Background: Patients’ expectations
of medical care are linked to their requests for treatment and to
their assessments of outcome and satisfaction. Our goals were to measure
patients" preoperative expectations of knee surgery and
to develop and test patient-derived knee expectations surveys.
Methods: An initial sample of 377 patients (mean
age, 54.6 18.2 years; 52% women) was enrolled in the survey-development
phase. One hundred and sixty-one (43%) of these patients
subsequently underwent total knee arthroplasty; seventy-five (20%),
cruciate ligament repair; eighty-five (23%), meniscal surgery;
and fifty-six (15%), surgery for another knee condition.
Preoperatively, these patients were asked open-ended questions
about their expectations of knee surgery. Their responses were grouped
with use of qualitative research techniques to generate categories
of expectations. Categories were transformed into specific questions
and were formatted into two draft surveys, one for patients undergoing total
knee arthroplasty and one for patients undergoing other surgical
procedures on the knee. A second sample of 163 patients (mean age,
55.1 17.5 years; 49% women) was enrolled in the survey-testing
phase, and they completed the draft surveys on two separate occasions
to establish test-retest reliability. Items were selected
for the final surveys if they were cited by 5% of the patients,
if they represented important functional changes resulting from
surgery, or if they represented potentially unrealistic expectations.
All selected items fulfilled reliability criteria, defined as a
kappa (or weighted kappa) value of 0.4, or were deemed to be clinically
relevant by a panel of orthopaedic surgeons.
Results: From the survey-development phase, a total
of fifty-two categories of expectations were discerned; they included
both anticipated items such as pain relief and improvement in walking
ability and unanticipated items such as improving psychological
well-being. Expectations varied by diagnosis and patient
characteristics, including functional status. Two final surveys
were generated: the seventeen-item Hospital for Special
Surgery Knee Replacement Expectations Survey and the twenty-item
Hospital for Special Surgery Knee Surgery Expectations Survey. Each
required less than five minutes to complete.
Conclusions: Patients have multiple expectations
of knee surgery in the areas of symptom relief and improvement of physical
and psychosocial function, and these expectations vary according
to the diagnosis. We developed two valid and reliable surveys that
can be used preoperatively to direct patient education and shared
decision-making and to provide a framework for setting
reasonable goals. Reexamining patients’ responses postoperatively
could provide a way to assess fulfillment of expectations, which
is a crucial patient-derived measure of outcome and satisfaction.