Relationship between Realistic Preoperative Expectations and Good Long-term Outcomes for Persons with Planned Lower Limb Amputation Allison Cerutti, MPO Candidate, BSBE Faculty Mentor: Stefania Fatone, PhD, BPO(Hons) Northwestern University Prosthetics-Orthotics Center Chicago, IL 60611
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Relationship between Realistic Preoperative Expectations and Good Long-term Outcomes for
Persons with Planned Lower Limb Amputation
Allison Cerutti, MPO Candidate, BSBE
Faculty Mentor: Stefania Fatone, PhD, BPO(Hons)
Northwestern University Prosthetics-Orthotics Center
Chicago, IL 60611
ABSTRACT 1
Introduction: To examine the relationship between preoperative expectations and long-term 2
postoperative outcomes in persons with planned lower limb amputation (PLLA), this project 3
aimed to: (1) define “patient expectations” and (2) analyze expectation measurement within a 4
model population where there is research available, lower limb total joint arthroplasty (TJA), in 5
order to make recommendations for measuring expectations of persons with PLLA where there 6
is no research yet. Materials and Methods: A Delphi survey was used to define “patient 7
expectations.” To contextualize the Delphi results and make recommendations for future study, 8
we reviewed literature on expectation measurement for TJA. First, we indexed items within 9
existing expectation measures according to “expectation themes” and “expectation measurement 10
methods.” Second, we analyzed existing methodologies investigating the relationship between 11
preoperative expectations and postoperative outcomes. Results: Though the Delphi survey did 12
not result in a complete definition, two components derived from it are suggested for inclusion in 13
a new definition: “expectation themes” and “expectation measurement methods.” Trends in 14
existing expectation measures suggested that a future measure for PLLA should represent the 15 15
expectation themes found relevant by the Delphi survey and measure using “order of 16
magnitude.” Lastly, we selected an existing methodology from the review and adapted it for 17
future study of the relationship between expectations and outcomes in persons with PLLA. 18
Conclusions: To complement existing expectation measures, a future definition of patient 19
expectations should contain expectation themes and measurement methods. Overlap in 20
expectation themes between persons with TJA and PLLA supports our rationale to model future 21
expectation measurement for persons with PLLA after existing TJA measurement. 22
Expectation Themes PF = physical functioning MF = mental functioning CF = cognitive functioning FI = functional independence P = pain SL = sleep HI = health improvement N = return to normal activities C = coping D = disability TE = treatment effectiveness TC = complications of treatment TO = treatment outcome R/S = risk/safety F = fears S/C = social/cultural role S = overall satisfaction with care QOL = health-related quality of life PC = personal challenges associated with rehabilitation C/A = cosmesis/appearance
SX = sexual activity S/R = sports and recreation/leisure activity R = recovery time E = employment/vocational activity
Expectation Measurement Methods OM = order of magnitude DI = degree of importance P = probability OE = open-ended
27
INTRODUCTION 28
Healthcare institutions in the U.S. have employed “patient-centered care” as a means to 29
improve quality of care.1-3 Patient-centered care incorporates two key constructs for clinicians to 30
measure: patient-reported outcomes (PROs) and patient expectations.1-4 To measure PROs, 31
healthcare institutions have adopted self-report instruments,5 e.g. questionnaires.4, 6, 7 Unlike the 32
established measurement of PROs, a recent review8 highlighted the difficulties of measuring 33
patient expectations given lack of a theoretical foundation for conceptualizing this construct. The 34
contradictory terminology8-10 and classification systems8-12 presently defining patient 35
expectations have impeded development of measurement guidelines.6, 8 Despite these 36
shortcomings,8 a growing body of literature4, 6, 8, 11, 12 has attempted to measure expectations of 37
patients awaiting surgery to investigate the relationship between preoperative expectations and 38
postoperative outcomes. Results have been ambiguous thus far.6 The importance of exploring 39
this relationship remains. 40
The long-term goal of this work is to examine the relationship between preoperative 41
expectations and long-term postoperative outcomes, specifically from the perspective of patients 42
undergoing planned LLA (PLLA). We have defined PLLA as a planned (or elective) amputation 43
procedure secondary to severe vascular dysfunction. We hypothesize that clinicians’ expertise 44
together with patients’ values can shape patients’ expectations. Additionally, shaping 45
expectations realistically will increase the likelihood for positive long-term outcomes for persons 46
with PLLA. 47
One impediment to exploring our hypotheses is the dearth of literature needed to guide 48
methodology. Only two studies have attempted to measure expectations of persons with PLLA. 49
The first study13 compared preoperative expectations of pain to actual postoperative pain. The 50
second study14 identified expectation themes through patient interviews, none of which related to 51
pain. This is despite the fact that the first study13 indicated the importance of pain expectations, 52
