Page 182 - The value of total hip and knee arthroplasties for patients
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                                Chapter 10
In total 343 THA and 322 TKA patients with complete follow-up were included. Preoperatively >60% of patients (both THA/TKA) expected to get back to normal or have much improvement in 19 of 20 (THA) and 12 of 19 (TKA) items. Expectations were fulfilled or exceeded in >60% of patients in all 20 items for THA and 17 of 19 items for TKA. In THA, items with the largest proportions patients with unfulfilled expectations (>30%) were “improvement in walking ability: long distances” (31%), “walking stairs” (33%), and “improve ability to cut toenails” (38%). In TKA, expectations for 12 of 19 items were unfulfilled in >30% of patients, with the largest proportions seen for “being able to kneel down” (44%) and “being able to squat” (47%).
This study concluded that, although for most items >60% of THA and TKA patients indicated that their expectations were met or exceeded, there was a substantial number of patients, particularly TKA patients, having one or more unfulfilled expectations.These findings indicate that expectation patterns and their fulfilment need more attention in preoperative patient information and education.
Chapter 5 describes whether measurement instruments used to assess the conceptually related constructs optimism, pessimism, hope treatment credibility and treatment expectancy truly measure distinct constructs in patients undergoingTHA or TKA.
This study concerned the same cohort as described in chapters 3 and 4.In that study,182 THA and 179TKA patients completed the Life OrientationTest-Revised for optimism and pessimism, the Hope Scale, the Credibility Expectancy Questionnaire (CEQ) for treatment credibility and treatment expectancy before surgery. Confirmatory factor analysis was used to examine whether the instruments measured distinct constructs. Theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ2 tests, followed by some posthoc models.The results of the theory driven confirmatory factor analysis showed that a five-factor model in which all constructs loaded on separate factors yielded the most optimal and satisfactory fit. Posthoc, a bifactormodel in which (besides the 5 separate factors) a general factor is hypothesized accounting for the commonality of the items showed a significantly better fit than the five factor model. Treatment expectancy, treatment credibility, optimism and pessimism explained a substantial amount of variance unique from the general factor, however hope did not.
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