title: The management of strabismus in adults--II. Patient and provider perspectives on the severity of adult strabismus and on outcome contributors.
abstract: OBJECTIVE
  As part of a larger study intended to evaluate the management of strabismus in adults, we documented and compared patient and provider perspectives on the various factors that may contribute to treatment outcome and value of strabismus care.
  
  
  METHODS
  By completing a questionnaire, 170 patients with strabismus (ages 19 to 87 years) and 11 strabismus specialists who performed surgery on these patients each indicated the relative weight of several disease- and treatment-related contributors to the outcome and value of care. In addition, each respondent rated the severity of the strabismus before and after surgery.
  
  
  RESULTS
  Overall severity ratings improved as a result of surgery. The improvement perceived by the physicians was 5.1 +/- 1.7 on a 10-point scale and was larger than the 2.6 +/- 3.6 points improvement perceived by the patients ( P < 0.001). Patients and physicians expressed different views on the relative contributions to outcome and value (overall P < 0.001). Both groups indicated "the condition," "the physician," and "the procedures" as the largest contributors, but "condition" was perceived as more important by the physicians than by the patients ( P < 0.001), and "physician" was more important to the patients than to the physicians ( P < 0.001).
  
  
  CONCLUSIONS
  Although in approximate agreement on the main contributors to outcome and value, discrepancies exist between perspectives of patients and physicians on the relative weights of those contributors. Public information, education, and counseling may bring these perspectives better in line and ultimately improve both quality and patient satisfaction.
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: George R
authors.initials: GR
authors.lastname: Beauchamp
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Black
authors.forename: David K
authors.initials: DK
authors.lastname: Coats
authors.forename: Robert W
authors.initials: RW
authors.lastname: Enzenauer
authors.forename: Amy K
authors.initials: AK
authors.lastname: Hutchinson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Saunders
authors.forename: John W
authors.initials: JW
authors.lastname: Simon
authors.forename: David R
authors.initials: DR
authors.lastname: Stager
authors.forename: David R
authors.initials: DR
authors.lastname: Stager
authors.forename: M Edward
authors.initials: ME
authors.lastname: Wilson
authors.forename: Jitka
authors.initials: J
authors.lastname: Zobal-Ratner
authors.forename: Joost
authors.initials: J
authors.lastname: Felius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013285:Strabismus / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology