title: Patient expectations and long-term outcomes in rheumatoid arthritis patients: results from the SARA (Silicone Arthroplasty in Rheumatoid Arthritis) study.
abstract: Little evidence exists to understand the influence of patient expectations on outcomes for silicone metacarpophalangeal arthroplasty (SMPA). The purpose of this paper is to compare long-term treatment outcome experiences regarding hand function/appearance for a surgical and nonsurgical cohort of rheumatoid arthritis (RA) patients and contrast them to expectations at baseline. This sample is part of a larger multicenter prospective cohort study of RA patients enrolled from 2004 to 2008. A total of 169 RA patients with severe deformities at the metacarpophalangeal (MCP) joints were recruited in the original study. Expectations for SMPA were collected at enrollment. A follow-up patient-reported questionnaire was completed at long-term follow-up. Baseline expectation questionnaires were collected from 137 patients, and follow-up data from 84 patients (average 6.7 years follow-up). At baseline, a significantly higher percent of patients who chose surgery expected to do "Anything I want" or "More activities than I do now" 1 year from enrollment than those who chose nonsurgical treatment. At follow-up, surgical patients remained more likely to indicate that they were currently able to do "Anything" or "More activities" than nonsurgical patients. A higher percentage of surgical patients were "very satisfied" or "quite satisfied" with their treatment compared to nonsurgical patients. RA subjects who chose SMPA reported greater expectations for surgery prior to surgery and also greater levels of hand function and satisfaction at long-term follow-up.
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Kate W
authors.initials: KW
authors.lastname: Nellans
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Burns
authors.forename: E F Shaw
authors.initials: EF
authors.lastname: Wilgis
authors.forename: Frank D
authors.initials: FD
authors.lastname: Burke
authors.forename: David A
authors.initials: DA
authors.lastname: Fox
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D050806:Arthroplasty, Replacement, Finger / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000473:pathology; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D011446:Prospective Studies; D012828:Silicones / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D012828:Silicones