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Patient Expectations Impact Patient-Reported Outcomes and Satisfaction after Lumbar Fusion – Lumbar Fusion

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The article discusses the impact of patient expectations on clinical outcomes and patient satisfaction after lumbar fusion surgery. The study used a modified version of the Oswestry Disability Index (ODI) to assess patient expectations. Patients were divided into high, moderate, and low expectation groups based on their expectation scores. The results showed that patients with higher expectations had worse ODI scores before surgery and expected a greater improvement in ODI. However, despite similar post-operative ODI scores and changes in ODI scores, fewer patients in the high expectation group reported satisfaction with the results compared to the moderate and low expectation groups. The study suggests that using an expectations tool linked to a disease-specific measure can help assess a patient’s expectations and support shared decision-making in the pre-operative surgical process

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced treatment clinic in London

Published article

: An expectations tool, linked to a disease-specific measure may provide the clinician with a practical method of assessing a patient’s expectation of results after treatment and aid in the shared decision making during the pre-operative surgical process.

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Spine J. 2023 Oct 3:S1529-9430(23)03427-7. doi: 10.1016/j.spinee.2023.09.023. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Prior studies suggest that patient expectations impact postoperative Patient-reported Outcomes (PROMs). However, no consensus exists on an appropriate expectations tool.PURPOSE: To examine the impact of patient expectations using a modified version of the Oswestry Disability Index (ODI) on clinical outcomes and patient satisfaction,

Spine J. 2023 Oct 3:S1529-9430(23)03427-7. doi: 10.1016/j.spinee.2023.09.023. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Prior studies suggest that patient expectations impact postoperative Patient-reported Outcomes (PROMs). However, no consensus exists on an appropriate expectations tool.

PURPOSE: To examine the impact of patient expectations using a modified version of the Oswestry Disability Index (ODI) on clinical outcomes and patient satisfaction at one year after lumbar fusion for degenerative pathologies.

STUDY DESIGN: Prospective longitudinal cohort PATIENT SAMPLE: Adults undergoing 1-2 level lumbar fusion were identified from four tertiaty spine centers.

OUTCOME MEASURES: ODI, EuroQol-5D, Numeric rating scales for back and leg pain.

METHODS: Preoperatively, patients completed the ODI, as well as a modified ODI reflecting their expected improvement across the 10 ODI items. For example, item 1 in the ODI asks about Pain Intensity at the moment whereas the Expectations ODI asks “One year after surgery, I expect to have…” The difference between this modified ODI score and the baseline ODI score (Baseine ODI minus Expectations ODI) was defined as the Patient Expectation Score. Patients were stratified into tertiles based on their Expectations score into High (HE), Moderate (ME) and Low (LE) Expectations and compared.

RESULTS: There were 30 patients in the HE, 35 in the ME and 26 in the LE Group, with similar demographics and surgical parameters. Patients in the HE group had worse ODI scores pre-operatively (54.96 vs 41.42, p<0.001) and were expecting a greater improvement in ODI (43.8 vs 13.5, p<0.001). There were fewer patients in the HE group (13, 43%) who reported that they were satisfied with the results of compared to either the ME (20, 71%) LE group (22, 85%, p=0.041) despite having similar ODI scores and change in ODI scores one year post-operatively.

: An expectations tool, linked to a disease-specific measure may provide the clinician with a practical method of assessing a patient’s expectation of results after treatment and aid in the shared decision making during the pre-operative surgical process.

PMID:37797842 | DOI:10.1016/j.spinee.2023.09.023

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Patient Expectations Impact Patient-Reported Outcomes and Satisfaction after Lumbar Fusion

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Spine J. 2023 Oct 3:S1529-9430(23)03427-7. doi: 10.1016/j.spinee.2023.09.023. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Prior studies suggest that patient expectations impact postoperative Patient-reported Outcomes (PROMs). However, no consensus exists on an appropriate expectations tool.PURPOSE: To examine the impact of patient expectations using a modified version of the Oswestry Disability Index (ODI) on clinical outcomes and patient satisfaction

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