ABSTRACT

Patients’ expectations are among the most frequently studied psychological prognostic factors in total knee and hip arthroplasty (TKA/THA). So far, however, evidence on the effect of patients’ preoperative expectations on surgery outcome is inconclusive. Heterogeneity of expectation constructs and the use of psychometrically not evaluated measurement instruments have constituted major obstacles for the integration of the current literature. Using a theory-based model of expectation constructs , this meta-analysis set out to disentangle the conflicting results in the current literature. Systematic literature searches yielded k = 46 studies (N = 10,465) that reported associations of preoperative expectations with postoperative pain, functioning and disability, and satisfaction. Random effects meta-analysis revealed a robust small association (r = .16; 95% CI .13, .19) between patients’ positive preoperative expectations and better postoperative outcomes. This effect did not differ between THA and TKA, different outcome categories and different follow-up periods. Studies using psychometrically evaluated expectation measures reported significantly higher effects (r = .19; 95% CI .16, .22). Whether this effect varies among different expectation constructs remains unclear. High-quality studies using validated, multidimensional expectation measures are needed to further understand the role of different expectation constructs in THA and TKA surgery.

摘要

患者的期望是全膝关节和全髋关节置换术 (TKA/THA) 中最常研究的心理预后因素之一。然而，到目前为止，关于患者术前期望对手术结果的影响的证据尚无定论。期望结构的异质性和使用心理测量学未评估的测量工具已构成整合当前文献的主要障碍。使用基于理论的期望结构模型，这项荟萃分析旨在理清当前文献中相互矛盾的结果。系统文献检索产生k  = 46 项研究（N = 10,465）报告了术前期望与术后疼痛、功能和残疾以及满意度的关联。随机效应荟萃分析显示 ，患者的积极术前期望与更好的术后结果之间存在强大的小关联（ r = .16；95% CI .13, .19）。这种效果在 THA 和 TKA、不同的结局类别和不同的随访期之间没有差异。使用心理测量评估期望测量的研究报告了显着更高的效果（r  = .19 ；95% CI .16, .22)。这种影响是否在不同的期望结构中有所不同仍不清楚。需要使用经过验证的多维期望测量的高质量研究来进一步了解不同期望结构在 THA 和 TKA 手术中的作用。