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How do the expectations of patients compare with their surgeons regarding outcomes of periacetabular osteotomy?

ABSTRACT: Our objective was to determine the frequency and strength of agreement between patients and their surgeons on preoperative expectations of the outcomes of periacetabular osteotomy (PAO) surgery. We also sought to determine whether patient preoperative function and pain levels were associated with patients' and surgeons' expectations and to identify the motivating factors for patients to undergo PAO. Two surgeons and their combined 68 patients preoperatively completed 4-point Likert-scales rating their expectations of improvement in six domains representing different hip symptoms after surgery. Domains included pain, stiffness, locking, stability, walking ability and athletic ability. Concordance between patient and surgeon expectation was evaluated by the percent of exact and partial agreement. Correlation analyses were performed to investigate associations between expectations of improvement and patient factors. Exact agreement between patients and surgeons ranged from 18.2% (stiffness) to 55.9% (pain) and partial agreement between patients and surgeons ranged from 48.5% (stiffness) to 100% (pain). Patients with higher UCLA scores tended to have lower surgeon expectations of improving walking ability (r?=?-0.34; P?=?0.007) but higher expectations for improved athletic ability (r?=?0.25; P?=?0.04), and surgeons anticipated more improvement in walking for patients with higher stiffness (r?=?0.31, P?=?0.01) and pain (r?=?0.38, P?=?0.002). Similarly, patients with higher Short Form-12 physical component summary had lower surgeon expectations of improvement in walking ability (r?=?-0.40, P?=?0.002) and stiffness (r?=?-0.35, P?=?0.006). In the most domains there was frequent discrepancy between patient and surgeon expectations, with patients being more optimistic than their surgeons in every domain. For the pain domain, patients and surgeons had similar expectations.

SUBMITTER: Boye GN

PROVIDER: S-EPMC6328751 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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How do the expectations of patients compare with their surgeons regarding outcomes of periacetabular osteotomy?

Boye Gloria N GN Wylie James D JD Miller Patricia E PE Kim Young-Jo YJ Millis Michael B MB

Journal of hip preservation surgery 20181127 4

Our objective was to determine the frequency and strength of agreement between patients and their surgeons on preoperative expectations of the outcomes of periacetabular osteotomy (PAO) surgery. We also sought to determine whether patient preoperative function and pain levels were associated with patients' and surgeons' expectations and to identify the motivating factors for patients to undergo PAO. Two surgeons and their combined 68 patients preoperatively completed 4-point Likert-scales rating ...[more]

PMID: 30647928

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Project description:Individuals with hip dysplasia report significant functional disability that improves with periacetabular osteotomy (PAO). Four physical performance measures (PPMs) have been recently validated for use with nonarthritic hip conditions; however, their ability to detect functional improvement and correlate with improvements in popular hip-specific patient-reported outcome (PRO) instruments after PAO is unknown. The purpose of this study was to evaluate the responsiveness of four PPMs up to 1 year after PAO, compare PPMs with established PRO measures at these time points, and report the acceptability and utility of PPMs for assessing outcomes after PAO. Twenty-two participants aged 15 to 39 years completed the timed stair ascent (TSA), sit-to-stand five times (STS5), self-selected walking speed, four-square-step test, and seven hip-specific PRO measures before surgery and at approximately 6 months and 1 year after PAO. They completed questions regarding acceptability and utility of both types of testing. Wilcoxon rank sum test and unpaired Student t-tests were used to assess differences between time points; Spearman correlation and generalized linear modeling were used to determine the relationship between PPMs and PRO measures. Six months after PAO, participants showed significant improvements on all seven PRO instruments (P < 0.001) and on the STS5 (P = 0.01). At one year, these improvements were maintained and TSA also improved (P = 0.03). Improvement in other PPMs did not reach significance (P = 0.07 and 0.08). The STS5 test demonstrated moderate to strong correlation (|r| = 0.43 to 0.76, P < 0.05) with all PRO measures, and the TSA test demonstrated moderate to strong correlation with almost all measures (|r| = 0.43 to 0.58, P < 0.05). Correlations strengthened on subanalysis of participants with unilateral disease (n = 11) (|r| = 0.56 to 0.94, P < 0.05). All participants (100%) found PPM testing acceptable despite disability; 25% preferred PPMs to PRO measures, whereas 75% of participants found them equal in usefulness. The STS5 and TSA tests demonstrated moderate to very strong correlation with PRO measures at six and 12 months after PAO for dysplasia. These tests could be used as a functional outcome to supplement PRO instruments after PAO.

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How do the expectations of patients compare with their surgeons regarding outcomes of periacetabular osteotomy?

Publications

How do the expectations of patients compare with their surgeons regarding outcomes of periacetabular osteotomy?

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