suggesting the themes identified within the second study14 are incomplete. From this limited 53
literature, two needs arise: (1) a clear definition of expectations of persons with PLLA, including 54
a comprehensive list of themes, and (2) better understanding of how to measure preoperative 55
expectations. 56
Due to the dearth of PLLA literature, this project proposed learning from a model 57
population for which there is abundant expectations literature11, 12, 15-17—lower limb total joint 58
arthroplasty (TJA). Both TJA and PLLA are surgical solutions to end-stage chronic disease, 59
osteoarthritis and vascular dysfunction, respectively. With similar rationales for electing surgery, 60
patients may share expectations. Some studies12, 16, 17 suggest decreased pain is the most 61
important expectation of persons with TJA. The theme of “pain” in the first study13 to measure 62
expectations of persons with PLLA provides rationale that these populations have overlapping 63
expectations. 64
The purpose of this project is to address the above needs through two aims: (1) to define 65
the construct of patient expectations as it applies to the general population and persons with 66
PLLA and (2) to analyze how expectations have been measured in the model population (persons 67
with TJA) in order to make recommendations for measuring expectations of persons with PLLA. 68
METHODS 69
Aim 1—Delphi Survey 70
Survey Design 71
To address the first aim, a Delphi survey was conducted to collect opinions on current 72
definitions and terminology describing patient expectations and to generate consensus 73
statements. Consensus statements were intended to (1) guide future development of a definition 74
of patient expectations specific to persons with PLLA, and (2) inform the Aim 2 literature 75
review. The Delphi Technique uses iterative survey rounds to derive consensus from among 76
“expert” opinions.18 Delphi surveys are often used to explore research areas, such as this one, 77
that are ambiguous and lack consensus.18 78
Prior to panel selection, a preliminary review of general expectations literature was 79
conducted6, 8, 11, 12, 14 to create questions for Round 1. Round 1 comprised two parts: (1) defining 80
patient expectations in the context of general surgical populations, and (2) identifying 81
expectation themes to describe expectations of persons with PLLA. The first part contained five 82
questions and asked participants to evaluate existing definitions of patient expectations and to 83
identify terminology—called “features”—that should be included in a new definition. With the 84
intention to guide future expectation measurement, participants were also asked to evaluate 85
existing measurement methods. Finally, participants were asked which features clinicians could 86
shape. The second part asked participants to rate the relevance of 20 themes8, 14 to expectations 87
of persons with PLLA. Free text response options were available to record additional participant 88
insights. Round 2 consisted of statements generated based on responses from Round 1. 89
Selection of Expert Panel 90
Members of the “expert” panel were identified by convenience sampling of professionals 91
known to the investigator (author AC). Three criteria were used to identify potential panelists: 92
1. Potential interest in defining “patient expectations” of persons with PLLA; 93
2. Email address available; 94
3. Access to internet (for completing and submitting online surveys). 95
Individuals were considered potentially interested in “patient expectations” if they had 96
experience in any of these areas: prosthetics, physical therapy training persons with LLA, 97
amputation surgery, general medicine treating persons with LLA, and/or undergoing LLA. 98
Hence, “experts” were selected from among certified prosthetists, physical therapists, surgeons, 99
physicians, and persons with LLA. This pilot project aimed to include at least six “expert” 100
panelists in the following proportion: one certified prosthetist, one physical therapist, two 101
surgeons or physicians, and two persons with LLA. 102
Administration of Survey 103
The survey was created and distributed online via SurveyMonkey (SurveyMonkey Inc, 104
SurveyMonkey.com, California, USA) and comprised two rounds. Though no evidence suggests 105
an ideal number of rounds, studies have commonly reported two or three rounds.18, 19 106
Institutional Review Board (IRB) approval was not needed because the survey did not constitute 107
human subjects research.19 Appendix A contains screenshots of the survey. 108
Individuals who met inclusion criteria were invited to participate in the survey via email. 109
The invitation introduced the project and its aims, described the Delphi survey process, and 110
detailed participant expectations, including estimated time to complete Round 1, deadline for 111
survey submission, and estimated timeframe for the entire survey process. A second email 112
containing the survey link was sent to those who consented participation. Because 113
SurveyMonkey maintains anonymity of responders, participants were asked to confirm survey 114
submission via email to the investigator. In this way, only participants who completed Round 1 115
were asked to participate in Round 2. Confirmation of submission did not link responses to 116
individuals, thereby maintaining anonymity of responders. 117
In Round 1, consensus was defined as greater than or equal to 70% agreement.18, 19 118
Percentage agreement was calculated for each response within each question. For each question, 119
