J Wrist Surg 2023; 12(04): 337-344
DOI: 10.1055/s-0042-1759524
Scientific Article

Development and Validation of a Survey to Measure Patients' Expectations of Wrist Arthritis Surgery

1   Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, New York, New York
2   Department of Rheumatology, Hospital for Special Surgery, New York, New York
Steve K. Lee
3   Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
Scott W. Wolfe
3   Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
› Author Affiliations
Funding Hospital for Special Surgery Surgeon-In-Chief Fund 2015.


Background The purpose of this study was to develop and test a patient-derived expectations survey for wrist arthritis surgery. We hypothesized that preoperative patient expectations are higher in people with greater functional impairment and that postoperative fulfilment of patient expectations correlates with functional improvement.

Methods The study was conducted in four phases.

Development (n = 22) Preoperatively, patients were asked open-ended questions regarding expectations of surgery. A draft survey was then assembled.

Reliability (n = 35) The survey was administered twice preoperatively. Concordance was measured with weighted kappa values and intraclass correlations (ICC).

Validity (n = 58) Validity was assessed by comparing responses from the Expectations Survey to the patient-rated wrist evaluation (PRWE).

Responsiveness (n = 18) Responsiveness was calculated by comparing the proportion of expectations fulfilled to PRWE scores 1-year postoperatively.

ResultsDevelopment Twenty-two distinct items representing the most frequent responses were utilized from the draft survey items of 1,244 expectations volunteered.

Reliability Patients had high preoperative expectations of surgery (mean = 76.8); 30% had scores ≥90. Test–retest reliability was high (Cronbach α coefficients = 0.91, 0.93, ICC = 0.86). Endorsement of items = 66 to 100%; and weighted kappa values = 0.39 to 0.96.

Validity Patients with greater preoperative expectations (≥63) had more pain, worse function, and worse PRWE scores than those with lower expectations.

Responsiveness The proportion of fulfilled expectations was high (mean 0.80, median 0.79), and greater fulfillment (proportion > 0.80, n = 8) was associated with better postoperative PRWE scores.

Conclusion The patient-derived expectations survey is reliable, valid, responsive, and addresses a spectrum of expectations for patients undergoing surgery for wrist arthritis.

Clinical relevance Understanding patient expectations can contribute to customized care given the range of surgical choices for the arthritic wrist.

Research Institution: Hospital for Special Surgery

Publication History

Received: 08 July 2022

Accepted: 12 October 2022

Article published online:
08 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

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