The Role of Patient Expectations in Treatment Outcome and Satisfaction in Osteoarthritis: A Scoping and Mapping Review
Abstract
1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Search Strategy
2.3. Selection of Studies
2.4. Data Charting Process

2.5. Synthesis of Results
3. Results
3.1. Expectations About Surgery
3.2. Expectations About Non-Surgical Management
3.3. Expectations About Patients’ Ability to Cope or Self-Efficacy
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
| OA | Osteoarthritis |
| KOA | Knee Osteoarthritis |
| HOA | Hip Osteoarthritis |
| TKA | Total Knee Arthroplasty |
| THA | Total Hip Arthroplasty |
| OARSI | Osteoarthritis Research Society International |
| AAOS | American Academy of Orthopaedic Surgeons |
| ESCEO | European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases |
| NICE | National Institute for Health and Care Excellence |
| KOOS | Knee injury and Osteoarthritis Outcome Score |
| OKS | Oxford Knee Score |
| HOOS | Hip disability and Osteoarthritis Outcome Score |
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| Author (Year) | Design and Population | Expectations Assessed | Main Findings |
|---|---|---|---|
| Barker et al. (2023) [9] | Qualitative synthesis, HOA | Expectations about surgery (THA) | 10–15% of patients remain dissatisfied due to unfulfilled expectations about the persistence of pain and ongoing functional limitations. |
| Mancuso et al. (1997) [11] | Prospective cohort, HOA | Expectations about surgery (THA) | Patients with expectations of improvements in nonessential activities reported lower rates of satisfaction. |
| Tilbury et al. (2016) [13] | Prospective cohort, HOA and KOA | Expectations about surgery | In THA, >30% of patients with unfulfilled expectations about “improvement in walking ability”: long distances” (31%), “walking stairs” (33%), and “improve ability to cut toenails” (38%). In TKA, >40% of patients with unfulfilled expectations about “walking middle long distances (up to 1.5 km’s)” (40%), “being able to kneel down” (44%) and “being able to squat” (47%). |
| Mannion et al. (2009) [28] | Prospective cohort, KOA | Expectations about surgery | Patients were overly optimistic about the likelihood of being pain-free (85% expected it, and 43% were pain-free; p < 0.05) and of not being limited in usual activities (52% expected it, and 20% experienced it; p < 0.05) |
| Noble et al. (2006) [16] | Prospective cohort, KOA | Expectations about surgery (TKA) | 50% of dissatisfied patients reported they were not as active as they expected (OR = 0.17, p < 0.001). 32% of dissatisfied patients reported they were less active after surgery (OR = 0.35, p = 0.013). 53% of dissatisfied patients reported that their knee kept them from doing activities they wanted to do (OR = 0.42, p = 0.016). |
| Lim et al. (2025) [12] | Prospective cohort, KOA | Expectations about surgery (TKA) | Expectation fulfillment was consistently associated with improvements in pain and function at 6 and 12 months (ß: 0.38, 95% CI: 0.35 to 0.40, p < 0.001) but baseline patient expectations were not. |
| Yapp et al. (2020) [29] | Prospective cohort, KOA | Expectations about surgery (TKA) | Higher risk of long-term dissatisfaction in patients with high preoperative expectations of kneeling (RR 2.2, 95% CI 0.9–5.5) and walking without aids (RR 2.4, 95% CI 0.7–7.6). |
| Sullivan et al. (2011) [30] | Prospective cohort, KOA | Expectations about surgery (TKA) | Expectations about the future resumption of household and social/recreational activities mediated the relation between catastrophizing and follow-up pain severity (accounted for 12% of the variance); and follow-up physical function (accounted for 19% of the variance). |
| Mancuso et al. (2009) [31] | Prospective cohort, HOA | Expectations about surgery (THA) | Patients with better preoperative scores were more likely to have fulfillment of function-related expectations (with the exceptions of daytime pain, transfer, exercise and cut toenails) (0.01; p = 0.05) |
| Hafkamp et al. (2020) [32] | Systematic review, HOA and KOA | Expectations about surgery | Both high and low expectations could lead to satisfaction when expectations are fulfilled, as patients might change their preoperative expectations postoperatively in order to diminish imbalance between expectations and outcomes to prevent dissatisfaction. However, high expectations have an advantage over low expectations. |
| Wallis et al. (2019) [4] | Qualitative review, KOA | Expectations about treatment | People with low expectations of treatment ended up having limited contact with health professionals. |
| Foster et al. (2010) [33] | Prospective cohort, KOA | Expectations about treatment (exercise or acupuncture) | No evidence of a relationship between patients’ baseline treatment expectations and pain reduction at 6 or 12 months. Patients who received the treatment for which they had high expectations were almost twice as likely to be classified as a treatment responder at 6 months (OR = 1.7, 1.06, 2.79) and 12 months (OR = 1.9, 1.13, 3.13). |
| Hawker et al. (2006) [34] | Review, KOA | Expectations about surgery (TKA) and self-efficacy | Positive patient expectations related to better postoperative pain and disability. Self-efficacy is associated with greater improvements in pain and disability. |
| Bennell et al. (2011) [15] | Review, HOA and KOA | Expectations about exercise and self-efficacy | Higher expectations about exercise related to better adherence, with high-intensity training expected to result in greater strength gains. Higher self-efficacy is also associated with higher adherence and better pain and function outcomes. |
| Wojcieszek et al. (2023) [35] | Cross-sectional, KOA | Self-efficacy | A higher sense of self-competence was associated with better quality of life (α = 0.84, p < 0.001). |
| Degerstedt et al. (2020) [36] | Prospective cohort, HOA and KOA | Self-efficacy | High self-efficacy for pain management at baseline resulted in reduced pain (37.43 ± 0.40, p < 0.01) and increased physical activity (5.05 ± 0.07; p < 0.01) at the follow-ups; High self-efficacy for management of other symptoms resulted in lower pain (35.78 ± 0.71, p < 0.01) and higher physical activity (5.08 ± 0.05, p < 0.01) at 3 and 12 months. |
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Flores-Cortés, M.; Stanton, T.R.; Cuenca-Martínez, F. The Role of Patient Expectations in Treatment Outcome and Satisfaction in Osteoarthritis: A Scoping and Mapping Review. J. Clin. Med. 2025, 14, 8440. https://doi.org/10.3390/jcm14238440
Flores-Cortés M, Stanton TR, Cuenca-Martínez F. The Role of Patient Expectations in Treatment Outcome and Satisfaction in Osteoarthritis: A Scoping and Mapping Review. Journal of Clinical Medicine. 2025; 14(23):8440. https://doi.org/10.3390/jcm14238440
Chicago/Turabian StyleFlores-Cortés, Mar, Tasha R. Stanton, and Ferran Cuenca-Martínez. 2025. "The Role of Patient Expectations in Treatment Outcome and Satisfaction in Osteoarthritis: A Scoping and Mapping Review" Journal of Clinical Medicine 14, no. 23: 8440. https://doi.org/10.3390/jcm14238440
APA StyleFlores-Cortés, M., Stanton, T. R., & Cuenca-Martínez, F. (2025). The Role of Patient Expectations in Treatment Outcome and Satisfaction in Osteoarthritis: A Scoping and Mapping Review. Journal of Clinical Medicine, 14(23), 8440. https://doi.org/10.3390/jcm14238440