responses with consensus were collated into a statement(s). Each statement was presented in 120
Round 2 and participants were asked to agree or disagree. For any disagreement, explanation was 121
requested using free text response format. In Round 2, percentage consensus was again 122
calculated for each proposed statement. 123
Aim 2—Literature Review 124
Study Design 125
To address the second aim, a two-part, “semi-structured” literature review was 126
conducted. The semi-structured literature review employed a formal search strategy but did not 127
adhere to evidence-based guidelines for reporting of systematic reviews.20 For example, this 128
review did not assess risk of bias within individual studies nor across studies.20 Part 1 identified 129
existing expectation measures and aimed to index individual items within each measure 130
according to three categories that paralleled the Delphi consensus statements. Part 2 identified a 131
subset of studies within Part 1, which investigated the relationship between preoperative 132
expectations and postoperative outcomes. This subset was analyzed for expectation and outcome 133
variables and methods used to compare expectations to outcomes. Ultimately, results of the 134
review were intended to (1) guide future development of an expectation measure for persons 135
with PLLA, and (2) recommend a methodology(ies) by which to study the relationship between 136
expectations and outcomes. 137
Search Strategy 138
The investigator conducted a search in PubMed from inception through December 2014. 139
The search strategy used free text and MeSH terms (whenever possible). Varied search terms 140
describing total hip arthroplasty, total knee arthroplasty, and lower limb amputation (e.g. “total 141
hip arthroplasty” or “total hip replacement”) were used. The Boolean “AND” operator combined 142
population terms with terms describing “patient-reported,” “patient,” and “preoperative” 143
expectations, which were in turn combined with “measure,” “questionnaire,” or “measurement.” 144
Filters such as “free text,” “English,” and “humans” were applied. Titles and abstracts of the 145
initial search results were reviewed for preliminary “relevancy” criteria: (a) total hip or knee 146
arthroplasty or LLA study population, and (b) mention of expectation measurement. 147
Study Selection 148
Full text versions of all studies that met relevancy criteria were reviewed for final 149
inclusion. Additionally, the references of these relevant articles were searched and relevant 150
references were also reviewed for final inclusion. Table 1 lists the inclusion and exclusion 151
criteria for Parts 1 and 2 of the literature review. 152
Data Extraction & Analysis 153
The investigator extracted all data. In Part 1, individual items comprising expectation 154
measures were indexed within these categories: expectation theme, expectation feature, and 155
expectation measurement method. Frequency data within each category were used to identify 156
trends in how expectations are currently being measured. These trends were compared to results 157
of the Delphi survey pertaining to expectation themes, features, and measurement methods. In 158
Part 2, the following information was extracted from each included study: expectation 159
variable(s), outcome variable(s), and discrete comparison(s). A discrete comparison was defined 160
as a comparison between an expectation variable and outcome variable, as defined in Table 1. 161
Additionally, it was noted when a comparison(s) between preoperative expectations and 162
postoperative outcomes was the primary study objective. 163
Each discrete comparison was labeled in two ways: (1) by type, according to types of 164
expectation and outcome variable, and as (2) “complementary” or “non-complementary.” 165
Complementary comparisons used expectation and outcome items that complemented one 166
another regarding themes and measurement methods. For example, a study13 measured pain 167
expectations according to order of magnitude and compared pain expectations to pain outcomes, 168
measured according to the same scale. Conversely, non-complementary comparisons used items 169
with discordant themes and/or measurement methods. For example, another study9 measured 170
expected order of magnitude of pain and activity limitation and expected probability of success 171
and complications; these expectations were compared to the order of magnitude of satisfaction 172
outcome. Neither themes nor measurement methods were complementary in this example. 173
Within each study, characteristics of its methodology were analyzed: comparison type(s), 174
complementary vs. non-complementary comparison(s), and primary objective of the study. The 175
goal of this analysis was to identify a study or studies’ methodology(ies) for future use (or 176
modified use) in a study to compare expectations and outcomes in persons with PLLA. To do so, 177
the investigator determined which comparison type was best suited and whether its measures 178
should be complementary or non-complementary. Comparisons within studies whose primary 179
objective was not to compare preoperative expectations to postoperative outcomes were 180
excluded. Ultimately, the investigator aimed to make a recommendation for future research 181
based on the selected methodology(ies), including any necessary modifications. 182
RESULTS 183
Aim 1—Delphi Survey 184
Participation throughout the Delphi survey is illustrated by Figure 1. Twelve individuals 185
