Evaluation of Expectations and Expectation Fulfillment in Patients Treated for Trapeziometacarpal Osteoarthritis

doi:10.1016/j.jhsa.2014.10.066

The Journal of Hand Surgery

Volume 40, Issue 3, March 2015, Pages 483-490

https://doi.org/10.1016/j.jhsa.2014.10.066 Get rights and content

Purpose

To determine the main reasons why patients with trapeziometacarpal osteoarthritis (TMC OA) seek treatment, their pretreatment expectations for the final outcome, fulfillment after one year, and predictors of fulfillment of the expectation.

Methods

We included 163 patients with TMC OA. They filled out questionnaires assessing expectations and functional status before and at 3, 6, and 12 months after treatment.

Results

Pain reduction was the most important reason why 65% of all patients sought treatment, whereas 17% and 13% requested treatment to improve hand function and activities of daily living, respectively. No patients considered improved appearance of the hand to be the main reason for undertaking treatment. Expectations before treatment were anticipated to be totally or mostly fulfilled by 93% of surgically treated patients and 59% of patients treated with corticosteroid injection. After one year, 77% of surgically treated patients rated their expectations as completely or mostly fulfilled, compared with 24% of patients treated with corticosteroid injections. Including all variables before treatment in a best-fit regression model, fulfillment of patients’ expectations could not be sufficiently predicted. However, with addition to the model of the outcome of pain at one year, 48% of the variance of fulfilled expectations could be accounted for.

Conclusions

Patients with TMC OA predominantly visit hand surgeons seeking treatment to reduce pain, whereas function and aesthetics have minor roles. Based on variables before treatment, no prediction can be made regarding whether expectations will be fulfilled after treatment because residual pain at one year contributes considerably to the variance in fulfilled expectations. Clinicians should assess patients’ expectations before treatment and explain realistic treatment outcomes to obtain best treatment results.

Type of study/level of evidence

Therapeutic II.

Section snippets

Materials and Methods

Between September 2011 and November 2012, 163 patients with radiographically confirmed TMC OA who received either corticosteroid injection or surgical treatment (trapeziectomy with ligament reconstruction and tendon interposition) were included in the study. Exclusion criteria were diseases other than TMC OA as the main condition at the time of clinical consultation, rheumatoid arthritis, concomitant surgery on other digits, legal incompetence, poor general health condition precluding study

Results

Of the 163 patients included in this analysis, 105 (64%) underwent surgery and 58 (36%) received corticosteroid injection treatment (Table 1). At one year, 94 surgical patients (89%) and 37 patients who received steroid injections (64%) were available for follow-up. In the surgical group, the MHQ pain score decreased from a mean of 65 (± 16) points before treatment to 24 (± 23) at one year (P ≤ .001), whereas patients with corticosteroid injections had before-treatment and one-year MHQ pain

Discussion

Analysis of patient expectations for treatment for TMC OA revealed that pain reduction was the most important reason why patients sought treatment, whereas improving the appearance of the hand was of minor importance. The anticipated fulfillment of expectations before treatment in the surgery group was higher than in the corticosteroid injection group. One year after initiation of treatment, more than three-quarters of surgically treated patients rated expectations to be mostly to completely

Acknowledgments

The authors thank Professor Dr Karin Niedermann from the Zurich University of Applied Sciences, Winterthur, Switzerland, for supporting this study, Professor Dr Thea Vliet Vlieland from Leiden University Medical Center for support in planning the study, and Dr Melissa Wilhelmi for copyediting the manuscript.

