title: Systematic review: do patient expectations influence treatment outcomes in total knee and total hip arthroplasty?
abstract: OBJECTIVE
  This systematic review aims to summarise all the available evidence related to the association between pre-operative patient expectations (outcome expectations, process expectations and self efficacy expectations) and 5 different treatment outcomes (overall improvement, pain, function, stiffness and satisfaction) in patients with total knee or total hip arthroplasty at three different follow-op periods (>6 weeks; >6 weeks- ≤6 months; >6 months).
  
  
  METHODS
  English and Dutch language articles were identified through PubMed, EMBASE.com, PsycINFO, CINAHL and The Cochrane Library from inception to September 2012. Articles assessing the association between pre-operative patient expectations and treatment outcomes for TKA/THA in either adjusted or unadjusted analysis were included. Two reviewers, working independently, determined eligibility, rated methodological quality and extracted data on study design, population, expectation measurements, outcome measurements and strength of the associations. Methodological quality was rated by the same reviewers on a 19 item scale. The scores on the quality assessment were taken into account when drawing final conclusions.
  
  
  RESULTS
  The search strategy generated 2252 unique references, 18 articles met inclusion criteria. Scores on the methodological quality assessment ranged between 6% and 79%. Great variety was seen in definitions and measurement methods of expectations. No significant associations were found between patient expectations and overall improvement, satisfaction and stiffness. Both significant positive and non-significant associations were found for the association between expectations and pain and function.
  
  
  CONCLUSIONS
  There was no consistency in the association between patients' pre-operative expectations and treatment outcomes for TKA and THA indentified in this systematic review. There exists a need for a sound theoretical framework underlying the construct of 'patient expectations' and consistent use of valid measurement instruments to measure that construct in order to facilitate future research synthesis.
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. t.haanstra@vumc.nl
authors.forename: Tsjitske M
authors.initials: TM
authors.lastname: Haanstra
authors.forename: Tobias
authors.initials: T
authors.lastname: van den Berg
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Ostelo
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Poolman
authors.forename: Elise P
authors.initials: EP
authors.lastname: Jansma
authors.forename: Ilse P
authors.initials: IP
authors.lastname: Jansma
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Henrica Cw
authors.initials: HC
authors.lastname: de Vet
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods; D010146:Pain / Q000523:psychology; D017060:Patient Satisfaction; D020377:Self Efficacy; D016896:Treatment Outcome