text:
The role of patient expectations in predicting outcome after total knee arthroplasty
DOI: 10.1186/ar2811
© Mannion et al.; licensee BioMed Central Ltd. 2009
Received: 10 May 2009
Accepted: 21 September 2009
Published: 21 September 2009
Patient's expectations are variably reported to influence self-rated outcome and satisfaction after medical treatment; this prospective study examined which of the following was the most important unique determinant of global outcome/satisfaction after total knee arthroplasty (TKA): baseline expectations; fulfilment of expectations; or current symptoms and function.
One hundred and twelve patients with osteoarthritis of the knee (age, 67 ± 9 years) completed a questionnaire about their expectations regarding months until full recovery, pain, and limitations in everyday activities after TKA surgery. Two years postoperatively, they were asked what the reality was for each of these domains, and rated the global outcome and satisfaction with surgery. Multivariable regression analyses using forward conditional selection of variables (and controlling for age, gender, other joint problems) identified the most significant determinants of outcome.
Patients significantly underestimated the time for full recovery (expected 4.7 ± 2.8 months, recalled actual time, 6.1 ± 3.7 months; P = 0.005). They were also overly optimistic about the likelihood of being pain-free (85% expected it, 43% were; P < 0.05) and of not being limited in usual activities (52% expected it, 20% were; P < 0.05). Global outcomes were 46.2% excellent, 41.3% good, 10.6% fair and 1.9% poor. In multivariable regression, expectations did not make a significant unique contribution to explaining the variance in outcome/satisfaction; together with other joint problems, knee pain and function at 2 years postoperation predicted global outcome, and knee pain at 2 years predicted satisfaction.
In this group, preoperative expectations of TKA surgery were overly optimistic. The routine analysis of patient-orientated outcomes in practice should assist the surgeon to convey more realistic expectations to the patient during the preoperative consultation. In multivariable regression, expectations did not predict global outcome/satisfaction; the most important determinants were other joint problems and the patient's pain and functional status 2 years postoperatively.
It is now generally accepted that the outcome of total joint replacement should be assessed not only on the basis of imaging, technical results, and objective functional/physiological findings, but also in relation to the patient's perception of the benefit gained, as regards domains of importance to them in their everyday life [1, 2]. Patients' expectations of treatment are a potentially important determinant of their subsequent ratings of outcome, yet one that remains relatively unexplored in the fields of rheumatology and orthopaedic surgery [3]. Various theoretical models exist describing the relationship between expectations and satisfaction in the setting of medical care. The most dominant model posits that expectations being met - that is, minimising the mismatch between prior expectations and the actual result - is the most important determinant [4, 5]. Other models, however, maintain that higher expectations per se are associated with better outcomes [6, 7], perhaps reflecting the influence of dispositional optimism [8] or a sort of placebo effect. Further models suggest that the actual post-treatment status with regards to symptoms or function more strongly governs whether the patient is satisfied with the results, regardless of their prior expectations [9, 10].
Only few studies have examined the relationship between expectations and outcome/satisfaction in relation to total joint replacement surgery, and even fewer specifically in relation to the knee joint. Engel and colleagues examined the influence of baseline expectations regarding improvement in the condition and regarding change in quality of life on outcome [11], as measured with both disease-specific and generic instruments, 6 months after total knee arthroplasty (TKA). They revealed that these expectations accounted for between 9% and 13% of the variance in outcome, depending on the instrument used. They did not, however, investigate how well the expectations met the reality of the situation at follow-up, or whether this had any independent influence on outcome ratings or satisfaction.
Mahomed and colleagues examined the importance of expectations (dichotomised as high or low, with respect to expected changes in pain, functional limitations, overall success, and the likelihood of complications) in predicting outcomes after total joint arthroplasty [12]. In multivariable analyses, expectations about pain (but not any other domains) had significant predictive value with respect to the outcomes of Western Ontario and McMaster Universities Osteoarthritis Index pain, of Western Ontario and McMaster Universities Osteoarthritis Index function, and of Short Form-36 function, although the unique variance accounted for in each case was relatively low. These authors, too, did not examine how well the reality of the outcome had met the prior expectations of the patients, or whether this influenced their satisfaction with treatment.