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Patient Perspectives on Cognitive Behavioral Therapy for Thumb, Hand, or Wrist Pain and Function: A Survey of 98 Patients
2024, Journal of Hand Surgery
Cognitive behavioral therapy (CBT) is an established option to improve pain and function for many orthopedic conditions. Our purpose was to obtain patient perspectives regarding CBT for thumb, hand, or wrist pain and function.
Between March and April 2022, we distributed an electronic survey via email to patients in our institution’s health system with a diagnosis of arthritic or non-specific thumb, hand, or wrist pain. The survey included the opening statement “Cognitive Behavioral Therapy (CBT) is a non-medication option to help manage pain and improve function” and up to 13 questions pertaining to patients’ experiences and perceptions regarding CBT. The survey was anonymous and did not collect protected health information. We used descriptive statistics for the findings.
We distributed the survey to 327 patients, yielding a 30% response rate (98/327). Of the respondents, 17 reported already using CBT to specifically help with pain/function. Of these, 15 felt it was helpful and agreed it could help others. Of the subset that used CBT for arthritis, all felt it was helpful. Of the 75 respondents with no CBT experience, 42 indicated “I’ve never heard of it,” 28 responded “I never had it recommended as an option,” and 16 marked “I don’t know enough about it.” Small subsets noted potential personal barriers to CBT implementation, such as cost, time involved, or perceived lack of potential efficacy for themselves.
A small proportion of patients from our institution with thumb, hand, or wrist pain are utilizing CBT, and the majority finds it helpful.
While some patients are already substantially benefiting from CBT to improve their thumb, hand, or wrist pain or function, there is a notable opportunity for providers to increase awareness and recommendations for this option.
Effect of pre-treatment expectations on post-treatment expectation fulfillment or outcomes in patients with distal radius fracture
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Citation Excerpt :
This study shows that the pre-treatment expectation score was significantly higher in surgically treated patients with DRF. Frouzakis et al.18 demonstrated that patients treated with surgical intervention had higher pre-treatment expectations than those treated with steroid injection for trapeziometacarpal osteoarthritis, although they were not statistically compared. Their finding was consistent with ours and could be interpreted to mean that patients treated with surgical interventions may be psychologically primed to obtain better outcomes after treatment, while those treated with conservative managements may have expected their treatment to be inadequate.
The influence of patient expectations on patient-rated outcomes (PRO) after elective orthopedic procedures has been addressed in previous studies. However, the influence of pre-treatment expectations on post-treatment PRO was rarely examined in patients with extremity fractures.
The purpose of this study was to determine if pre-treatment expectations have an effect on post-treatment expectation fulfillment or PRO in patients surgically and conservatively managed for distal radius fractures (DRFs).
Prospective cohort study
For this study, 114 consecutive patients treated for DRF between January 2017 and February 2018 were enrolled. Of the 114 patients, 81 underwent surgical treatment (surgical group), and 33 were managed conservatively (conservative group). All patients completed a 7-item pre-treatment expectation questionnaire initially. There were 66 patients in the surgical group and 25 patients in the conservative group available at the 1-year follow-up and completed a 6-item post-treatment expectation fulfillment questionnaire and patient-reported wrist evaluation (PRWE) questionnaire.
The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group. However, no significant differences in post-treatment expectation fulfillment scores and PRWE scores were observed between groups. Higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score (r = 0.36, P = 0.003) and lower PRWE score (r = -0.3, P = 0.02) in the surgical group. However, the pre-treatment expectation score was not significantly correlated with the post-treatment expectation fulfillment score (r = -0.09, P = 0.65) or PRWE score (r = -0.02, P = 0.93) in conservative group. In the surgical group, multivariable linear regression analysis showed that post-treatment expectation fulfilment score could be explained by the pre-treatment expectation score (Beta = 0.41, P = 0.001), accounting for 15% of the variance, and PRWE score was also explained by the pre-treatment expectation score (Beta = 0.39, P = 0.001), accounting for 14% of the variance.
In conclusion, higher pre-treatment expectation score was moderately correlated with higher the post-treatment expectation fulfillment score and lower PRWE score, and the pre-treatment expectation score could only explain a small amount of variance seen in the post-treatment expectation fulfillment and PRWE scores in the surgical group. However, there was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment score or the PRWE score in the conservative group.
Trapeziectomy and Alternative Suspension Technique in Thumb Carpometacarpal Arthritis: Patient-Reported Outcome Measures
2022, Journal of Hand Surgery Global Online
Citation Excerpt :
The DASH-DLV, PRWHE-DLV, and SF-12 are 3 validated questionnaires. Furthermore, the patients were asked to choose from an 8-option list indicating why they requested the operation (Table 1).17 We reported descriptive statistics as medians and interquartile ranges (IQRs) because of their nonnormal distribution, or as absolute values.
For treatment of carpometacarpal thumb joint osteoarthritis, a trapeziectomy with an alternative suspension technique can be performed as the primary surgery or as the secondary after a failed primary surgery. This study evaluates the midterm follow-up (median, 54 months) for this technique using patient-reported outcome measures.
After trapeziectomy, an alternative suspension technique is performed with a flexor carpi radialis tendon strip. Leaving the insertion intact, the strip is tunneled through a drill hole in the base of the first metacarpal and then through a drill hole in the second metacarpal neck and then sutured back onto itself. This suspends the first metacarpal to the shaft of the second metacarpal, creating a strong, V-shaped suspension. As the technique is performed in both the primary and secondary surgery, we analyzed both groups separately. As the primary outcome, we evaluated pain and function with the Patient-Rated Wrist and Hand Evaluation. Further, we evaluated the Disabilities of the Arm, Shoulder and Hand and Short Form 12 questionnaire scores from eligible patients. Finally, we correlated pain and function to quality of life.