were invited to participate and ultimately six participated in Round 1 and four in Round 2. Figure 186
2 shows the demographics of those panelists who confirmed participation in each Delphi round. 187
Figure 2 compares target demographic distribution to actual distribution achieved in Rounds 1 188
and 2. 189
Round 1 190
For Round 1, percentage response agreement for each question is shown in Tables 2a-2d. 191
Because no responses were received for Question 4, which was optional, it is not shown. Based 192
on free text responses to Question 1, there was apparent confusion interpreting the question and 193
understanding its content. Subsequently Questions 1 and 4 were eliminated from Round 2. Using 194
responses to the remaining questions from Round 1—2, 3, 5 and 6—six statements were 195
generated and presented to the panel in Round 2. 196
Round 2 197
In Round 2, unanimous agreement was reached on all six statements. These statements 198
are also shown in Tables 2a-2d. 199
Aim 2—Literature Review 200
Results of the literature review are illustrated by Figure 3. Initial search results yielded 201
378 studies. After removing duplicates, 34 articles met preliminary “relevancy” criteria and an 202
additional 27 articles were identified through their references. Of these 61 articles, 50 were 203
included in Part 1 of the Aim 2 literature review.6, 9, 11-13, 15-17, 21-62 Of those 50 included in Part 1, 204
16 were included in Part 2.9, 13, 16, 17, 24, 26, 27, 29, 31, 33, 38, 40, 48, 51, 53, 62 205
Part 1 206
Within the 50 included studies there were five review papers.6, 11, 12, 21, 22 Expectation 207
measures and items were extracted directly from the included studies of these five reviews. 208
Overall, expectation measures and items were extracted from 45 studies9, 13, 15-17, 23-62; one study13 209
pertained to lower limb amputation and the remaining pertained to total hip or knee arthroplasty. 210
This resulted in 483 expectation items total. The items were indexed according to two of the 211
intended categories: expectation theme and expectation measurement method. Items could not be 212
indexed according to expectation feature. 213
Expectation theme. The 483 items were indexed to 18 expectation themes. Fourteen 214
themes were from the original 20 included in the Delphi survey: physical functioning, mental 215
functioning, functional independence, pain, sleep, health improvement, return to normal 216
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
PF Improvement in walking
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
PF Be able to climb the stairs
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
PF Sitting Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
PF Future walking ability
Eisler 2002
4-point Likert scale
Same as after the primary THA; very much improved; slightly improved; not altered
PF Improve ability to walk short distance (indoors, 1 block
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to walk medium distance (take a walk, <1mile)
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to walk long distance (>1mile)
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Make knee or leg straight
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to go up stairs
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to go down stairs
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to kneel
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to squat
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to change position (for example, go from sitting to standing or from standing to sitting)
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improved ability to walk
Gonzalez 2010
5-point Likert scale
No expectations; few expectations; some expectations; many expectations; very high expectations
PF Improve ability to walk
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Make knee or leg straight
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to go up stairs
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to go down stairs
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to kneel
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to squat
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to change position (for example, go from sitting to standing or from standing to sitting)
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
PF Improve ability to walk
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
PF Improve ability to stand
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
PF Improve ability to climb stairs
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
PF Distance able to walk without support
Lingard 2006
4-point Likert scale
>2 mi (>3.2 km); 1 to 2 mi (1.6 to 3.2 km); about 0.5 mi (0.8 km); only a few yards (meters)
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to walk
Mancuso 2001
NA Short distance (indoors 1 block) OR medium distance (take a walk, less than 1 mile) OR long distance (more than 1 mile)
PF Get rid of limp Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to walk
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Make knee or leg straight
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to go up stairs
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to go down stairs
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to kneel
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to squat
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to change position (for example, go from sitting to standing or from standing to sitting)
