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Missverständnisse und die Akzeptanz evidenzbasierter nicht chirurgischer Interventionen bei Kniearthrose. Eine qualitative Studie. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1649-7106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bunzli S, O'Brien P, Klem N, Incoll I, Singh J, Davaris M, Choong P, Dowsey M. Misconceived expectations: Patient reflections on the total knee replacement journey. Musculoskeletal Care 2020; 18:415-424. [PMID: 32323918 DOI: 10.1002/msc.1475] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Fifty per cent of patients consent for total knee replacement (TKR) with unrealistic expectations about what it involves and can achieve. A framework is needed to help surgeons identify key knowledge gaps and misconceptions that can be targeted during the informed consent process. In this qualitative study, we explored knowledge gaps and misconceptions by asking patients to reflect on their expectations along the TKR journey. METHODS Eligible adults were ≥18 years, 12-month post-TKR and had completed a validated expectations questionnaire pre-TKR as part of a joint replacement registry. To capture a variety of perspectives, people with a range of pre-TKR expectation scores were invited. In interviews, participants reflected on anticipated and actual experiences and unexpected experiences they had along the way. Transcripts were analysed through inductive thematic analysis. Recruitment ceased when thematic saturation was reached. ETHICS APPROVAL Ethical approval for this study was granted by the St Vincent's Hospital Melbourne Ethics Committee (LRR 077/18). RESULTS In the final sample (n = 20; 50% female; median age = 72 years; contralateral TKR = 11), all participants described instances where their anticipated and actual experiences diverged, including high expectations of improvements in pain/function (pre-surgical optimism), lacking awareness about anaesthetic procedures (perioperative misunderstandings), feeling unprepared for the length of the recovery period (post-operative misestimations) and trying to make sense of ongoing functional limitations (long-term misattributions). DISCUSSION AND CONCLUSION These findings are captured in a preliminary framework of therapeutic misconception. Although future research is needed to test this framework prospectively in larger, more generalisable samples, surgeons can consider these key knowledge gaps and misconceptions when consenting for TKR.
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Affiliation(s)
- Samantha Bunzli
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Penny O'Brien
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nardia Klem
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ian Incoll
- Australian Orthopaedic Association, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jasvinder Singh
- Medicine Service, VA Medical Center, Birmingham, Alabama, USA.,Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Myles Davaris
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
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