DEVELOPMENT OF A PATIENT-DERIVED EXPECTATIONS SURVEY FOR DEGENERATIVE WRIST ARTHRITIS SURGERY
Aviva Wolff, EdD, OTR, CHT1, Carol A. Mancuso, MD, FACP2, Esther Zusstone, BS1 and Scott W Wolfe, MD3, (1)Hospital for Special Surgery, New York, NY, (2)Department of Medicines, Hospital for Special Surgery, New York, NY, (3)Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
Introduction:
The purpose was to develop a patient-derived expectations survey for degenerative wrist arthritis.
Methods:
Patients were eligible if they were undergoing wrist surgery for degenerative wrist arthritis and were recruited in-person or by telephone. Qualifying diagnoses for recruitment included: scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), scaphlunate interosseous ligament tear (SLIL), and Kienbock Disease. The survey was developed in 3 phases. During phase 1, 22 patients were interviewed pre-operatively and asked open-ended questions about their expectations of surgery; a draft survey was assembled by categorizing responses. During phase 2, the survey was administered twice to another group of 27 patients preoperatively to assess test-retest reliability and concordance was measured with weighted kappa values and intraclass correlations. All patients also completed valid standard wrist outcome measures (Patient Rated Wrist Evaluation (PRWE) and Canadian Occupational Performance Measure (COPM). During phase 3 (ongoing), the survey is being administered to a final group of patients at one year post-operatively and scores are compared to pre-operative expectations and standard wrist outcome measures. Measures of responsiveness will be comparisons of change in expectation survey scores to change in PRWE and COPM.
Results:
In phase 1, 244 expectations were volunteered from which 22 distinct categories were discerned and became the items for the draft survey. In phase 2, the draft survey was completed twice, 3-5 days apart. In phase 3, all 22 items were retained for the final survey addressing pain, mobility, sports, resumption of functional activities, active lifestyles, future function and psychological well-being. An overall score is calculated from the number of items expected and the amount of improvement expected, and ranges from 0-100; higher is more expectations. For phase 2 patients, mean scores for both administrations were 74.5 (+17.8, range =37.5-98.9) and 76(+21.2, range 30.7-100). Cronbach alpha coefficients were .91 and .93 and the intraclass correlation coefficient between administrations was .85. Phase 3 results are pending.
Conclusions:
We developed a patient-derived survey that is reliable and addresses a spectrum of expectations for degenerative wrist arthritis surgery. The survey is designed to generate an overall score that is easy to calculate and interpret and offers a practical and comprehensive way to recored patient's pre-operative expectations. Defining individual patient expectations and understanding how well different interventional methods achieve those self-defined expectations can lead to customized patient care, where clinician and patient together select the treatment that best meets the specific needs of the patient.
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