Satisfied with the worst health outcomes or unsatisfied with the best: explaining the divergence between good patient-reported outcomes and low satisfaction and vice versa among knee arthroplasty patients - a retrospective cohort study

Abstract

Objectives: Total knee arthroplasty (TKA) is an effective treatment for patients with end-stage knee osteoarthritis but some patients exhibit a discrepancy between patient-reported outcomes (PROs) and patient satisfaction (PS). This study aims to identify predictors for patients reporting unfavorable PROs but high PS and vice versa.

Materials and methods: This retrospective cohort study categorized patients from nine German hospitals into four groups based on (i) whether they achieved a minimal clinically important difference (MCID) in knee functionality, measured with a joint-specific PRO from admission to 12-month post-surgery; and (ii) whether they were satisfied at 12 months post-surgery. The groups were (A) Satisfied Achievers (satisfied, MCID reached), (B) Dissatisfied Achievers (not satisfied, MCID reached), (C) Satisfied Non-Achievers (satisfied, MCID not reached) and (D) Dissatisfied Non-Achievers (not satisfied, MCID not reached). Exploratory analyses were performed to understand differences between the four groups using chi-squared tests and ANOVA. Multinomial logistic regression models were conducted to identify predictors for the allocation of patients in groups.

Results: A total of 1546 knee arthroplasty patients with a mean age of 65.9 years, 54.1% female, were included. 1146 (74.1%) patients were Satisfied Achievers, 131 (8.5%) were Dissatisfied Achievers, 141 (9.1%) were Satisfied Non-Achievers, and 128 (8.3%) Dissatisfied Non-Achievers. The results showed that higher improvements in health-related quality of life, pain and fatigue symptoms significantly decreased the likelihood of being a Dissatisfied Achiever and a Satisfied Non-Achiever. Comorbidities of blood circulation, chronic back pain or diabetes increased the likelihood of being a Dissatisfied Achiever, while depression decreased the likelihood of being a Satisfied Non-Achiever.

Conclusion: Addressing individual health concerns, e.g. through expectation management, and assessing alternative treatment options might improve satisfaction in line with functional improvements. A closer evaluation at which physical impairment level surgery is beneficial could help to improve the care of Satisfied Non-Achievers.

Keywords: Expectation management; Knee arthroplasty; Patient satisfaction; Patient-reported outcome; Quality measurement; Value-based healthcare.