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to walk
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to stand
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to climb stairs
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Distance you expect to be able to walk before the pain from your knee becomes severe (with or without a stick)
Moran 2003
5-point Likert scale
1=no pain/>30min; 2=16 to 30 min; 3=5 to 15 min; 4=around the house only; 5=not at all-severe on walking
PF Ability to kneel down and get up again afterwards
Moran 2003
5-point Likert scale
1=yes, easily; 2= with little difficulty; 3=with moderate difficulty; 4=with extreme difficulty; 5=no, impossible
Expectation Theme Item Reference Response
Format Response Options
PF Ability to walk down a flight of stairs
Moran 2003
5-point Likert scale
1=yes, easily; 2= with little difficulty; 3=with moderate difficulty; 4=with extreme difficulty; 5=no, impossible
PF Distance you expect to be able to walk before the pain from your hip becomes severe (with or without a stick)
Moran 2003
5-point Likert scale
1=no pain/>30min; 2=16 to 30 min; 3=5 to 15 min; 4=around the house only; 5=not at all-severe on walking
PF Walking ability Nilsdotter 2009
6-point Likert scale
Crutches: need for crutches or some other device to move more than a few steps; Indoors: able to walk indoors; <1km: able to walk indoors and less than 1km outdoors; >1km: able to walk more than 1 km; Unlimited: unlimited walking on even ground; Uneven terrain: unlimited walking on uneven terrain
PF Other symptoms Nilsdotter 2009
5-point Likert scale
Much less to Much more
PF How functionally able do you think you will be 3 months after surgery?
Oettingen 2002
5-point Likert scale
1=not at all to 5= fully
Expectation Theme Item Reference Response
Format Response Options
PF Walking Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Standing Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Limp Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Climbing stairs Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Get rid of limp Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to walk
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Make knee or leg straight
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to go up stairs
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to go down stairs
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to kneel
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to squat
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to change position (for example, go from sitting to standing or from standing to sitting)
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to walk
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to stand
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to climb stairs
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Get rid of limp Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to walk short distance
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to walk medium distance
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to walk long distance
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Make knee or leg straight
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to go up stairs
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to go down stairs
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to kneel
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to squat
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to change position
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to walk
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to stand
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
PF Improve ability to climb stairs
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
PF Improve ability to cut toenails
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
FI Walk without walking aids
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
FI Feel more independent
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
FI Remove the need for a cane, crutch or walker
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
FI Remove the need for a cane, crutch or walker
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
FI Remove need for cane or other assistive device
Jourdan 2012
5 point Likert
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
FI Walking aid required Lingard 2006
Multiple choice
None; Stick/cane; Crutches; Walker
FI Remove the need for a cane, crutch or walker
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
FI Remove need for cane or other assistive device
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
FI Using a cane Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
FI Remove the need for a cane, crutch or walker
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
FI Remove need for cane or other assistive device
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
FI Remove the need for a cane, crutch or walker
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
FI Remove need for a cane or other assistive device
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Relief of pain during the day
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
Expectation Theme Item Reference Response
Format Response Options
P Relief of pain during the night
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
P Reduce requirements for pain medication
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
P How painful do you expect your hip to be when you are fully recovered from surgery?
