Patient preoperative expectations of total hip replacement in European orthopedic centers

Hobbs, Nicola and Dixon, Diane and Rasmussen, Susan and Judge, Andy and Dreinhöfer, Karsten E and Günther, Klaus-Peter and Dieppe, Paul (2011) Patient preoperative expectations of total hip replacement in European orthopedic centers. Arthritis Care and Research, 63 (11). pp. 1521-1527. ISSN 2151-464X (https://doi.org/10.1002/acr.20596)

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Abstract

Patient expectations have been identified as a factor that may account for individual differences in recovery after total hip replacement (THR) surgery. However, patient expectations have not been studied within a valid theoretical framework. This study employed the WHO’s model of health; the International Classification of Functioning, Disability and Health (ICF) to classify the content of pre-operative patient expectations of THR. A European cohort of 1108 patients pre-operatively reported two types of expectations. Patients reported what they anticipated surgery would enable them to do that they needed to be able to do (‘need’ expectation); and what they would like to be able to do (‘desire’ expectation) in a year’s time. Free-text responses were independently classified by two researchers to one or more of the ICF constructs of impairment, activity limitation and participation restriction. Inter-rater reliability was high (κ ≥ 0.87). All patient expectations were classified to the ICF constructs. Less than 5% of patient expectations were identified as impairment, 58% of ‘need’ expectations were identified as activity limitations and 45% of ‘desire’ expectations were identified as activity limitations & participation restrictions combined. The ICF is a suitable theoretical framework to study patient expectations of THR. THR targets impairment, however few patient expectations were classified to the ICF definition of impairment. The majority of patient expectations were classified as activity limitation or a combination of activity limitation & participation restriction. Thus, patient expectations of surgery focus on recovering valued activities rather than reversal of bodily impairments.

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