title: Development of an Expectations Survey for Patients Undergoing Foot and Ankle Surgery.
abstract: BACKGROUND
  Many authors have reported on patient satisfaction from foot and ankle surgery, but rarely on expectations, which may vary widely between patients and strongly affect satisfaction. In this study, we aimed to develop a patient-derived survey on expectations from foot and ankle surgery.
  
  
  METHODS
  We developed and tested our survey using a 3-phase process. Patients with a wide spectrum of foot and ankle diagnoses were enrolled. In phase 1, patients were interviewed preoperatively with open-ended questions about their expectations from surgery. Major concepts were grouped into categories that were used to form a draft survey. In phase 2, the survey was administered to preoperative patients on 2 occasions to establish test-retest reliability. In phase 3, the final survey items were selected based on weighted kappa values for response concordance and clinical relevance.
  
  
  RESULTS
  In phase 1, 94 preoperative patients volunteered 655 expectations. Twenty-nine representative categories were discerned by qualitative analysis and became the draft survey. In phase 2, another 60 patients completed the draft survey twice preoperatively. In phase 3, 23 items were retained for the final survey. For retained items, the average weighted kappa value was 0.54. An overall score was calculated based on the amount of improvement expected for each item on the survey and ranged from zero to 100, with higher scores indicating more expectations. For patients in phase 2, mean scores for both administrations were 65 and 66 and approximated normal distributions. The intraclass correlation coefficient between scores was 0.78.
  
  
  CONCLUSIONS
  We developed a patient-derived survey specific to foot and ankle surgery that is valid, reliable, applicable to diverse diagnoses, and includes physical and psychological expectations. The survey generates an overall score that is easy to calculate and interpret, and thus offers a practical and comprehensive way to record patients' expectations. We believe this survey may be used preoperatively by surgeons to help guide patients' expectations and facilitate shared decision making.
  
  
  METHODS
  Level II, cross-sectional study.
authors.affiliation: Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA codye@hss.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cody
authors.affiliation: Clinical Epidemiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.affiliation: Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Aoife
authors.initials: A
authors.lastname: MacMahon
authors.affiliation: Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Anca
authors.initials: A
authors.lastname: Marinescu
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Jayme C
authors.initials: JC
authors.lastname: Burket
authors.affiliation: Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Drakos
authors.affiliation: Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Roberts
authors.affiliation: Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: foot and ankle surgery; patient expectations; patient satisfaction; patient-derived survey