Arden 2011
3-point Likert scale
Not at all painful; slightly painful; very painful
P Future pain Eisler 2002
4-point Likert scale
None at all; much less; slightly less; not altered
P Level of pain expected after surgery
Gandhi 2009
5-point Likert scale
No pain; slightly painful; moderately painful; very painful; extremely painful
P Relief of pain Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Pain relief Gonzalez 2010
5-point Likert scale
No expectations; few expectations; some expectations; many expectations; very high expectations
Expectation Theme Item Reference Response
Format Response Options
P Relieve pain Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Pain Haddad 2001
5-point Likert scale
Increasing severity from 1 to 5
P Relieve daytime pain
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
P Relieve nighttime pain
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
P How painful do you expect your hip to be when you are fully recovered from this surgery?
Katz 1995 3-point Likert scale
1=not at all painful; 2=slightly painful; 3=very painful
Expectation Theme Item Reference Response
Format Response Options
P Do you expect your joint replacement surgery will relieve your pain?
Koenen 2014
5-point Likert scale
no, not at all = 0; yes, a little bit = 1; yes, somewhat = 2; yes, a moderate amount = 3; yes, a lot = 4
P Level of pain Lingard 2006
4-point Likert scale
None; Slight; Moderate; Very severe
P How painful do you expect your hip/knee to be?
Mahomed 2002
4-point Likert scale
Not at all OR slightly painful OR moderately painful OR very painful
P Relieve pain Mancuso 2001
N/A Relieve some pain OR relieve most pain OR relieve all pain
P Relieve pain Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Relieve daytime pain
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
P Relieve nighttime pain
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P How painful do you expect your hip to be when you are fully recovered from this surgery?
Mannion 2009
3-point Likert scale
1=not at all painful; 2=slightly painful; 3=very painful
P Pain from your knee Moran 2003
5-point Likert scale
1=None; 2=very mild; 3=mild; 4=moderate; 5=severe
P After a meal (sat at a table), pain level expected when standing up from a chair because of your knee
Moran 2003
5-point Likert scale
1=Not at all painful; 2= slightly painful; 3=moderately painful; 4=very painful; 5=unbearable
P Be troubled by pain from your knee in bed at night
Moran 2003
5-point Likert scale
1=no nights; 2=only 1 or 2 nights; 3=some nights; 4=most nights; 5= every night
P Experience pain from your knee that interferes with your usual work (including housework)
Moran 2003
5-point Likert scale
1=not at all; 2=a little bit; 3=moderately; 4=greatly; 5=totally
Expectation Theme Item Reference Response
Format Response Options
P Pain from your hip Moran 2003
5-point Likert scale
1=None; 2=very mild; 3=mild; 4=moderate; 5=severe
P After a meal (sat at a table), pain level expected when standing up from a chair because of your hip
Moran 2003
5-point Likert scale
1=not at all painful; 2=slightly painful; 3=moderately painful; 4=very painful; 5=unbearable
P Experience pain from your hip that interferes with your usual work (including housework)
Moran 2003
5-point Likert scale
1=not at all; 2=a little bit; 3=moderately; 4=greatly; 5=totally
P Be troubled by pain from your hip in bed at night
Moran 2003
5-point Likert scale
1=no nights; 2=only 1 or 2 nights; 3=some nights; 4=most nights; 5= every night
P Experience sudden, severe pain - "shooting," "stabbing," or "spasms" - from the affected hip
Moran 2003
5-point Likert scale
1=no days; 2=only 1 or 2 days; 3=some days; 4= most days; 5=every day
P Pain Muniesa 2010
Numerical rating scale
0=most intense pain to 50=absence of pain
Expectation Theme Item Reference Response
Format Response Options
P Do you expect your knee joint replacement surgery will relieve your knee pain?
Nakano 2013
5-point Likert scale
no, not at all = 1; yes, a little bit = 2; yes, somewhat = 3; yes, a moderate amount = 4; yes, a lot = 5
P Pain Nilsdotter 2009
5-point Likert scale
Much less to Much more
P Do you expect your knee joint replacement surgery will relieve your knee pain?
Noble 2012
5-point Likert scale
no, not at all = 1; yes, a little bit = 2; yes, somewhat = 3; yes, a moderate amount = 4; yes, a lot = 5
P To what extent do you think you will be without pain 3 months after surgery?
Oettingen 2002
5-point Likert scale
1=not at all to 5= fully
P Relieving day pain Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
P Relieving night pain Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Relieve pain Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Relieve daytime pain
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Relieve nighttime pain
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
P Do you expect your knee joint replacement surgery will relieve your knee pain?
