PATIENT MOTIVATIONS AND CORRELATION OF OUTCOME MEASURES WITH SELF-REPORTED SATISFACTION IN MP ARTHROPLASTY FOR RHEUMATOID ARTHRITIS

Abstract

Metacarpophalangeal (MP) arthroplasty restores function, corrects deformity and reduces pain in patients with rheumatoid arthritis (RA). In a randomised controlled trial of MP hand reconstruction, we investigated RA patient motivations and expectations and whether self-reported patient satisfaction with appearance, function and pain correlated with objective and subjective outcome measures.

From forty patients (one hundred and sixty joints), randomised for an MP arthroplasty trial, we collected preoperative and postoperative objective measures (range of motion (ROM), ulnar drift, JAMAR grip strength), subjective measures (Michigan Hand Questionnaire (MHQ), Sollerman Hand Function test), pre-operative patient-reported motivations and expectations of surgery (appearance, function, pain), and postoperative patient-reported improvement and satisfaction with surgery (appearance, function, pain, overall). Spearman correlations determined associations between patient satisfaction and specific outcome measures.

Mean age was 60.3 years, mean disease duration at time of surgery 22.9 years, mean follow-up time 386.4 days, and 87.5% of patients were female. Seven of forty patients (17.5%) rated improved function as the single biggest motivator for surgery, one (2.5%) rated pain, the remainder (80%) rated two or more motivators equally high. Function was rated as the most important or one of the most important motivators for surgery by 92.5% of patients, pain by 67.5% and appearance by 47.5%. Several MHQ subscores (function, work, ADL) were moderately correlated (|rho|=0.67, 0.52, 0.54, respectively), and the Sollerman Score was weakly correlated (|rho|=0.39) with self-reported satisfaction with function, but ROM and grip strength were not (|rho||< 0.25). Self-reported satisfaction scores for appearance, pain and overall were moderately correlated with analogous MHQ subscores (|rho|=0.78, 0.65, 0.71, respectively).

Patient expectations of MCP arthroplasty were uniformly high. The greatest motivation for surgery was functional improvement. Pain was highly ranked, but nearly half of the patients rated hand appearance as one of the highest co-ranked motivators. Patient satisfaction correlated poorly with traditional outcome measures (ROM, grip strength) and moderately with subjective outcome measures (MHQ). Aesthetic appearance is probably underrated as a motivator for surgery and determinant of satisfaction.