Development and Validation of the Wrist Surgery Expectations Survey for Wrist Arthritis
Aviva L. Wolff, EdD, OT, CHT1; Carol A. Mancuso, MD, FACP2; Steve K. Lee, MD1; Scott W Wolfe, MD3
1Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; 2Department of Medicines, Hospital for Special Surgery, New York, NY; 3Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
Background: The purpose of this study was to develop and test a patient-derived expectations survey for wrist arthritis surgery. We hypothesized that pre-operative patient expectations are higher in people with greater functional impairment and that post-operative fulfilment of patient expectations correlate with functional improvement.
Methods: The study was conducted in 4 phases. Development Phase (n=22): Patients were asked open-ended questions regarding preoperative expectations of surgery. A draft survey was then assembled. Possible score range is 0-100; zero is lowest expectation. Reliability Phase (n=35): The survey was administered twice pre-operatively 3-5 days apart. Concordance was measured with weighted kappa values and intraclass correlations (ICC). Validity Phase (n=58): Validity was assessed by comparing responses from the Expectations Survey to the Patient Rated Wrist Evaluation (PRWE). Responsiveness Phase (n=18): Responsiveness was calculated by comparing the proportion of expectations fulfilled to Patient Rated Wrist Evaluation (PRWE) scores one year postoperatively.
Results: Development: 22 distinct items representing symptoms, function, and emotional well-being comprised the draft survey items from the 1244 expectations volunteered (Figure 1). Reliability: Patients had high pre-operative expectations of surgery (mean=76.8); 30% had scores ? 90 (Figure 2). Test-retest reliability was high. Cronbach alpha coefficients were .91 and .93, and ICC between administrations was .86. Endorsement of items ranged from 66%-100%; and weighted kappa values ranged from .39-.96. Validity: Patients with greater pre-op expectations (?63) had more pain, worse function, and worse PRWE scores than those with lower expectations. Responsiveness: The proportion of fulfilled expectations was high (mean .80, median .79), and greater fulfillment (proportion > .80, n=8) was associated with better postop PRWE scores, indicating good responsiveness.
Conclusions:
- The Wrist Surgery Expectations Survey is reliable, valid, responsive, and addresses a spectrum of expectations for patients undergoing surgery for wrist arthritis.
- The Wrist Surgery Expectations Survey measures fulfillment of expectations post-surgery.
- High fulfillment of expectations was associated with better post-operative measures of function.
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