Burton and colleagues did examine the notion of expectations being met in relation to the outcome of total joint replacement (hip) [13], and noted that expectations were fulfilled in just over one-half (55%) of the patients interviewed. A high proportion of patients (86%) nonetheless claimed that the operation had been successful - although the unfulfilled patients reported a significantly lower quality of life than those whose expectations were met [13]. Unfortunately, the investigation was retrospective, with patients being required to recall their preoperative expectations of an average 3.5 years ago; it is well known that the data collected using such study designs are subject to strong recall bias and potential confounding by the actual outcome of the surgery. The study by Mancuso and colleagues of total hip replacement patients was beset with the same limitations of the retrospective study design; these authors also reported a high proportion of satisfied patients overall (89%), but satisfaction rates were lower in those expecting improvement in nonessential activities (perhaps suggesting overly ambitious or unrealistic expectations) and those with a poor postoperative condition [14].
Moran and colleagues [15] quantified the preoperative expectations of hip and knee total joint replacement patients, by asking them to rate their current status on the Oxford hip or Oxford knee questionnaires and to predict the level of symptoms expected 6 months after surgery. The operating surgeons also completed the latter task. It was shown that the surgeons expected significantly better results than the patient. The researchers, however, did not go on to examine these expectations in relation to the actual changes achieved or the patients' satisfaction with their postoperative status.
In summary, previous investigations in the field of joint replacement have delivered inconclusive findings, in part due to the retrospective nature of the investigations or failure to use multivariable models to identify the relative importance of putative predictors.
The present study seeks to expand our knowledge of the relationship between expectations and outcome, measured as satisfaction with surgery and the global outcome of surgery, in patients undergoing joint replacement for osteoarthritis of the knee. Specifically, in multiple regression analysis we tested, when controlling for potential confounding variables, which (if any) of the following variables made a unique significant contribution to explaining the variance in satisfaction and in global outcome 2 years after TKA: baseline expectations, the actual knee status (pain and function) at 2-year follow-up, and expectations being fulfilled (preoperative declared expectations minus 2 year postoperative actual status).
Materials and methods
Overview of the study
The patients described in the present investigation were participating in a large-scale prospective study examining subjective and objective aspects of locomotor function before and after TKA (results on objective changes in function to be reported elsewhere). The participants completed questionnaires before total joint replacement surgery and again 2 years later. The study group comprised those with questionnaire data from both baseline and follow-up assessments (n = 112/146 (77%); for details on drop-outs, see later).
The patients received an oral and written explanation of what would be required of them, and signed an informed consent form confirming their agreement to participate. The study was approved by the local University Ethics Committee.
Study admission criteria
All patients who were scheduled for a primary knee arthroplasty (TKA) at the authors' hospital in the year of study were invited to participate; approximately 55% volunteered. The only inclusion criteria were a willingness to comply with the test battery and complete the follow-up assessments, and a good understanding of written German. No patients were excluded on the basis of their age or activity level.
Pre surgery
Approximately 2 weeks before the operation, during a visit to the hospital for the accompanying functional tests (reported elsewhere), the patients completed the Total Arthroplasty Outcome Evaluation Questionnaire Baseline and History Forms of Katz and colleagues [16] (modified for the knee; the actual questionnaire can be found in the Appendix of Katz and colleagues [16]). The Baseline form enquired, amongst other things, about the patient's main reasons for choosing knee replacement surgery (10 options - multiple answers allowed, with the most important reason also to be indicated); the importance of decreasing pain and increasing function; and expectations of surgery in relation to expected time until full recovery (open answer, in months), expected pain after recovery from surgery (not at all painful through to very painful), and expected limitations in everyday activities after recovery from surgery (not limited at all through to greatly limited).
The History Form enquired (amongst other things) about various sociodemographic characteristics, pain in the left and right knees (recoded to obtain the answer for the index knee - four categories: no pain, slight pain, moderate pain, severe pain), and extent of limitation in usual activities (five categories: not limited at all, slightly limited, moderately limited, greatly limited, totally limited).
