A Self-fulfilling Prophecy? Pretreatment Patient Expectation and Its Effects on Outcome and Patient Satisfaction in Distal Radius Fractures : Results of the Trauma Expectation Factor-Trauma Expectation Factor -Trauma Outcome Measure (TEFTOM-DR) Multicentre Study

Abstract

Introduction: Our objective was to determine whether pretreatment patient expectation predicted outcomes and whether expectation fulfilment correlated with satisfaction in patients with distal radius fractures. Methods: In all, 132 patients with distal radius fractures were prospectively recruited from three institutions in Hong Kong, Shenzhen, and Shanghai. The validated Trauma Expectation Factor (TEF)–Trauma Outcome Measure (TOM) questionnaire developed by the AO Foundation was used. Patients pretreatment expectation was measured using the TEF scale. The TEF and baseline factors: fracture classification, treatment method, age or injury on duty state were compared with the SF-12 Health Survey version 2 (SF-12v2), TOM, and quick Disabilities of the Arm Shoulder and Hand (qDASH) outcome scores after casting or internal fixation at 6 and 12 months. “Fulfilment of expectation” defined by the difference between TEF and TOM scores was compared with the Patient Satisfaction Questionnaire Short Form (PSQ-18) general satisfaction scale. Correlation was calculated using the Spearman’s rho (r). Results: A total of 61 patients reaching 1-year follow-up were analysed. At 6 months, pretreatment expectation (TEF) demonstrated statistically significant correlation with SF12-general health (r=0.443, p=0.000) and qDASH (r=0.302, p=0.000). At 12 months, TEF correlated with TOM (r=0.273, p=0.33) and SF12-general health (r=0.338, p=0.08). At 6 and 12 months, PSQ-18 general satisfaction scores had statistically significant correlation (r>0.44, p<0.001) with absolute TOM, qDASH, and SF-12 scales but not with “fulfilment of pretreatment expectations” (TEF-TOM) [r=0.2, p=0.12]. Conclusion: Pretreatment expectation is correlated with eventual outcome scores in the SF-12 scale. Patient satisfaction is related to absolute outcomes but not fulfilment of expectations.