A qualitative investigation and article by Nardia Klem, Clinical Physiotherapist and Curtin University PhD Candidate
Patient satisfaction is frequently discussed in the clinical research sphere, yet its definition is broad and varied. Our research sought to understand what patient satisfaction is, and what influences patient satisfaction after total knee arthroplasty (TKA). Prior to conducting this study there was no qualitative data that examined the patients’ perspective on this topic. Due to this, as researchers and clinicians in the field of joint replacement, we couldn’t be sure what we were capturing when we measured satisfaction levels after TKA.
The findings from our study demonstrated that people who reported being satisfied with their TKA said they were satisfied due to experiencing an improvement in symptoms and movement as a result of the surgery. However, people who had low satisfaction after TKA said they weren’t satisfied as they hadn’t experienced a complete resolution in symptoms and movement problems (as compared to an improvement).
The results from our study also illustrated how there were three main pathways after TKA, which led to either higher or lower levels of satisfaction. Firstly, there was a pathway we called the “full glass”, which were people in our study who reported either none or very minimal symptoms or movement problems as a result of their TKA. This group of people experienced a direct pathway to high satisfaction. The remaining people in our study experienced some level of symptoms and movement problems after their TKA, and these people could end up in either the “glass half full” or the “glass half empty” pathway. In the “glass half full” pathway, these participants reported high satisfaction despite ongoing symptoms and/ or movement problems as a result of three key mechanisms: (1) people could recalibrate how severe they felt their symptoms where, which meant they would arrive at a low appraisal of their symptom severity as a result of calibrating their outcomes against someone they felt had a worse outcome to TKA than them; (2) they could reframe valued activities, which meant they could either modify existing enjoyable activities or find new activities that they enjoyed instead of not participating due to their knees; and (3) have a non-bothersome conceptualisation of symptoms, which meant they weren’t worried or fearful of the symptoms or movement problems they experienced. These three key mechanisms were influenced by positive thoughts and feelings, as well as positive social and contextual factors. In the “glass half empty” pathway, these participants did not experience the positive effects of the three key mechanisms, instead they: (1) calibrated their outcomes against people who they felt were better than them; (2) could not modify or find new valued activities; and (3) were worried and fearful of the continued symptoms and movement problems they experienced. The “glass half full” participants also experienced negative thoughts and feelings, as well as negative social and contextual factors.
The findings from our research indicate how important patient education is about likely outcomes from TKA, particularly the possibility of continued symptoms and movement problems. Additionally, our findings demonstrate how there are possible avenues through the three key mechanisms where clinicians can assist patients to be more satisfied after TKA.