The form also enquired about the involvement of other joints by asking 'Other than your knee, what areas are very painful?' (none, back and/or buttocks, left hip, right hip, other - give details). The answer was then dichotomised as yes if any of the joints given in the option list (or feet as other) were indicated, and as no if the answer was none or any other areas of the body, with the rationale that these other joints might affect overall mobility/locomotor function.
The American Society of Anesthesiologists Physical Status Classification System was used to assess the patient's overall physical health (1 = normal healthy, 2 = mild/moderate systemic disease, 3 = severe systemic disease, 4 = life-threatening systemic disease), since it was considered that this may have influenced the patient's function or postoperative outcome.
Two years post surgery
Two years after surgery, when the patients attended for their follow-up assessment, they completed the same items from the History Form to assess current status in relation to the domains that had been enquired about in the preoperative expectations questionnaire (months required until recovered, pain, limitations in everyday activities). They also completed the Post-operative Form, which asked them to rate the global outcome/result of surgery (1 = excellent, 2 = good, 3 = fair, 4 = poor) and their satisfaction with surgery (1 = very satisfied, 2 = somewhat satisfied, 3 = somewhat dissatisfied, 4 = very dissatisfied) - these two measures were to serve as the dependent variables in the multiple regression analyses - and to state whether they would choose to undergo the procedure again if they found themselves in the same situation, knowing what they now know about the outcome (yes, definitely; yes, probably; no, probably not; no, definitely not).
In summary, expectations were measured at baseline, and current pain and function were measured prospectively (each preoperatively and at 2 years), also yielding a measure of the change in pain and function. In each expectations domain (time to recovery, pain, and function), the difference between the preoperative expected score and the follow-up actual score yielded a measure of the extent to which expectations had been fulfilled.
Statistical analysis
Descriptive data are presented as the mean and standard deviations unless otherwise stated. Contingency analyses were used to examine associations between categorical variables. Bivariate analyses (Spearman rank or Pearson correlations, as appropriate) were used to examine the zero-order correlations between global outcome (or satisfaction) and the potential predictors.
Multiple linear regression analyses were carried out to identify the variables that made a significant unique contribution to explaining the variance in outcome, using firstly global treatment outcome and then satisfaction with treatment as the dependent variable to be predicted. Age, gender, and presence of other joint problems were entered into the model as a first step, to control for these potential confounding variables. After this, the following variables were entered using a forward conditional selection criterion (with a probability-of-F-to-enter ≤ 0.05): the two expectations items (that is, regarding expected pain and function); pain and function at 2 years; the change in pain and the change in function (in each case, the value measured prospectively from pre surgery to 2-year follow-up); and the fulfilment of expectations (expectations minus actuality) scores for each of the three domains.
Collinearity was assessed by examining the tolerance values and variance inflation values for the independent variables in the final regression models; values < 0.1 and > 5, respectively, were considered to suggest problematic collinearity [17] (no problems with collinearity were found within the analyses carried out).
Statistical analyses were carried out using Statview (SAS Institute Inc, San Francisco, CA, USA) and SPSS version 16.0 for Apple Macintosh (Chicago, IL, USA).
Statistical significance was accepted at the P < 0.05 level and no corrections were made for multiple testing [18].
Baseline sociodemographic, pain, function and co-morbidity characteristics of patients
Baseline value
Demographic/physical variables
Gender (n)
78 women, 34 men
Age (years)
67 ± 9
Body weight (kg)
87.5 ± 15 (men), 76.6 ± 15.5 (women)
Job status (%)
Full time
Part time
Marital status (%)
Never married
Living conditions (%)
With partner
With family
Pain, function and co-morbidity variables
Affected knee (%)
Both within 3 months
Pain duration (%)
< 6 months
6 to 12 months
1 to 3 years
3 to 5 years
> 5 years
Pain intensity (%) (n = 110)
When is the pain bothersome? (%)
Have no pain
First few steps only
After long walks (> 30 minutes)
Whenever walk
Constantly, even at rest
Knee limits ability to do sports (%)
No limitation
Slightly limits me
Moderately limits me
Greatly limits me
Totally limits me
Do not participate in sport for reasons unrelated to my knee
Knee limits/interferes with sexual activity (%)
No limitation
Slightly limits me
Moderately limits me
Greatly limits me
Totally limits me
Not sexually active for reasons unrelated to my knee
Knee limits ability to work (%)
No limitation
Slightly limits me
Moderately limits me
Greatly limits me
Totally limits me
Not working for reasons unrelated to my knee
Other painful joints (back, hip, foot) (%)
American Association of Anaesthesiologists co-morbidity grade (%)
Grade I
Grade II
Grade III
Thirteen out of the 112 patients with baseline data and 2-year follow-up data had undergone some sort of further surgery on the same knee, between 1 month and 21 months after the index surgery (eight early wound revisions, including evacuation of haematomas; four revisions with exchange of the implant; and one secondary implantation of a patella component). As expected, this group recorded significantly worse 2-year global outcomes (P = 0.003) and satisfaction grades (P = 0.012) than the rest of the group - since these revisions could not have been anticipated at baseline, yet they may have had an influence on the overall outcome rating at 2 years, the data from this group were not included in the multivariable analyses of predictors of outcome.
