Characterizing the Use of Expectations in Orthopedic Surgery Research: A Scoping Review

Orthopedic literature on expectations is limited by lack of uniformity in how expectations are defined, conceptualized, and measured. Within this scoping review, we present a conceptual framework for understanding the construct of expectations and its derivatives (ie, expectation, expectancy, expectancies, etc) in studies of elective surgical orthopedic procedures. We also utilize this framework to map the current orthopedic surgery literature on expectations, highlighting its strengths, weaknesses, and gaps in its knowledge base.

We included articles that mentioned both expectations and one or more of 10 selected surgeries in their title or abstract. We focused on representative elective orthopedic surgeries that covered the body's major regions. We operationalized each study's individual expectation items into one of the expectation concept types within the presented conceptual model. We also extracted the name and type of expectations measurement tool used, whose expectations were measured, and descriptive information (eg, surgery type, publication date, country of origin, and study type).

Ninety studies were included, with 70% published after 2008. A total of 64% investigated total knee and total hip arthroplasty, whereas 90% of studies investigated the expectations of patients, 5.6% investigated the expectations of physicians, and 4.4% investigated both. Of all studies, 72% utilized either study-specific instruments with close-ended, Likert-type response formats or modifications of existing expectations questionnaires. Most studies focused on desirable, nontimeline-related, treatment outcome expectations. Many studies aggregated multiple expectation results into a single score.

Adopting the standardized framework for expectations presented in this study will foster clearer communication and permit researchers to aggregate results across studies.