Scuderi 2012
5-point Likert scale
no, not at all = 1; yes, a little bit = 2; yes, somewhat = 3; yes, a moderate amount = 4; yes, a lot = 5
P Pain Suda 2010 Visual analog scale (VAS)
Not specified
P Relief pain Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Relief of daytime pain
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Relief of pain that interferes with sleep
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
P Pain level Vissers 2010
4-point Likert scale
1=not at all painful; 2=slightly painful; 3=moderately painful; 4=very painful
Expectation Theme Item Reference Response
Format Response Options
P On average, how much pain do you expect to have 4/12 months after your recovery?
Williams 2014
Numerical rating scale
0=no pain to 10=pain as bad as it can be
HI Eliminate need for medications
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
HI Eliminate need for medications
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
HI Using medication Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
HI Eliminate need for medications
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
HI Eliminate need for medications
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Feel more normal Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
N Performing usual occupation
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
N Using a bathtub Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
Expectation Theme Item Reference Response
Format Response Options
N Driving Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
N Using public transport
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
N Wearing shoes and socks
Adie 2011 5-point Likert scale
0=no improvement expected or not applicable; 1=slight improvement only; 2=mild improvement; 3=moderate improvement; 4=significant improvement
N Ability to perform his/her usual activities
Gandhi 2009
5-point Likert scale
No limitations (able to perform high-impact activities such as running, doubles, tennis, or hiking); slightly limited or moderately limited (walking a distance of 1 hour or playing golf); very limited or totally limited (walking, maximum of 20 minutes)
N Improve ability to use public transportation or drive
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to perform daily activities (for example, daily routine, household chores)
Ghomrawi 2011
5-point Likert scale
4=complete improvement or back to normal; 3= not back to normal but complete improvement; 2=not back to normal but a moderate amount of improvement; 1=not back to normal but little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improved ability to perform daily activities
Gonzalez 2010
5-point Likert scale
No expectations; few expectations; some expectations; many expectations; very high expectations
N Improve ability to use public transportation or drive
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activities (for example, daily routine, household chores)
Groeneveld 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Personal care Haworth 1981
4-point Likert scale
1=toilet transfers; 2= car transfers; 3=bath transfers; 4= cutting toenails
N Improve ability to get in or out of a bed, chair, or car
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
N Improve ability to perform daily activities around the home
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
N Improve ability to perform daily activities away from the home
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
N Improve ability to put on shoes and socks
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to cut toenails
Jourdan 2012
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=I do not have this expectation; NA = this expectation does not apply to me
N Do you expect your surgery will help you carry out your normal activities of daily living?
Koenen 2014
5-point Likert scale
no, not at all = 0; yes, a little bit = 1; yes, somewhat = 2; yes, a moderate amount = 3; yes, a lot = 4
N Improve ability to use public transportation or drive
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activities (for example, daily routine, household chores)
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to get in or out of a bed, chair, or car
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activites around the home
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activites away from the home
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to put on shoes and socks
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to cut toenails
Mancuso 2008
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Difficulty washing and drying yourself (all over) because of your knee
Moran 2003
5-point Likert scale
1=No trouble at all; 2=very little trouble; 3=moderate trouble; 4=extreme difficulty; 5=impossible to do
N Difficulty getting in and out of a car or using public transport because of your knee (whichever you tend to use)
Moran 2003
5-point Likert scale
1=No trouble at all; 2=very little trouble; 3=moderate trouble; 4=extreme difficulty; 5=impossible to do
N Ability to do household shopping on your own
Moran 2003
5-point Likert scale
1=yes, easily; 2= with little difficulty; 3=with moderate difficulty; 4=with extreme difficulty; 5=no, impossible
N Difficulty washing and drying yourself (all over) because of your hip
Moran 2003
5-point Likert scale
1=No trouble at all; 2=very little trouble; 3=moderate trouble; 4=extreme difficulty; 5=impossible to do
Expectation Theme Item Reference Response
Format Response Options
N Difficulty getting in and out of a car or using public transport because of your hip (whichever you tend to use)
Moran 2003
5-point Likert scale
1=No trouble at all; 2=very little trouble; 3=moderate trouble; 4=extreme difficulty; 5=impossible to do
N Ability to put on a pair of socks, stockings or tights
Moran 2003
5-point Likert scale
1=yes, easily; 2= with little difficulty; 3=with moderate difficulty; 4=with extreme difficulty; 5=no, impossible
N Ability to do household shopping on your own
Moran 2003
5-point Likert scale
1=yes, easily; 2= with little difficulty; 3=with moderate difficulty; 4=with extreme difficulty; 5=no, impossible
N Do you expect your surgery will help you carry out your normal activities of daily living?