Reasons for surgery
By far the most common primary reason for deciding to undergo TKA, given by over one-half of those responding (53/99, 53.5%), was 'I can't stand the pain any longer; something has to be done'. This was followed by 'I want to walk without a limp, and/or without using a cane/crutch' (17.2%), 'I want to increase my walking endurance' (14.1%), and 'doctor's recommendation' (6.1%). The other six options were each chosen by 1 to 3% patients (13 patients were not able to answer the question).
The distribution of answers (n = 111) to the question 'In deciding to have knee replacement surgery, how important was it for you to decrease your pain' was as follows: 44.1% extremely important, 51.4% very important, 3.6% moderately important, and just 0.9% slightly important. The same question in relation to 'increasing your ability to do normal activities' returned the following answer distribution (n = 112): 48.2% extremely important, 47.3% very important, and 4.5% moderately important.
Preoperative expectations regarding recalled time to recovery
Preoperative expectations compared with actual results 2 years after surgery
Distribution of baseline expectations and actual status at 2-year follow-up for pain and for function
Expected status, declared pre operation
Actual status 2 years post operation
How painful?
Not at all
All options
Not at all
45 (43)
32 (30)
12 (8)
5 (4)
94 (85)
3 (2)
4 (4)
7 (4)
3 (3)
17 (13)
All options
48 (45)
36 (34)
19 (12)
8 (7)
111a (98)
How limited in function?
Not at all
All options
Not at all
16 (16)
22 (21)
15 (10)
5 (3)
58 (50)
5 (5)
12 (12)
18 (17)
13 (9)
48 (43)
4 (4)
4 (4)
1 (1)
1 (1)
All options
Consistent with the most common reason for deciding to undergo surgery, the majority of patients (94/111, 85%) declared that they expected no knee pain and the remainder (17/111, 15%) declared expectation of only slight knee pain after surgery. In reality, only 43% of the group reported being pain-free at 2 years post operation. The patients were similarly overly optimistic about function, with the majority of the group expecting no limitations (58/111, 52%) or only slight limitations (48/111, 43%) after surgery, but with only 20% and 30% patients, respectively, achieving such a status.
On an individual basis, expectations regarding pain were met or exceeded in 47% patients; for function, just 30% achieved their expected function or better (Table 2).
Global outcome and satisfaction 24 months post surgery
The ratings of the global outcome of the knee replacement 24 months after surgery (n = 112) were as follows: 46.4% excellent, 42.0% good, 9.8% fair, and 1.8% poor (excluding the revision patients, ratings were 49.5%, 41.4%, 9.1% and 0%, respectively).
The ratings for satisfaction with the results of the knee replacement (n = 112) were similarly distributed, although with somewhat more patients in the highest category: 58.6% very satisfied, 31.5% satisfied, 8.1% somewhat dissatisfied, and 1.8% dissatisfied (excluding the revision patients, ratings were 62.3%, 29.6%, 7.1% and 1.0%, respectively).
Decision to undergo surgery
In response to the question 'Now that you have learned a lot about knee replacement surgery, if you could go back in time and make the decision again, would you choose to have the surgery?', 73.9% patients said 'yes, definitely', 18.9% said 'yes, probably', 6.3% said 'no, probably not', and 0.9% said 'no, definitely not'.
