Article

In health care, increased emphasis has been placed on
patient-centered care, but to our knowledge little work has been conducted to
understand the influences on patient satisfaction after surgery for the treatment
of severe lower-extremity injury. Our purpose was to analyze how the patient's
satisfaction with the outcome correlates with other measures of outcome
(clinical, functional, physical impairment, psychological impairment, and pain)
and with the sociodemographic characteristics of the patient, the nature of the
injury, and the treatment decisions. Four hundred and sixty-three
patients treated for limb-threatening lower-extremity injuries at eight level-I
trauma centers were followed prospectively. Multivariate regression techniques
were used to identify factors correlating with variation in patient self-reported
satisfaction at two years after the injury. The outcomes that were tested in the
model were pain, range of motion, muscle strength, self-selected walking speed,
depression, anxiety, the physical and psychosocial scores of the Sickness Impact
Profile (SIP), return to work, and the number of major complications. The patient
characteristics that were tested in the model were age, sex, education, poverty
status, insurance status, occupation, race, personality profile, and medical
comorbidities. Injury severity was tested in the model with use of both the
Injury Severity Score and a score reflecting the probability of amputation. The
treatment decisions that were tested were amputation versus reconstruction and
time to treatment. RESULTS: No patient demographic, treatment, or injury
characteristics were found to correlate with patient satisfaction. Only measures
of physical function, psychological distress, clinical recovery, and return to
work correlated with patient satisfaction at two years. Five of these outcome
measures accounted for >35% of the overall variation in patient satisfaction;
these were return to work (p < 0.05), depression (p < 0.05), the physical
functioning component of the SIP (p < 0.01), self-selected walking speed (p <
0.001), and pain intensity (p < 0.001). The absence of major complications and
less anxiety were marginally significant (p < 0.1). CONCLUSIONS: Patient
satisfaction after surgical treatment of lower-extremity injury is predicted more
by function, pain, and the presence of depression at two years than by any
underlying characteristic of the patient, injury, or treatment.

Langue : ANGLAIS

Tiré à part : OUI