Nakano 2013
5-point Likert scale
no, not at all = 1; yes, a little bit = 2; yes, somewhat = 3; yes, a moderate amount = 4; yes, a lot = 5
N ADLs Nilsdotter 2009
5-point Likert scale
Much better to much worse
N Do you expect your surgery will help you carry out your normal activities of daily living?
Noble 2012
5-point Likert scale
no, not at all = 1; yes, a little bit = 2; yes, somewhat = 3; yes, a moderate amount = 4; yes, a lot = 5
Expectation Theme Item Reference Response
Format Response Options
N getting in or out of bed, chair, car
Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Putting on shoes Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Cutting toe nails Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Indoor activities Palazzo 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to use public transportation or drive
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activities (for example, daily routine, household chores)
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to get in or out of a bed, chair, or car
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activites around the home
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to perform daily activities away from the home
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to put on shoes and socks
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to cut toenails
Poultsides 2014
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Do you expect your surgery will help you carry out your normal activities of daily living?
Scuderi 2012
5-point Likert scale
no, not at all = 1; yes, a little bit = 2; yes, somewhat = 3; yes, a moderate amount = 4; yes, a lot = 5
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to use public transportation, drive
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activities
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to get in or out of a bed, chair or car
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to perform daily activities around the home
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
Expectation Theme Item Reference Response
Format Response Options
N Improve ability to perform daily activities away from the home
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
N Improve ability to put on shoes and socks
Van den Akker-Scheek 2010
5-point Likert scale
4=complete improvement or back to normal; 3= a lot of improvement; 2=a moderate amount of improvement; 1=a little improvement; 0=this expectation does not apply to me/I do not have this expectation
D How limited do you expect to be in your usual activities, when you are fully recovered from surgery?
Arden 2011
4-point Likert scale
Not limited at all; slightly limited; moderately limited; greatly limited
D How limited do you expect to be in your usual activities, when you are fully recovered from this surgery?
Katz 1995 4-point Likert scale
1=not limited at all; 2=slightly limited; 3=moderately limited; 4=greatly limited
D How limited do you expect to be in your usual activities?
Mahomed 2002
4-point Likert scale
Not at all limited OR slightly limited OR moderately limited OR very limited
Expectation Theme Item Reference Response
Format Response Options
D How limited do you expect to be in your usual activities, when you are fully recovered from this surgery?
Mannion 2009
4-point Likert scale
1=not limited at all; 2=slightly limited; 3=moderately limited; 4=greatly limited
D Limp when walking, because of your knee
Moran 2003
5-point Likert scale
1=rarely/never; 2=sometimes or just at first; 3=often, not just at first; 4=most of the time; 5=all of the time
D Limp when walking, because of your hip
Moran 2003
5-point Likert scale
1=rarely/never; 2=sometimes or just at first; 3=often, not just at first; 4=most of the time; 5=all of the time
D Feel that your knee might suddenly "give way" or let you down
Moran 2003
5-point Likert scale
1=rarely/never; 2=sometimes or just at first; 3=often, not just at first; 4=most of the time; 5=all of the time
D Limitations of ADL Vissers 2010
4-point Likert scale
1=not at all limited; 2=slightly limited; 3= moderately limited; 4=very limited
TC Complications Venkataramanan 2006
5-point Likert scale
No; Not sure; Yes
TO Overall success of TKA
Vissers 2010
Visual analog scale (VAS)
0=no success; 10=optimal success
S Expectation of satisfaction with surgery 1 year postoperative
Brokelman 2008
Visual analog scale (VAS)
0 to 100
Expectation Theme Item Reference Response
Format Response Options
QOL What change do you expect in your overall quality of life as a result of the surgery?
Engel 2004
4-point Likert scale
No change; small change; moderate increase; significant increase