Interrelationships between the baseline and outcome variables
Correlation matrix showing inter-relationships between the examined predictors, global outcome and satisfaction
Gender (male 0, female 1)
Other joint problems (no 1, yes 2)
ASA score (co-morbidity)
Pain pre operationa
Functional limitations pre operationa
Expectations about paina
Expectations about functional limitationsa
Expectations about recovery time
Pain at 2 yearsa
Functional limitations at 2 yearsa
Change in pain, pre operation to 2 yearsa
Change in functional limitations, pre operation to 2 yearsa
Expectations fulfilled, painb
Expectations fulfilled, functional limitationsb
Global treatment outcomec
Gender (male 0, female 1)
Other joint problems (no 1, yes 2)
ASA score (co-morbidity)
Pain pre operationa
Functional limitations pre operationa
Expectations about paina
Expectations about functional limitationsa
Expectations about recovery time
Pain at 2 yearsa
Functional limitations at 2 yearsa
Change in pain, pre operation to 2 yearsb
Change in functional limitations, pre to 2yb
Expectations fulfilled, painb
Expectations fulfilled, functional limitationsb
Global treatment outcomec
Expectations, change in symptoms, and the expectations- actuality discrepancy as predictors of global rating of outcome
Results of multiple regression analysis explaining variance in global outcome at 2 years
Step change in R2
Pvalue for step change in R2
β for final model (only significant predictor variables shown)
0.189 (other joint problems)
< 0.0001
0.384 (pain at 2 years)
0.238 (functional limitations at 2 years)
Adjusted R2 for model
Results of multiple regression analysis explaining variance in satisfaction at 2 years
Step change in R2
Pvalue for step change in R2
β for final model (only significant predictor variables shown)
0.194 (other joint problems)
< 0.0001
0.517 (pain at 2 years)
< 0.0001
Adjusted R2 for model
A similar pattern of variable selection was seen when satisfaction with treatment was used as the dependent variable, although in the final model only other joint problems (P = 0.042) and knee pain at 2 years (P < 0.0001) were unique significant predictors (model R2 = 29%; Table 5).
Although relevant in the bivariate analyses, in neither of the multivariable models did baseline expectations or expectations being fulfilled make a significant contribution to explaining the variance in global outcome or satisfaction, when the 2-year status for pain and for functional limitations were also included in the model.
The present study sought to examine the extent to which patient self-ratings of global outcome and satisfaction after TKA were determined by prior expectations of the outcome, by expectations being met, or by the actual symptom/functional status after surgery. Studies supporting each of these putative predictors of satisfaction have been reported in the literature in relation to the treatment of various medical conditions [3, 4, 6].
Overall, the results did not support the notion that expectations per se are important unique determinants of outcome: the results showed low but significant associations with global outcome and satisfaction in bivariate analyses (Table 3), but in the multivariable analyses they did not explain any additional variance in outcome once the (more significant) current pain/functional status variables had been selected for entry. Some previous studies in orthopaedics also found no unique role for expectations per se in predicting the improvement in function [19] or the global outcome of surgery [20]. Other authors found that baseline expectations in some domains explained up to 13% of the variance in total joint replacement outcome [11, 12], measured using either generic, joint-specific or pain-scale instruments. In neither of these studies, however, was the relationship between expectations and global outcome or satisfaction assessed. Also in the present study, bivariate analyses showed that baseline expectations predicted the change in pain and change in functional limitations, accounting for a similar proportion of variance to that reported by Engel and colleagues [11] and by Mahomed and colleagues [12] (9 to 16%, r = 0.3 to 0.4; Table 3); however, these results did not retain significance in the multivariable model predicting the overall global outcome or satisfaction. De Groot and colleagues reported that spine surgery patients who had optimistic expectations about postoperative pain were less disappointed with surgery than were patients with pessimistic expectations, although the same did not apply for the outcomes rate of recovery or return to work [21]. Further, similar to the results of the multivariable analysis in the present study, it transpired that when the postoperative back pain at 3 months was considered a covariate in predicting disappointment with surgery, the influence of baseline expectations regarding pain was lost [21]. It therefore appears that the actual status may be more predictive than expectations per se when satisfaction or global outcome is modelled using multivariable techniques.
