Background
Methods
Definitions used in this review
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Outcome expectations: beliefs that certain actions will achieve particular outcomes.
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Process expectations: beliefs about the content and process of interventions.
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Self-efficacy expectations: beliefs in one’s capabilities to organize and execute the courses of action required to produce given attainments.
Data sources and searches
Study selection
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The patients were adults (>18 years, no upper limit) who received total hip or total knee arthroplasty.
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Expectations had to be measured before surgery.
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The association between pre-operative expectations and one or more out of 5 different treatment outcomes namely overall improvement, pain, function, stiffness and satisfaction had to be tested either in a unadjusted or adjusted analysis.
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The article had to be written in English or Dutch.
Data extraction and methodological quality assessment
Study participation
Measurement of determinant
Outcome measurement
Confounding measurement and account
Analysis
Data syntheses and analysis
Results
Study characteristics
Study | Quality score (%) | N | Hip or knee | Type of expectations | Measure of expectations | Timing of expectation measurement | Health outcome measures | Timing of outcome measures |
---|---|---|---|---|---|---|---|---|
Vd Akker-Scheek 2007[30] | 79 | 123 | Knee | Self efficacy expectations | - Self efficacy for rehabilitation outcome scale | 6 weeks prior to surgery | 1. WOMAC overall score | 6 months post surgery |
2. SF-36 physical function | ||||||||
Arden 2011[35] | 50 | 799 | Hip | Outcome expectations | 2 items | Pre-operative | 1. Satisfaction | 1 year and 2 years post surgery |
- How painful do you expect your hip to be when you are fully recovered from surgery (not at all painful, slightly painful, very painful) | No specific time point reported | 2. Change in oxford hip score | ||||||
- How limited do you expect to be in your usual activities when you are fully recovered from surgery (not limited at all, slightly limited, moderately limited, greatly limited) | ||||||||
Brokelman 2008[24] | 50 | 44 | Knee and hip | Outcome expectations | - VAS (0–100) for expectation of satisfaction with surgery 1 year postoperative | After pre-operative information meeting | 1. VAS for Satisfaction | Mean = 13.1 months post surgery |
Cross 2009[16] | 39 | 106 | Knee and hip | Outcome expectations | - Hospital for Special Surgery Hip or Knee Replacement Expectations Questionnaire | Pre-operative | 1. WOMAC pain change | 6 months post surgery |
Self efficacy expectations | - Arthritis Self Efficacy Scale | No specific time point reported | 2. WOMAC function change | |||||
3. WOMAC stiffness change | ||||||||
Engel 2004[25] | 58 | 78 | Knee | Outcome expectations | - Expected probability of recovery (VAS) | 2 weeks prior to surgery | 1. WOMAC pain | 6 months post surgery |
Self efficacy expectations | - Expected change in quality of life (4 response choices) | 2. WOMAC function | ||||||
- Coping efficacy (two items, 5 point Likert-type scaled) | 3. WOMAC stiffness | |||||||
4. Overall recovery (clinician assessment) | ||||||||
Gandhi 2009[14] | 58 | 2350 | Knee and hip | Outcome expectations | 3 ‘open’ questions | Pre-operative | 1. WOMAC pain change | 1 year post surgery |
