Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction
Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction
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DOI：
10.2106/00004623-200209000-00008
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发表时间：
2002-09-01
影响因子：
5.3
通讯作者：
Hawkins, RJ
中科院分区：
文献类型：
--
作者：
Kocher, MS;Steadman, R;Hawkins, RJ
背景资料：本研究的目的是确定患者满意度的决定因素与重建后的结果前交叉韧带。方法：一个队列的201例患者接受前交叉韧带的初步重建进行了前瞻性研究。所有患者随访至少2年（平均35 9个月）。结果：人口统计学变量与患者满意度无显著相关性（p > 0 0 5）。手术时的变量仅在外侧半月板的状态、骨赘的存在和同时的皱襞切除方面与患者满意度有显著相关性（p <0.05）。随访时的客观变量显示，如果患者有屈曲挛缩、KT-1000器械手动最大测试中受累腿松弛度增加、髋关节移位检查结果异常、积液或内侧关节线或髌骨压痛，则患者的满意度显著降低（p <0.05）。在随访时的主观症状方面，如果患者有疼痛、肿胀、部分屈服、完全屈服、锁定、噪音、僵硬或跛行的症状，则患者对结果的满意度显著降低（p <0.05）。随访时的主观功能分析表明，患者的满意度明显较低（p <0.05）如果他们有较低水平的活动、体育活动、剧烈工作、日常生活活动、整体膝关节功能、体育参与或无关节活动，如果他们失业，或者如果他们有行走、下蹲、上下楼梯、跑步困难，跳跃、切割或扭曲。总体而言，患者满意度与Lysholm膝关节评分显著相关（p <0.05）。国际膝关节文献委员会（IKDC）膝关节评分、IKDC主观分项评分、IKDC症状分项评分和IKDC活动度分项评分。七个独立的多元决定因素患者满意度（校正R-2 = 0.83，p <0.001）包括Lysholm评分、总体主观膝关节功能、IKDC活动度子量表、髌骨压痛、完全屈服、屈曲挛缩和肿胀。建立了前交叉韧带重建术后患者满意度的单变量和多变量决定因素。虽然一些特定的手术和客观变量是重要的，主观变量的症状和功能与患者的满意度最强大的关联。在从患者对结果满意度的角度评估重建结果时，我们应该强调患者对症状和功能的主观评估，特别是那些涉及僵硬、屈服、肿胀和髌股症状的问题。
Background: The purpose of this study was to identify the determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament.Methods: A cohort of 201 patients undergoing primary reconstruction of the anterior cruciate ligament was studied prospectively. All patients were followed for a minimum of two years (mean, 35 9 months). The dependent variable was patient satisfaction with the outcome, graded ordinally on a scale of 1 to 10 Nonparametric univariate analysis and multivariable modeling were performed to identify determinants of satisfaction.Results: The demographic variables were not found to have a significant association (p > 0 05) with patient satisfaction. The variables at surgery demonstrated a significant association (p < 0 05) with patient satisfaction only with respect to the status of the lateral meniscus, the presence of osteophytes, and concurrent plica excision. The objective variables at follow-up revealed that patients were significantly less satisfied (p < 0 05) if they had a flexion contracture, increased laxity of the involved leg on the manual maximum test as measured on a KT-1000 device, an abnormal result on the pivot-shift examination, effusion, or tenderness at the medial joint line or patella. With regard to the subjective symptoms at follow-up, patients were found to be significantly (p < 0 05) less satisfied with the outcome if they had symptoms of pain, swelling, partial giving-way, full giving-way, locking, noise, stiffness, or a limp. Analysis of the subjective function at follow-up demonstrated that patients were significantly less satisfied (p < 0 05) with the outcome if they had a lower level of activity, sports activity, strenuous work, activities of daily living, overall knee function, sports participation, or symptom-free activity, if they were unemployed, or if they had difficulty with walking, squatting, ascending or descending stairs, running, jumping, cutting, or twisting. Patient satisfaction was significantly associated (p < 0 05) with the Lysholm knee score, overall. International Knee Documentation Committee (IKDC) knee score, IKDC subjective subscore, IKDC symptoms subscore, and IKDC range-of-motion subscore. The seven independent multivariate determinants (adjusted R-2 = 0 83, p < 0 001) of patient satisfaction included the Lysholm score, overall subjective knee function, IKDC range-of-motion subscale, patellar tenderness, full giving-way, flexion contracture, and swelling.Conclusions: Univariate and multivariate determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament were established. Although some specific surgical and objective variables were important, subjective variables of symptoms and function had the most robust associations with patient satisfaction. In assessing the outcome of reconstruction from the perspective of patient satisfaction with the outcome, we should emphasize patient-derived subjective assessment of symptoms and function, particularly those involving issues of stiffness, giving-way, swelling, and patellofemoral symptoms.