The median Patient-Rated Wrist and Hand Evaluation score was 16.0 (interquartile range, 1.5–40.4) after the primary surgery and 46 (interquartile range, 34.0–75.5) after the secondary surgery. Patients after the primary surgery also scored better on the Disabilities of the Arm, Shoulder, and Hand questionnaire compared to patients after the secondary surgery. The Short Form 12 questionnaire physical scores were negatively correlated with the Disabilities of the Arm, Shoulder, and Hand questionnaire scores for the primary group (correlation coefficient, −0.468) and negatively correlated with the Patient-Rated Wrist and Hand Evaluation pain scores for the secondary group (correlation coefficient, −0.703).
Trapeziectomy with this alternative suspension technique for treatment of carpometacarpal thumb joint osteoarthritis shows good patient-reported outcome measures for primary surgery and poor patient-reported outcome measures after the secondary surgery.
Therapeutic IV.
Patients With Higher Treatment Outcome Expectations Are More Satisfied With the Results of Nonoperative Treatment for Thumb Base Osteoarthritis: A Cohort Study
2021, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Because the number of patients treated in our clinic during the study period exceeded 260, we included all patients treated in our clinic during the study period. Because both patients with overly high and very low expectations have been suggested to be less satisfied, we hypothesized that there might be an optimum for CEQ Expectancy Score.12,13,16,18-22 We therefore tested whether our multivariable regression model would better fit the data when a nonlinear effect of the CEQ Expectancy Score was included, using splines.
To investigate how satisfaction with treatment outcome is associated with patient mindset and Michigan Hand Outcome Questionnaire (MHQ) scores at baseline and 3 months in patients receiving nonoperative treatment for first carpometacarpal joint (CMC-1) osteoarthritis (OA).
Cohort study
A total of 20 outpatient locations of a clinic for hand surgery and hand therapy in the Netherlands.
Patients (N=308) receiving nonoperative treatment for CMC-1 OA, including exercise therapy, an orthosis, or both, between September 2017 and February 2019.
Nonoperative treatment (ie, exercise therapy, an orthosis, or both)
Satisfaction with treatment outcomes was measured after 3 months of treatment. We measured total MHQ score at baseline and at 3 months. As baseline mindset factors, patients completed questionnaires on treatment outcome expectations, illness perceptions, pain catastrophizing, and psychological distress. We used multivariable logistic regression analysis and mediation analysis to identify factors associated with satisfaction with treatment outcomes.
More positive pretreatment outcome expectations were associated with a higher probability of being satisfied with treatment outcomes at 3 months (odds ratio, 1.15; 95% confidence interval, 1.07-1.25). Only a relatively small part (33%) of this association was because of a higher total MHQ score at 3 months. None of the other mindset and hand function variables at baseline were associated with satisfaction with treatment outcomes.
This study demonstrates that patients with higher pretreatment outcome expectations are more likely to be satisfied with treatment outcomes after 3 months of nonoperative treatment for CMC-1 OA. This association could only partially be explained by a better functional outcome at 3 months for patients who were satisfied. Health care providers treating patients nonoperatively for CMC-1 OA should be aware of the importance of expectations and may take this into account in pretreatment counseling.
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Citation Excerpt :
For the latter, we analyzed the score for the dominant hand. The satisfaction questionnaire (based on previous reports on patient satisfaction after treatment of CMC thumb joint arthritis) differentiated between sides.23,24 We asked patients why they sought treatment based on 8 items: improvement of (1) thumb function, (2) thumb appearance, (3) power, (4) pain, (5) daily activities, (6) activities of leisure, (7) return to work, or (8) other.
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Therapeutic IV.
Trapeziometacarpal Joint Arthritis: Is Duration of Symptoms a Predictor of Surgical Outcomes?
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Great effort has been placed on determining the optimal surgical treatment for trapeziometacarpal joint arthritis (TMA). However, a paucity of literature exists concerning the optimal timing of surgical intervention. We hypothesized that an increased duration of TMA symptoms before operative intervention would negatively affect surgical outcomes.
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Among 109 patients, average QuickDASH score at initial presentation was 41.1 ± 17.9. Patients had symptoms of TMA for an average of 3.2 years (median, 2.1 years) before undergoing operative intervention. Patients were divided into 2 groups: those with symptoms less than 2 years and those with symptoms greater than 2 years. Patients who underwent LRTI after less than 2 years of symptoms achieved a significantly greater degree of improvement in the QuickDASH score compared with patients with symptoms greater than 2 years (26.2 vs 5.3).
Patients with less than 2 years of symptomatic TMA before LRTI can expect the greatest improvement in patient-reported disability impairment compared with those with more than 2 years of symptoms. This can be used to counsel patients regarding the optimal timing of surgery if nonsurgical treatment has failed to provide durable symptomatic relief.
Therapeutic IV.

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Scientific articleEvaluation of Expectations and Expectation Fulfillment in Patients Treated for Trapeziometacarpal Osteoarthritis

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

Surgery

J Hand Surg Am

J Arthroplasty

J Arthroplasty

Patient Educ Couns

J Arthroplasty

Ann Chir Main

J Hand Surg Am

J Hand Surg Am

Arthroplasty

Surgery

Soc Sci Med

J Hand Surg Am

Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study

Spine (Phila Pa 1976)

Great expectations: really the novel predictor of outcome after spinal surgery?

Spine (Phila Pa 1976)

Individual expectation: an overlooked, but pertinent factor in the treatment of individuals experiencing musculoskeletal pain

Phys Ther

Hope, expectations and recovery from illness: a narrative synthesis of qualitative research

J Adv Nurs

Expected and actual improvement of symptoms with carpal tunnel release

J Hand Surg Am

The importance of patient expectations in predicting functional outcomes after total joint arthroplasty

J Rheumatol

Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties

Clin Orthop Relat Res

Scientific article
Evaluation of Expectations and Expectation Fulfillment in Patients Treated for Trapeziometacarpal Osteoarthritis