- Time to fully recover from surgery | No specific time point reported | 2. WOMAC function change | ||||||
- Pain expected after surgery | ||||||||
- Ability to perform usual activities when recovered | ||||||||
Hartley 2008[36] | 53 | 100 | Knee and hip | Self efficacy expectations | - Self efficacy for rehabilitation outcome scale | 1 month prior to surgery | 1. Harris Hip Scale / The American Knee Society Score (function) | 6 weeks post surgery |
- 12 items about outcome expectations with Likert type scales from 0–10. | ||||||||
Judge 2011[34] | 63 | 1327 | Hip | Outcome expectations | Number of expectations answered on the following open answered item: | Pre-operative | 1. Improved/not improved according to the OMERACT- | 1 year post surgery |
- What things do you think your might be able to do in a year’s time, that you NEED to be able to do, but CANNOT do now, if the operation is a total succes | No specific time point reported | OARSI criteria | ||||||
2. WOMAC pain | ||||||||
3. WOMAC stiffness | ||||||||
4. WOMAC function | ||||||||
Lingard 2006[26] | 53 | 598 | Knee | Outcome expectations | 4 items answered on a 5 point Likert-type scale (not at all important – very important). | 6 weeks prior to surgery | 1 year post surgery | |
- Expectations regarding pain level | 1. WOMAC pain | |||||||
- Expectations regarding walking distance | 2. WOMAC function | |||||||
- Expectations regarding limitation of recreational activity | 3. Satisfaction | |||||||
- Expectations regarding the use of a walking aid | ||||||||
Lopez-Olivo 2011[32] | 74 | 272 | Knee | Self efficacy expectations | Arthritis Self Efficacy Scale | Within a month prior to surgery | 1. WOMAC pain | 6 months post surgery |
2. WOMAC function | ||||||||
3. KSRS total | ||||||||
4. KSRS knee score | ||||||||
5. KSRS function | ||||||||
Mahomed 2002[15] | 58 | 222 | Knee and hip | Outcome expectations | 2 items answered on a 4 point Likert type scale | Prior to surgery | 1. WOMAC pain | 6 months post surgery |
- Limitations in activities of daily living | No specific time point stated | 2. WOMAC function | ||||||
- Pain relief | 3. WOMAC stiffness | |||||||
2 items answered on a VAS 0-100 | ||||||||
- Overall success | ||||||||
- Likelihood of complications | ||||||||
Mannion 2009[27] | 58 | 146 | Knee | Outcome expectations | - Expected time to full recovery (open answer in months) | Approximately 2 weeks prior to surgery | 1. Global outcome/result of surgery | 2 years post surgery |
- Expected pain after recovery from surgery (not at all through very painfull) | 2. Satisfaction with surgery | |||||||
- Expected limitations in everyday activities after recovery from surgery (not at all limited through greatly limited) | ||||||||
Nilsdotter 2009[28] | 44 | 102 | Knee | Outcome expectations | -Expectations in relation to walking ability measured on a 6 point likert type scale | Pre-operative, no exact time point stated | 1. SF-36 physical function | 6 months, |
1 year and | ||||||||
5 years post surgery | ||||||||
-Expectations in relation to leisure activities measured on a 7 point likert scale | ||||||||
-Estimated time to recovery. And also about the 5 KOOS domains | ||||||||
-Expectations dichotomized in high and low expectations | ||||||||
Oettingen 2002[33] | 68 | 51 | Hip | Outcome expectations | 5 items answered on 5 point Likert type scales combined in a single score. | On the day of admission to the hospital | 1. Range of hip motion (3 items, rated by PT) | Two weeks post surgery |
-How likely do you think it is that two weeks after surgery you will be able to go for a brief walk using an assistive cane | 2. Walking on stairs (1 item rated by PT), | |||||||