In the present study, in both of the multivariable regression models, the most significant predictor of the 2-year global outcome/satisfaction was the current knee status (pain and functional limitations). Interestingly, and in contrast to some previous studies [4, 5, 20], the variable describing the fulfilment of expectations for pain (expectations- actuality discrepancy) did not achieve significance in the multivariable model, even though it had shown a significant correlation with both global outcome and satisfaction in the bivariate analyses (r = 0.3 to 0.5, P < 0.05). This was most probably the result of the high correlations between pain/functional limitations at the 2-year follow-up and the fulfilment of expectations in these domains (r = 0.8 to 0.9; Table 3), leading to just one of these two variables retaining significance in the given multivariable model.
The patients' expectations of surgery declared in the present investigation were quite high, and were overly optimistic compared with the actual results achieved. The vast majority (85%) of patients expected to be pain free, yet only 43% were; and 52% expected to have no functional limitations, yet just 20% achieved this. This overestimation of the probable improvement after TKA [12, 13] and other kinds of elective orthopaedic surgery [20, 22] has been reported before. Mahomed and colleagues found that, in a mixed sample of hip and knee arthroplasty patients, 75% expected to be pain-free and 40% expected to be unlimited in their usual activities [12]. Burton and colleagues reported that the majority expected to be pain-free but only 55% actually were [13]. In most expectations studies, the present one included, it is not known whether expectations reflect dispositional optimism (that is, the expectation that good outcomes generally occur when confronted with problems across important life domains) [8] or reflect considered expectations based on information received (for example, during the consultation, through patient information sources, personal experience), or indeed a combination of both. Either way, these findings in relation to the overestimation of the probable result of surgery highlight the importance of both routine outcome assessment and longitudinal studies of the factors influencing outcome, to guide informed discussion with the patient regarding the extent of improvement that can realistically be achieved.
The negative influence of other joint problems on the probable outcome of TKA may need to be emphasised to a greater extent in the preoperative informed consent process. As banal as it may seem, it is important that patients with co-morbidity in terms of other joint problems (though according to the present study not in relation to general co-morbidity as measured with the American Association of Anaesthesiologists co-morbidity score) are made aware that the operation is being carried out for the specific knee joint disease identified, and that it will not necessarily serve as a general panacea for other ongoing medical problems. Indeed, ongoing pain and functional limitations in connection with other joint problems will probably persist after the surgery, and influence general functioning and the quality of life accordingly. If this is not explicitly discussed with the patient prior to surgery, then inappropriate expectations may go unchecked, ultimately leading to disappointment with the result.
The salient features of the present study include its prospective nature, its relatively large sample size, its examination of different domains for which the patient may hold expectations, and its multivariable approach to the analysis. Further, the overall proportion of successful outcomes (88.5% excellent and good) was similar to the figures presented in previous studies (86% [13], 85% [23]), providing confidence in the generalisability of the findings. Several limitations, however, must also be acknowledged.
The questionnaire used to assess the (preoperative) expectations of improvement and the (postoperative) achievement of improvement and overall outcome has not been validated for use in the knee; it was originally developed and validated for use in the hip [16]. Many of the current hip and knee questionnaires, however, show considerable overlap in their item content (for example, the Oxford hip questionnaire and the Oxford knee questionnaire [24]), and the items in the Total Arthroplasty Outcome Evaluation Questionnaire appeared to display acceptable face validity also for the knee. In fact, no questions in the questionnaire relate to specifically hip-related activities and most questions just focus on pain and general activities that affect the lower extremities. Nonetheless, future studies would be required to establish the questionnaire's construct validity by comparison with other knee-specific questionnaires. Furthermore, our German version of the Total Arthroplasty Outcome Evaluation Questionnaire did not undergo the currently recommended, stringent procedure for the cross-cultural adaptation of questionnaires [25]; indeed, the questionnaire was produced for use in the hospital before the widespread adoption of such guidelines. Primarily, it represented a translation by a bilingual (first language, German) rheumatologist, cross-checked by a bilingual colleague (first language, English) and reviewed by various bilingual clinicians.
