Differences Between Patients' and Physicians' Evaluations of Outcome After Total Hip Arthroplasty

Published in: Journal of Bone and Joint Surgery, v. 78, no. 6, June 1996, p. 835-838

Posted on RAND.org on December 31, 1995

by Jay R. Lieberman, Frederick Dorey, Paul G. Shekelle, Lana Schumacher, Bert J. Thomas, Douglas J. Kilgus, Gerald A. Finerman

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The purpose of this study was to compare patients' and physicians' evaluations of the results of 147 total hip arthroplasties. The patients and physicians independently evaluated pain and over-all satisfaction with the outcome of the procedure using a 10.0-centimeter visual-analog scale. They also answered a questionnaire with which they assessed general health, functional ability, and pain. The mean (and standard deviation) analog rating for pain (with 0.0 centimeters indicating no pain and 10.0 centimeters, severe pain) was 1.7 +/- 2.6 centimeters as assessed by the patients and 1.1 +/- 1.8 centimeters as assessed by the physicians (p < 0.001, paired t test). The mean analog rating for over-all satisfaction (with 0.0 centimeters indicating poor and 10.0 centimeters, excellent) was 8.6 +/- 2.1 centimeters as assessed by the patients and 8.8 +/- 1.7 centimeters as assessed by the physicians (p = 0.07, paired t test). There was a marked disparity between the patients' and the physicians' scores when the patients assigned a low score to a particular area. For the thirty patients who rated the pain as more than 4.0 centimeters, the mean analog rating was 6.8 +/- 2.1 centimeters according to the patients, while it was 3.6 +/- 2.7 centimeters according to the physicians (p < 0.001, linear regression). The mean analog rating for over-all satisfaction according to the nineteen patients who rated this parameter as less than 7.0 centimeters was 3.8 +/- 2.0 centimeters, while the mean rating according to the physicians 6.5 +/- 2.8 centimeters (p < 0.001, linear regression). The patients' and physicians' evaluations were similar regarding the results of the total hip arthroplasty when the patients had little or no pain and were satisfied with the result. However, the disparity increased as the patients' ratings for pain increased and their ratings for over-all satisfaction decreased. This study highlights a discrepancy between patients' and physicians' evaluations of the results of total hip arthroplasty. This discrepancy increased when the patient was not satisfied with the outcome. The use of patients' self-administered questionnaires as well as traditional physician-generated assessments may provide a more complete evaluation of the results of total hip arthroplasty.

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