The Relationship Between Patient Expectations and Functional Outcomes in Patients Undergoing Cartilage Repair of the Knee: A Mixed Methods Study

in Journal of Sport Rehabilitation
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Context: Patient expectations have been shown to be a major predictor of outcomes. Fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, preoperative function, or disease characteristics. It is currently unknown what factors may influence patient expectations prior to cartilage repair of the knee, and to what degree. Furthermore, understanding the importance and values of those expectations for recovery using mixed methods has not previously been conducted in this patient population. The purpose of this mixed methods study is to examine and explore the relationships between patient expectations and functional outcome in patients undergoing cartilage repair of the knee. Design: A mixed methods design was used. Methods: Twenty-one patients scheduled to undergo cartilage repair of the knee were included. Participants completed the Hospital for Special Surgery Knee Surgery Expectations Survey and the Knee Injury and Osteoarthritis Outcome Score at their preoperative visit. Knee Injury and Osteoarthritis Outcome Scores were also obtained at 3 and 6 months postsurgery. A selected sample of 6 participants participated in semi-structured interviews 6 months postsurgery. Pearson correlation coefficients were used to determine relationships between expectations and functional outcome. Results: Patients have moderate expectations for recovery, and these expectations were positively associated with preoperative pain, activities of daily living, and quality of life. Expectations also correlated with symptoms 3 months postsurgery, but there were no other significant correlations between preoperative expectations and postoperative function in the short term. Four qualitative themes emerged as participants described how previous recovery experiences shaped their expectations. Conclusions: Formalized patient and caregiver education, prehabilitation, and the use of psychological skills during rehabilitation may help to manage patient expectations and provide more focused and individualized care, thus improving outcomes.

Toonstra is with the School of Human Movement, Sport, and Leisure Studies, Bowling Green State University, Bowling Green, OH, USA. Howell is with the Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, KY, USA. English is with the Division of Physical Therapy, University of Kentucky, Lexington, KY, USA. Lattermann is with Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA. Mattacola is with the School of Health and Human Services, University of North Carolina at Greensboro, Greensboro, NC, USA.

Toonstra (jltoons@bgsu.edu) is corresponding author.
  • 1.

    Tetteh ES, Bajaj S, Ghodadra NS. Basic science and surgical treatment options for articular cartilage injuries of the knee. J Orthop Sports Phys Ther. 2012;42(3):243253. PubMed ID: 22383075 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Lefkoe TP, Trafton PG, Ehrlich MG, et al. . An experimental model of femoral condylar defect leading to osteoarthrosis. J Orthop Trauma. 1993;7(5):458467.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Hirschmuller A, Baur H, Braun S, Kreuz PC, Sudkamp NP, Niemeyer P. Rehabilitation after autologous chondrocyte implantation for isolated cartilage defects of the knee. Am J Sports Med. 2011;39(12):26862696. PubMed ID: 21602564

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Hambly K, Bobic V, Wondrasch B, Van Assche D, Marlovits S. Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. Am J Sports Med. 2006;34(6):10201038. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR. Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med. 2009;37(1 suppl):167S176. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    van den Akker-Scheek I, Stevens M, Groothoff JW, Bulstra SK, Zijlstra W. Preoperative or postoperative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty? Patient Educ Couns. 2006;66(1):9299. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Arden NK, Kiran A, Judge A, et al. . What is a good patient reported outcome after total hip replacement? Osteoarthritis Cartilage. 2011;19(2):155162. PubMed ID: 20951814 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Cross M, Lapsley H, Barcenilla A, Parker D, Coolican M, March L. Patient expectations of hip and knee joint replacement surgery and postoperative health status. Patient. 2009;2(1):5160. PubMed ID: 22273059 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Lingard EA, Sledge CB, Learmonth ID. Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia. J Bone Joint Surg Am. 2006;88(6):12011207. PubMed ID: 16757751

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Mahomed NN, Liang MH, Cook EF, et al. . The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29(6):12731279. PubMed ID: 12064846

