Department of Orthopaedic Surgery and Trauma, Máxima MC, Eindhoven, The Netherlands.
Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven.
Bone Joint J. 2021 Apr;103-B(4):619-626. doi: 10.1302/0301-620X.103B4.BJJ-2020-0629.R3.
Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment.
In total, 204 primary TKA patients with osteoarthritis were enrolled in this randomized controlled trial (RCT). Patients were allocated to either usual preoperative education (control group) or usual education plus an additional module on realistic expectations (intervention group). Primary outcome was being very satisfied (numerical rating scale for satisfaction ≥ 8) with the treatment result at 12 months' follow-up. Other outcomes were change in preoperative expectations and postoperative expectation fulfilment.
A total of 187 patients (91.7%) were available for analysis at follow-up. In the intention-to-treat analysis, 58.5% (55/94) of patients were very satisfied with the treatment result in the control group, and 69.9% (65/93) of patients in the intervention group (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 0.90 to 3.29). A per-protocol analysis for patients who attended the education session (92.0%, n = 172) showed that 56.9% (49/86) of patients were very satisfied in the control group and 74.4% (61/86) in the intervention group (AOR 2.44, 95% CI 1.21 to 4.91). After preoperative education, the expectation scores in the intervention group were significantly lower (mean difference -6.9 (95% CI -10.2 to -3.6)) and did not alter in the control group (mean difference 0.5 (95% CI -2.9 to 3.9)). Overall, fulfilment of expectations at 12 months was significantly higher in the intervention group (mean difference 11.4% (95% CI 2.3 to 20.5)).
Improved preoperative patient education can modify patient expectations, resulting in higher postoperative fulfilment of expectation and higher satisfaction in the group that attended the preoperative education. This is the first RCT to confirm the potential of improved expectation management on satisfaction after TKA. Cite this article: 2021;103-B(4):619-626.
全膝关节置换术（TKA）后，满足术前预期被认为对术后满意度有重大影响。更好地管理预期，使预期更加现实，可能会导致更高的术后满意度。本研究的目的是评估在术前教育模块中增加一个针对长期功能恢复的现实期望的模块对术后满意度和期望满足的影响。
本随机对照试验（RCT）共纳入 204 例原发性骨关节炎 TKA 患者。患者被分配到常规术前教育（对照组）或常规教育加现实期望模块（干预组）。主要结局是在 12 个月随访时对治疗结果非常满意（满意度数字评分量表≥8）。其他结局包括术前期望的变化和术后期望的满足程度。
共有 187 例患者（91.7%）在随访时可进行分析。在意向治疗分析中，对照组有 58.5%（55/94）的患者对治疗结果非常满意，干预组有 69.9%（65/93）的患者（调整后的优势比（AOR）为 1.72，95%置信区间（CI）为 0.90 至 3.29）。对于参加教育课程的患者（92.0%，n=172）的方案分析显示，对照组有 56.9%（49/86）的患者非常满意，干预组有 74.4%（61/86）的患者（AOR 2.44，95%CI 1.21 至 4.91）。经过术前教育，干预组的期望评分显著降低（平均差值-6.9[95%CI-10.2 至-3.6]），而对照组无变化（平均差值 0.5[95%CI-2.9 至 3.9]）。总体而言，干预组在 12 个月时的期望满足率显著更高（平均差值 11.4%[95%CI2.3 至 20.5]）。
改进术前患者教育可以改变患者的期望，从而提高术后期望的满足度，并在参加术前教育的患者中提高满意度。这是第一项证实 TKA 后改善期望管理对满意度有潜在影响的 RCT。
2021;103-B（4）：619-626.
