Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes.
OBJECTIVE
The present study was performed to determine the extent to which physicians and patients rate preoperative and postoperative knee pain and function differently, and to determine whether physicians or patients more accurately predict postoperative knee pain and function.


METHODS
Longitudinal, prospective study.


METHODS
Ninety-eight patients requiring either anterior cruciate ligament reconstruction surgery or meniscectomy and related surgery were interviewed 1 week before surgery, as well as 3 and 24 weeks postoperatively. Patients and their physicians completed ratings on knee pain and function at each time point. In addition, at their preoperative visit, patients and physicians completed ratings predicting their postoperative pain and functional status.


RESULTS
Physicians rated patients as having less pain and greater knee function preoperatively and at 24 weeks postoperatively. Patients had more significant differences between predicted and actual ratings.


CONCLUSIONS
Physicians tended to underestimate knee pain and overestimate knee function compared with patients. However, physicians better predicted postoperative knee pain and function ratings than did patients. These findings suggest that physician-patient discussions about preoperative expectations and postoperative reality might be an important part of clinical care.


METHODS
Level II, Prospective Longitudinal Study.
Rosenberger
Patricia H
PH
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA. patricia.rosenberger@yale.edu
Jokl
Peter
P
Cameron
Ann
A
Ickovics
Jeannette R
JR
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001265:Athletic Injuries / Q000601:surgery*; D003657:Decision Making; D006801:Humans; D007407:Interviews as Topic; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008592:Menisci, Tibial / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000145:classification / Q000523:psychology*; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D016896:Treatment Outcome; D014481:United States; D014942:Workers' Compensation