-How likely do you think it is that two weeks after surgery you will be walking on stairs up and down with the help of an assistive cane? | 3. Recovery. How well the patient does in comparison to other patients (4 items, rated by PT) | |||||||
-How functionally able do you think you will be 3 months after surgery | Al questions were answered on a 5 point likert type scale. | |||||||
-To what extent do you think you will be without pain 3 months after surgery | ||||||||
Quintana 2009[17] | 74 | 788 | Hip | Outcome expectations | 1 item about expectation of pain relief | Whilst patients were on the waiting list | 1. WOMAC pain | 6 months and 2 years post surgery |
2. WOMAC function | ||||||||
3. WOMAC stiffness | ||||||||
Riddle 2009[29] | 68 | 157 | Knee | Self efficacy expectations | Arthritis self efficacy scale short form | Preoperatively, no specific time point mentioned | 1. WOMAC pain | 6 months post surgery |
2. WOMAC function | ||||||||
Suda 2010[37] | 6 | 130 | Knee and hip | Outcome expectations | Expectations in relation to 5 items: | 1 month pre-operative | 1. Harris Hip scores | 3 years post surgery |
-Pain | ||||||||
-Change in personal relationships | ||||||||
-Decrease in worries about life | ||||||||
-Resuming old hobbies | ||||||||
-Overall expectations of the new joint | ||||||||
-The FFbH-OA-survey adapted to expectations | ||||||||
Vissers 2010[31] | 61 | 45 | Knee | Outcome expectations | 2 items answered on a 4 point Likert type scale | +− 6 weeks pre-operative | 1. Satisfaction with surgery | 6 months post surgery |
-Limitations in activities of daily living | ||||||||
-Pain relief | ||||||||
1 item answered on a VAS 0-100 | ||||||||
-Overall success |
Methodological quality
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | Total score | % | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Vd Akker- Scheek
| ? | + | + | - | + | + | + | + | + | + | + | - | ? | + | + | + | + | + | + | 15/19 | 79 |
Arden
| + | + | + | ? | - | + | + | + | + | + | - | + | - | - | - | - | - | - | n/a | 9/18 | 50 |
Brokelman
| - | + | + | ? | + | + | + | - | + | + | ? | ? | ? | - | + | - | - | + | n/a | 9/18 | 50 |
Cross
| - | + | - | - | - | + | + | - | + | + | - | ? | - | - | + | - | - | + | n/a | 7/18 | 39 |
Engel
| + | - | - | ? | - | + | + | + | + | + | + | + | ? | - | - | + | - | + | + | 11/19 | 58 |
Gandhi
| + | - | + | + | + | - | + | - | + | + | - | ? | - | - | - | + | + | - | + | 11/19 | 58 |
Hartley
| - | - | + | ? | - | + | + | - | + | + | - | - | - | - | + | + | + | + | + | 10/19 | 53 |
Judge
| + | - | + | ? | + | + | + | ? | + | + | - | - | + | - | + | + | + | - | + | 12/19 | 63 |
Lingard
| + | + | + | ? | + | - | + | ? | + | + | + | + | - | - | - | ? | + | ? | ? | 10/19 | 53 |
Lopez Olivo
| + | + | + | ? | + | + | + | ? | + | + | + | ? | - | - | + | + | + | + | + | 14/19 | 74 |
Mahomed
| + | ? | + | - | + | - | + | - | + | + | + | ? | - | - | + | + | + | - | + | 11/19 | 58 |
Mannion
| + | + | + | - | + | - | + | - | - | + | - | - | - | - | + | + | + | + | + | 11/19 | 58 |
Nilsdotter
| + | + | + | ? | + | - | + | ? | + | + | + | - | - | - | - | - | - | - | n/a | 8/18 | 44 |
Oettingen
| - | + | + | ? | - | + | - | + | + | + | + | + | + | - | - | + | + | + | + | 13/19 | 68 |
Quintana
| + | + | + | + | + | - | - | + | + | + | - | + | - | - | + | + | + | + | + | 14/19 | 74 |
Riddle
| - | + | + | + | + | + | + | + | + | - | + | ? | - | - | + | + | + | - | - | 13/19 | 68 |
Suda
| - | - | + | ? | - | - | - | ? | - | - | - | - | - | - | - | - | - | ? | n/a | 1/18 | 6 |
Vissers
| + | ? | + | + | + | + | + | ? | + | + | + | + | + | - | + | - | - | - | n/a | 11/18 | 61 |
Associations between patient expectations and treatment outcomes