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients’ expectations fulfilled? Acta Orthopaedica. 2009;80(1):5561. PubMed ID: 19234886 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Mancuso CA, Graziano S, Briskie LM, et al. . Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res. 2008;466(2):424431. PubMed ID: 18196427 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Gandhi R, Davey JR, Mahomed N. Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty. 2009;24(5):716721. PubMed ID: 18701241 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Mancuso CA, Sculco TP, Wickiewicz TL, et al. . Patients’ expectations of knee surgery. J Bone Joint Surg Am. 2001;83(7):10051012. PubMed ID: 11451969 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:3543. PubMed ID: 16967035 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Iversen MD, Daltroy LH, Fossel AH, Katz JN. The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis. Patient Educ Couns. 1998;34(2):169178. PubMed ID: 9731176 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Flood AB, Lorence DP, Ding J, McPherson K, Black NA. The role of expectations in patients’ reports of post-operative outcomes and improvement following therapy. Med Care. 1993;31(11):10431056. www.jstor.org/stable/3766302. PubMed ID: 7694013 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Niemeyer P, Porichis S, Salzmann G, Sudkamp NP. What Patients Expect About Autologous Chondrocyte Implantation (ACI) for Treatment of Cartilage Defects at the Knee Joint. Cartilage. 2012;3(1):1319. PubMed ID: 26069615 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Toonstra JL, Howell D, English RA, Lattermann C, Mattacola CG. Patient experiences of recovery after autologous chondrocyte implantation: a qualitative study. J Athl Train. 2016;51(12):10281036. PubMed ID: 27835044 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Heijne A, Axelsson K, Werner S, Biguet G. Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients’ experiences. Scand J Med Sci Sports. 2008;18(3):325335. PubMed ID: 18067526 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Rauscher L, Greenfield BH. Advancements in contemporary physical therapy research: use of mixed methods designs. Phys Ther. 2009;89(1):91100. PubMed ID: 19008328 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):8896. PubMed ID: 9699158 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1(1):64. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB. Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthritis Cartilage. 2009;17(11):14341439. PubMed ID: 19454278 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Hinkle DE, Wiersma W, Jurs SG. Applied Statistics for the Behavioral Sciences. 5th ed. Boston: Houghton Mifflin; 2003.

  • 26.

    Leahey E. Alphas and asterisk: the development of statistical significance testing standards in sociology. Soc Forces. 2005;84(1):124. doi:

  • 27.

    Warner RM. Applied statistics: from bivariate through multi-variate techniques. 2nd ed. Los Angeles, CA: SAGE; 2013.

  • 28.

    Colaizzi P. Existential Phenomenological Alternative for Psychology. New York: Oxford University Press; 1978.

  • 29.

    Judge A, Cooper C, Arden NK, et al. . Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. Osteoarthritis Cartilage. 2011;19(6):659667. PubMed ID: 21447395 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Sluijs EM, Knibbe JJ. Patient compliance with exercise: different theoretical approaches to short-term and long-term compliance. Patient Educ Couns. 1991;17(3):191204. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Brewer BW, Raalte JLV, Cornelius AE, et al. . Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction. Rehab Psychol. 2000;45(1):2037. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Gonzalez Saenz de Tejada M, Escobar A, Herrera C, Garcia L, Aizpuru F, Sarasqueta C. Patient expectations and health-related quality of life outcomes following total joint replacement. Value Health. 2010;13(4):447454. PubMed ID: 20088892

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Strecher VJ, DeVellis BM, Becker MH, Rosenstock IM. The role of self-efficacy in achieving health behavior change. Health Educ Q. 1986;13(1):7392. PubMed ID: 3957687 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    McGaughey I. Informed consent and knee arthroscopies: an evaluation of patient understanding and satisfaction. Knee. 2004;11(3):237242. PubMed ID: 15194102 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Turner P, Williams C. Informed consent: patients listen and read, but what information do they retain? N Z Med J. 2002;115(1164):17.

  • 36.

    Hepinstall MS, Rutledge JR, Bornstein LJ, Mazumdar M, Westrich GH. Factors that impact expectations before total knee arthroplasty. J Arthroplasty. 2011;26(6):870876. PubMed ID: 21074356 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Saris DB, Vanlauwe J, Victor J, et al. . Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med. 2009; 37(1 suppl):10S19S. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Krishnan SP, Skinner JA, Bartlett W, et al. . Who is the ideal candidate for autologous chondrocyte implantation? J Bone Joint Surg Br. 2006;88(1):6164. PubMed ID: 16365122 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Burton KE, Wright V, Richards J. Patients’ expectations in relation to outcome of total hip replacment surgery. Ann Rheum Dis. 1979;38(5):471474. PubMed ID: 518147 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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