Consultant Trauma and Orthopaedic Surgeon, Epsom and St Helier University Hospitals NHS Trust/SWLEOC Epsom, Surrey, UK.
Senior Foot and Ankle Fellow, Royal National Orthopaedics Hospital Stanmore, London, UK.
J Foot Ankle Surg. 2022 May-Jun;61(3):528-532. doi: 10.1053/j.jfas.2021.10.004. Epub 2021 Oct 30.
The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. The primary objective of the study was to identify the most common patient "expectations" from hallux valgus surgery and establish over what time period postsurgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (>18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre- and postoperative Manchester-Oxford Foot Questionnaire and Visual Analogue Scale scores. A separate "expectations" questionnaire was designed and completed assessing the patient's preoperative rehabilitation expectations compared to the actual time taken to achieve those goals. These included 5 domains: pain improvement, return to walking unaided, return to normal foot sensation, return to normal footwear, and return to driving. The postoperative functional scores demonstrated statistically significant improvement postsurgery (p < .001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (p < .001) along with trends toward an earlier return to driving function of patient expectation (p < .05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weightbearing and return to function.
管理患者预期与术后功能结果之间的关系已在其他骨科领域得到广泛研究，但在足踝文献中信息匮乏。该研究的主要目的是确定拇外翻手术中最常见的患者“期望”，并确定术后多长时间可以达到这些目标。在单一中心进行了一项前瞻性研究，共纳入 45 例连续患者。该研究包括接受 Scarf 截骨术治疗原发性拇外翻的成年患者（>18 岁）。患者随访 6 个月，完成术前和术后曼彻斯特-牛津足部问卷和视觉模拟评分。设计并完成了一份单独的“期望”问卷，评估患者术前康复期望与实际达到这些目标所需的时间。这些期望包括 5 个方面：疼痛改善、无需辅助行走、恢复正常足部感觉、恢复正常鞋类、恢复驾驶。术后功能评分显示术后有统计学显著改善（p<0.001）。它还突出了满足上述期望的总体时间框架。平均而言，患者在预期时间之前 1.4 周达到满意的疼痛改善（p<0.001），并且有提前恢复驾驶功能的趋势（p<0.05）。因此，可以可靠地告知患者，他们的疼痛症状可能会在手术后一个月内得到缓解。这应该使患者能够更明智地为康复做准备，从而促进早期负重和恢复功能。
