Do Patient Personality Traits and Self-Reported Physical and Psychosocial Symptoms Help to Predict Hallux Valgus Surgery Outcomes?, 2021, Klein et al

[Andy]

[Hallux valgus = bunions. Posting this because I thought the null result was interesting as so many of this type of paper seem designed to report a positive result.]

ABSTRACT

As many as 10% of patients remain unsatisfied after hallux valgus surgery. We explored the effects of patient personality traits and other preoperative patient characteristics on patient-reported outcomes following surgery.

Eighty consecutive adult patients (mean age 45 ± 14 years, 91% female [73/80]) undergoing scarf bunionectomy at our practice were prospectively enrolled from January 2016 to January 2017 and followed for 12 months. Predictor variables included preoperative physical and psychosocial complaints (determined via Brief Battery for Health Improvement-2 questionnaire), patient aggression level, and personality traits (extraversion, agreeableness, conscientiousness, emotional stability and openness). Primary outcome measures included the Foot and Ankle Outcome Score (FAOS) with its 5 subscales, and patient satisfaction. Multiple multivariable regression models were used to determine preoperative patient characteristics associated with FAOS outcome and satisfaction at 12 months. Seventy subjects (70/80, 87.5%) completed the study. All patients experienced technically successful surgery.

In the multivariable regression analyses, none of the combinations of potentially important predictor variables explained more than 19.8% of the variance in any of the 5 FAOS subscales at 12 months (range: 6.1%-19.8%). Furthermore, no predictor was associated with patient satisfaction in either the univariate or multivariable analyses.

We conclude that patient personality traits, aggression level, and self-reported physical and psychological symptoms do very little to predict outcomes in hallux valgus surgery. As healthcare delivery in the United States has increasingly prioritized patient satisfaction, we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.

Paywall, https://www.jfas.org/article/S1067-2516(21)00510-X/fulltext

 

[Ash]

I guess one could justify such intrusive assessments of patients general character and personality and using these to make generalised conclusions, by suggesting ones rational for doing so is in order to assess whether or not it is worth putting people through this surgical procedure, based on a potential positive finding.

But then I’d have to ask is this a reasonable, morally neutral or scientifically grounded question to be asking?

Might there be some motivations behind the funding of this work that could run counter to the patients best interests?


Could passing responsibility onto the women for poor outcomes of surgery let their surgeons off the hook for poor knowledge and skills?

Should one perhaps also assess the affect, attitudes and psychosocial functioning of these surgeons?


So many questions…..

 

[Trish]

I wonder how they explained to participants that having their bunions removed required them first to fill in personality questionnaires.
And why would they conclude that:

'we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.'
​

Surely the logical conclusion is that there may actually be differences in physical outcome such as ongoing pain and loss of function that might lead to dissatisfaction after surgery - nothing to do with personality type.

 

[Barry]

I wonder how they explained to participants that having their bunions removed required them first to fill in personality questionnaires.
And why would they conclude that:

'we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.'
​

Surely the logical conclusion is that there may actually be differences in physical outcome such as ongoing pain and loss of function that might lead to dissatisfaction after surgery - nothing to do with personality type.

Unless by that they mean they need to consider predictors that are not related to personality type? Might be more to do with what people's expectations of the surgery are in the first place, and how that might fit with reality? Could it be more to do with the personality type of the consultants, and how well they explore and manage such expectations?

 

[Ash]

I wonder how they explained to participants that having their bunions removed required them first to fill in personality questionnaires.
And why would they conclude that:

'we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.'
​

.

Would be interested to know the answer to your first question.

I feel I am in position to proffer a provisional answer to the second question. If I may be so bold.

An extended search in this area following null result wouldn’t immediately suggest the utility of a repeat effort. So some other motivation to expand the project seems like a possibility. For some motivation the nature of which I cannot comment on from such a distance. So my stand in answer would be that sadly due to a combination of unidentified factors, on this occasion they couldn’t accept the direction of travel of their own study results.

If someone wishes to fund me so that I may convert my personal speculation into gold standard evidence, I will graciously accept this charge.

 

[rvallee]

I question the judgment of anyone who thinks this is a valid question to ask. Any of anyone who approves and funds this.

But it seems like the one thing they couldn't consider is that the surgery was either botched, or not appropriate, essentially assume a 100% success rate. They can't consider being wrong, or simply not perfect. Amazing.

 

[Ash]

Yeah. Difficult for the average lay person to imagine another motivation outside of malevolence, victim blaming and or economic self interest.

However give me some funding and I will gladly explore this area ‘thinking outside the box’ as is my area of expertise.

 

[Sean]

We conclude that patient personality traits, aggression level, and self-reported physical and psychological symptoms do very little to predict outcomes in hallux valgus surgery.

Surprise!

Or not.

 

[JemPD]

As healthcare delivery in the United States has increasingly prioritized patient satisfaction, we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.

errrr.... how about doing the surgery really well, giving patients excellent care, and y'know doing your job, properly, respectfully, professionally & to a very high standard... that tends to predict the best patient outcomes IME.

But it seems like the one thing they couldn't consider is that the surgery was either botched, or not appropriate, essentially assume a 100% success rate. They can't consider being wrong, or simply not perfect. Amazing.

Precisely. People cant possibly be unhappy because of us, it must be in them.
Et voila! even the poor buggers with bunions get the ME/CFS treatment these days