Overall improvement | Pain | Function | Stiffness | Satisfaction | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
E1/E2 | Association individual studies | Quality score | N | Overall association | E1/E2 | Association individual studies | Quality score | N | Overall association | E1/E2 | Association individual studies | Quality score | N | Overall association | E1/E2 | Association individual studies | Quality score | N | Overall association | E1/E2 | Association individual studies | Quality score | N | Overall association | ||
Unadjusted associations
| ||||||||||||||||||||||||||
≤ 6 weeks | E2 | r=−0.08 [36] | 53% | 100 | O | E2 | r=−0.05 [36] | 53% | 100 | O | E1 | r=0.165 ‡ [16]hips | 39% | 106 | 0 | E1 | OR=1.176 (ns)∫ [31] | 61% | 45 | O | ||||||
>6 weeks – ≤6 months | E2 | r=0.13 [30] | 79% | 123 | O | E1 | r=0.118* [16]hips | 39% | 106 | +− | E1 | r=0.170†[16]hips | 39% | 106 | +− | r=−0.024 ‡ [16]knees | 39% | 106 | OR=0.593 (ns)# [31] | |||||||
r=0.24 [32] | 74% | 272 | r=0.188* [16]knees | 39% | 106 | r=−0.208†[16]knees | 39% | 106 | ns [15] | 58% | 222 | OR=1.000 (ns)∞ [31] | ||||||||||||||
p=0.001 [14] | 58% | 2350 | p<0.001 [14] | 58% | 2350 | p=0.46 [17] | 74% | 788 | ||||||||||||||||||
p<0.05 [15] | 58% | 222 | ns [15] | 58% | 222 | |||||||||||||||||||||
p=0.62 [17] | 74% | 788 | p=0.90 [17] | 74% | 788 | |||||||||||||||||||||
E2 | r=−0.12 [32] | 74% | 272 | E2 | r=0.19 [30] | 79% | 123 | O | ||||||||||||||||||
r=−0.19 [32] | 74% | 272 | ||||||||||||||||||||||||
> 6 months | E1 | r=0.24 [27] | 58% | 146 | +− | E1 | p=0.012 [14] | 58% | 2350 | + | E1 | r=−0.547 [37] | 6% | 1302 | +− | E1 | OR= 1.23 (p<0.001) [34] | 63% | 1327 | + | E1 | r=−0.03 [24] | 50% | 44 | +− | |
p=0.70 ∏ [35] | 50% | 799 | OR=1.17 (p<0.001) [34] | 63% | 1327 | p<0.001 [14] | 58% | 350 | r=0.274 ∫[27] | 58% | 146 | |||||||||||||||
p=0.013 Ω [35] | 50% | 799 | p<0.001 [28] | 44% | 102 | r=0.262
#
[27] | 58% | 146 | ||||||||||||||||||
OR=1.36 (=0.013) [34] | 63% | 1327 | OR=1.25 (p<0.001) [34] | 63% | 1327 | r=0.102§ [27] | 58% | 146 | ||||||||||||||||||
Adjusted associations
| p=0.171 ∫ [35] | 50% | 799 | |||||||||||||||||||||||
≤ 6 weeks | E1 | β0.23 (p0.10) [33] | 68% | 51 | O | E1 | β 0.23 (p=0.11) [33] | 68% | 51 | O | p=0.013 # [35] | 50% | 799 | |||||||||||||
E2 | β 0.151 (ns) [36] | 53% | 100 | O | ||||||||||||||||||||||
>6 weeks – ≤6 months | E1 | β-0.107(ns) [25] | 58% | 78 | O | E1 | β0.364 (p<.01)* [25] | 58% | 78 | +− | E1 | β 0.081 (ns) [25] | 58% | 78 | +− | E1 | ns [15] | 58% | 222 | O | ||||||
β7.8 (p<.01) [15] | 58% | 222 | ns [15] | 58% | 222 | ns [17] | 74% | 788 | ||||||||||||||||||
ns [17] | 74% | 788 | β 8.10 (p<0.01)∞ [15] | 58% | 222 | |||||||||||||||||||||
E2 | β0.09 (ns) [30] | 79% | 123 | 0 | ns § [17] | 74% | 788 | |||||||||||||||||||
β-0.193 (ns) [25] | 78 | E2 | β-0.388 (p<.01)†[25] | 58% | 78 | +− | E2 | β0.18 [30] | 78% | 123 | +− | |||||||||||||||
ns [32] | 58% | 272 | OR=0.80§ [29] | 68% | 157 | β-0.337 (p<0.05) [25] | 58% | 78 | ||||||||||||||||||
74% | ns [32] | 74% | 272 | ns § [29] | 68% | 157 | ||||||||||||||||||||
ns [32] | 74% | 272 | ||||||||||||||||||||||||
> 6 months | E1 | ns [27] | 58% | 146 | +− | E1 | p<0.001‡ [14] | 58% | 2350 | +− | E1 | p>0.05‡ [14] | 58% | 2350 | +− | E1 | OR= 1.21 (p=0.003) [34] | 63% | 1327 | + | E1 | ns [26] | 53% | 598 | O | |
OR=1.34 (p = 0.04) [34] | 63% | 1327 | p<0.05 [26] | 52% | 598 | ns [26] | 52% | 598 | ns ∫ [27] | 58% | 146 | |||||||||||||||
ns [17] | 74% | 788 | ns [17] | 74% | 788 | ns #[27] | 58% | 146 | ||||||||||||||||||
OR=1.14 (p=0.049) [34] | 63% | 1327 | OR=1.20 (p<0.001) [34] | 63% | 1327 | ns § [27] | 58% | 146 |