Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Lana Kang MD, MSc, Sohaib Z. Hashmi BS, Joseph Nguyen MPH, Steve K. Lee MD, Andrew J. Weiland MD, Carol A. Mancuso MD

Abstract

Background

Although patient expectations associated with major orthopaedic conditions have shown clinically relevant and variable effects on outcomes, expectations associated with thumb carpometacarpal (CMC) arthritis have not been identified, described, or analyzed before, to our knowledge.

Questions/purposes

We asked: (1) Do patients with thumb CMC arthritis express characteristic expectations that are quantifiable and have measurable frequency? (2) Can a survey on expectations developed from patient-derived data quantitate expectations in patients with thumb CMC arthritis?

Methods

The study was a prospective cohort study. The first phase was a 12-month-period involving interviews of 42 patients with thumb CMC arthritis to define their expectations of treatment. The interview process used techniques and principles of qualitative methodology including open-ended interview questions, unrestricted time, and study size determined by data saturation. Verbatim responses provided content for the draft survey. The second phase was a 12-month period assessing the survey for test-retest reliability with the recruitment of 36 participants who completed the survey twice. The survey was finalized from clinically relevant content, frequency of endorsement, weighted kappa values for concordance of responses, and intraclass coefficient and Cronbach’s alpha for interrater reliability and internal consistency.

Results

Thirty-two patients volunteered 256 characteristic expectations, which consisted of 21 discrete categories. Expectations with similar concepts were combined by eliminating redundancy while maintaining original terminology. These were reduced to 19 items that comprised a one-page survey. This survey showed high concordance, interrater reliability, and internal consistency, with weighted kappa values between 0.58 and 0.78 (95% CI, 0.39–0.78; p < 0.001); intraclass correlation coefficient of 0.94 (95% CI, 0.94–0.98; p < 0.001), and Cronbach’s alpha values of 0.94 and 0.95 (95% CI, 0.91–0.96; p < 0.001). The thumb CMC arthritis expectations survey score is convertible to an overall score between 0 to 100 points calculated on the basis of the number of expectations and the degree of improvement expected, with higher scores indicating higher expectations.

Conclusions

Patients with thumb CMC arthritis volunteer a characteristic and quantifiable set of expectations. Using responses recorded verbatim from patient interviews, a clinically relevant, valid, and reliable expectations survey was developed that measures the physical and psychosocial expectations of patients seeking treatment for CMC arthritis. The survey provides a calculable score that can record patients’ expectations. Clinical application of this survey includes identification of factors that influence fulfilment of these expectations.

Level of Evidence

Level II, prospective study.

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