术治疗的患者将他们的期望评为完全或大部分得到满足，而接受皮质类固醇注射治疗的患者这一比例为24%。将治疗前的所有变量纳入最佳拟合回归模型后，无法充分预测患者期望的达成情况。然而，在模型中加入一年时的疼痛结果后，可以解释48%的期望达成差异。
TMC OA患者主要就诊于手外科医生以寻求减轻疼痛的治疗，而功能和美观的作用较小。基于治疗前的变量，无法预测治疗后期望是否会达成，因为一年时的残余疼痛对期望达成的差异有很大影响。临床医生应在治疗前评估患者的期望，并解释实际的治疗结果，以获得最佳治疗效果。
研究类型/证据水平：治疗性研究II级
