Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands.
Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands; Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
J Arthroplasty. 2020 Jul;35(7):1806-1812. doi: 10.1016/j.arth.2020.02.061. Epub 2020 Mar 3.
This prospective study aimed to examine whether patients' and physicians' outcome expectations were related to subjective (ie, fulfillment of expectations) and objective outcomes (ie, change in pain and function) in hip and knee arthroplasty patients up to 6 months post-surgery.
Patients' (N = 395) and physicians' outcome expectations were examined 1 week post-consultation. Patients' post-operative functional status and the extent of fulfillment of expectations were examined 5 weeks, 3 months, and 6 months post-surgery. Patients and physicians completed the Hospital for Special Surgery Hip/Knee Replacement (Fulfillment) Expectations Survey. Patients completed the Hip/Knee injury and Osteoarthritis Outcome Score. Linear regression analyses were performed to examine the relationship between physicians' expectations and patients' change in pain and function and extent of fulfillment of expectations, and a possible mediated effect of patients' pre-operative expectations.
Patients' high expectations were consistently associated with better objective outcomes (ie, change in pain and function). Yet, high expectations in patients were also negatively related to subjective outcomes (ie, the extent of fulfillment of expectations). Physicians' expectations were only positively associated with objective improvement in knee patients, and not in hip patients. Additionally, knee patients' expectations partly mediated the relationship between physicians' expectations and change in pain and function, 6 months post-surgery.
Although patients' high expectations were associated with better objective outcomes, improvement was still less than patients expected. Thus, patients often have too high expectations of outcomes of surgery. In addition, physicians were able to influence patients' expectations and to change experienced knee patients' outcomes.
本前瞻性研究旨在探讨髋关节和膝关节置换术后 6 个月内，患者和医生的结局预期是否与主观结局（即期望的实现）和客观结局（即疼痛和功能的变化）相关。
在咨询后 1 周评估患者（N=395）和医生的结局预期。术后 5 周、3 个月和 6 个月评估患者的术后功能状态和期望的实现程度。患者和医生完成了特殊外科医院髋关节/膝关节置换术（实现）期望调查。患者完成了髋关节/膝关节损伤和骨关节炎结局评分。线性回归分析用于检验医生的期望与患者疼痛和功能的变化以及期望的实现程度之间的关系，以及患者术前期望的可能中介效应。
患者的高期望与更好的客观结局（即疼痛和功能的变化）始终相关。然而，患者的高期望也与主观结局（即期望的实现程度）呈负相关。医生的期望仅与膝关节患者的客观改善呈正相关，而与髋关节患者无关。此外，膝关节患者的期望部分中介了医生的期望与术后 6 个月疼痛和功能变化之间的关系。
尽管患者的高期望与更好的客观结局相关，但改善程度仍低于患者的预期。因此，患者通常对手术结局的期望过高。此外，医生能够影响患者的期望并改变膝关节患者的体验结局。
