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.
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Acknowledgments
Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number (2R01 AR047328-06) and a Midcareer Investigator Award in Patient-Oriented Research (2K24 AR053120-06) (to Dr. Kevin C. Chung). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors acknowledge the assistance of Evan McGlinn (University of Michigan) in converting the survey into a web-based format. We also appreciate the ongoing efforts of Lorraine Zellers (Curtis National Hand Center) and Melanie Arundell (Pulvertaft Hand Centre) to facilitate long-term follow-up of the cohort. The study is registered at Clinical trials.gov, NCT00124254, http://www.clinicaltrials.gov
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Appendices
Appendix 1. Expectations with MCP arthroplasty questionnaire
Appendix 2. Surgical subject follow-up questionnaire
Appendix 3. Nonsurgical subject follow-up questionnaire
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Chung, K.C., Nellans, K.W., Burns, P.B. et al. Patient expectations and long-term outcomes in rheumatoid arthritis patients: results from the SARA (Silicone Arthroplasty in Rheumatoid Arthritis) study. Clin Rheumatol 34, 641–651 (2015). https://doi.org/10.1007/s10067-014-2775-z
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DOI: https://doi.org/10.1007/s10067-014-2775-z