The Total Arthroplasty Outcome Evaluation Questionnaire was chosen for use in the present investigation because, when the study was first designed, this instrument appeared to offer one of the most comprehensive, but simple and efficient, means of assessing the many domains/constructs of interest in arthroplasty patients. Most of the individual scales in the questionnaire are single-item measures (that is, one item per construct) with adjectival or Likert scales; although a number of studies have shown that these can be just as valid and representative of a domain as multi-item scales [26, 27], it would be of interest to confirm the present findings using the currently more popular multi-item scales such as the Oxford-12, the Western Ontario and McMaster Universities Osteoarthritis Index, and so forth [28]. Similarly the use of a more extensive questionnaire to assess co-morbidity might deliver more precise information about other illnesses/disorders potentially influencing outcome [29] than does the American Association of Anaesthesiologists co-morbidity score.
In relation to the statistical analyses used in the present study, the regression models examined the main effects of level of expectations, regardless of whether these were met, and of fulfilled expectations, independent of their preoperative level. However, perhaps the interaction of both should be considered, for example to investigate whether expectations that are met lead to a good outcome only when expectations are high. This particular analysis could not be carried out in the present study, because, for the given sample size, the power using moderated hierarchical regression analysis would have been too low [30] and because there were so few patients with low expectations that the moderated test would have been somewhat biased. Future studies should address these issues.
In the patient group examined, patient expectations of surgery were generally overly optimistic. This highlights the importance of routinely assessing patient-orientated outcome and the various factors influencing it, such that realistic expectations for different outcome domains can be discussed with the individual patient prior to surgery. Although in bivariate analyses expectations being met were significantly associated with outcome, in the final multivariable model only the presence of other joint problems and the degree of improvement in symptoms and function were unique significant determinants of a good global outcome and of satisfaction with the procedure.
total knee arthroplasty.
The authors thank the physiotherapists of the Schulthess Klinik, in particular Michelle Van Damne, Mario Bizzini, and Filomena Caporaso, for their assistance with the data collection.
The present research project was supported by a project research grant from the Swiss National Science Foundation (grant number 32/4984396) and by the Wilhelm Schulthess Foundation Research Fund. All authors were employees of the Schulthess Klinik at the time of the study.
Authors' Affiliations
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- Lutz GK, Butzlaff ME, Atlas SJ, Keller RB, Singer DE, Deyo RA: The relation between expectations and outcomes in surgery for sciatica. J Gen Intern Med. 1999, 14: 740-744. 10.1046/j.1525-1497.1999.10417.x.PubMed CentralView ArticlePubMedGoogle Scholar
- Mannion AF, Junge A, Elfering A, Dvorak J, Porchet F, Grob D: Great expectations: really the novel predictor of outcome after spinal surgery?. Spine. 2009, 34: 1590-1599. 10.1097/BRS.0b013e31819fcd52.View ArticlePubMedGoogle Scholar
- de Groot KI, Boeke S, Passchier J: Preoperative expectations of pain and recovery in relation to postoperative disappointment in patients undergoing lumbar surgery. Med Care. 1999, 37: 149-156. 10.1097/00005650-199902000-00005.View ArticlePubMedGoogle Scholar
- McGregor AH, Hughes SP: The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 2: patient expectations and satisfaction. Spine. 2002, 27: 1471-1476. 10.1097/00007632-200207010-00019. discussion 1476-1477.View ArticlePubMedGoogle Scholar
- Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D: Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998, 80: 163-173.PubMedGoogle Scholar
- Pynsent PB, Adams DJ, Disney SP: The Oxford hip and knee outcome questionnaires for arthroplasty. J Bone Joint Surg Br. 2005, 87: 241-248. 10.1302/0301-620X.87B2.15095.View ArticlePubMedGoogle Scholar
- Beaton DE, Bombardier C, Guillemin F, Ferraz MB: Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000, 25: 3186-3191. 10.1097/00007632-200012150-00014.View ArticlePubMedGoogle Scholar
- van Hooff ML, Geurts SA, Kompier MA, Taris TW: 'How fatigued do you currently feel?' Convergent and discriminant validity of a single-item fatigue measure. J Occup Health. 2007, 49: 224-234. 10.1539/joh.49.224.View ArticlePubMedGoogle Scholar
- Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N: Outcome assessment in low back pain: how low can you go?. Eur Spine J. 2005, 14: 1014-1026. 10.1007/s00586-005-0911-9.View ArticlePubMedGoogle Scholar
- Johanson NA, Liang MH, Daltroy L, Rudicel S, Richmond J: American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg Am. 2004, 86-A: 902-909.PubMedGoogle Scholar
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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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|Egg whites
|Castor sugar
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Cut tops off oranges and scoop out centre.
Put back into orange cases with ice cream and a little sugar.
Whisk egg whites, fold in sugar.
Pile on top of ice cream and oranges and brown for 3 minutes in a very hot oven (475° F.€"Gas Mark 8).
Rate It
Nutrition Rank
Nutrition Facts
Serving size: Complete recipe
Calories 558 Calories from Fat 16
% Daily Value*
Total Fat 2 g2.9%
Saturated Fat 0.42 g2.1%
Trans Fat 0 g
Cholesterol 1.7 mg0.6%
Sodium 97.9 mg4.1%
Total Carbohydrates 131 g43.7%
Dietary Fiber 15.3 g61%
Sugars 115.9 g
Protein 11 g21.8%
Vitamin A 28.9% Vitamin C 477%
Calcium 28.1% Iron 3.4%
*Based on a 2000 Calorie diet


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Although YouTube has a genuine breakout marketing star in "Fred," a show about a fictitious 6-year-old that has triggered "5 [million] to 10 million" ad-driven hits, video sites still face resistance from marketers, according to Eileen Naughton, director of media platforms for Google. Among the issues for marketers are the various ad formats, how well the sites can target certain demographics and whether common metrics are needed, Naughton said at an industry event.
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Browse By:
All Topics » Information Technology » Strategic information systems planning » Information technology
Information technology (1 - 10 of 88 items)
Information Technology: HUD Needs to Address Significant Weaknesses in Its Cost Estimating Practices
GAO-17-281: Published: Feb 7, 2017. Publicly Released: Feb 7, 2017.
The cost estimates that the Department of Housing and Urban Development (HUD) developed for the four selected information technology (IT) investments were unreliable and, thus, lacked a sound basis for informing the department's investment and budgetary decisions. GAO's Cost Estimating and Assessment Guide (Cost Guide) defines best practices that are associated with four characteristics of a rel...
Veterans Affairs Information Technology: Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems
GAO-17-408T: Published: Feb 7, 2017. Publicly Released: Feb 7, 2017.
GAO noted in July 2016 that the Department of Veterans Affairs (VA) had moved forward with an effort to modernize its health information system—the Veterans Health Information Systems and Technology Architecture (VistA)—but that the department is uncertain of its long-term plan for addressing its electronic health record system needs beyond fiscal year 2018. Beyond modernizing VistA, GAO repor...
Joint Information Environment: DOD Needs to Strengthen Governance and Management [Reissued on October 25, 2016]
GAO-16-593: Published: Jul 14, 2016. Publicly Released: Jul 14, 2016.
The Department of Defense (DOD) plans to spend almost $1 billion by the end of this fiscal year to implement one element of the Joint Information Environment (JIE); however, the department has not fully defined JIE's scope or expected cost. Officials reported that assessing the cost of JIE is complex because of the size and the complexity of the department's infrastructure and JIE's implementation...
Information Technology: Federal Agencies Need to Address Aging Legacy Systems
GAO-16-696T: Published: May 25, 2016. Publicly Released: May 25, 2016.
The federal government spent more than 75 percent of the total amount budgeted for information technology (IT) for fiscal year 2015 on operations and maintenance (O&M) investments. Specifically, 5,233 of the government's approximately 7,000 IT investments are spending all of their funds on O&M activities. Such spending has increased over the past 7 fiscal years, which has resulted in a $7.3 billio...
Information Technology: FDA Has Taken Steps to Address Challenges but Needs a Comprehensive Strategic Plan
GAO-16-182: Published: Dec 17, 2015. Publicly Released: Dec 17, 2015.
As of September 2015, the Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), had developed and released a new information technology (IT) strategic plan, entitled Information Technology Strategic Plan, Version 1.0 . The plan, according to the agency's Chief Information Officer (CIO), was developed to help FDA's Office of Information Management a...
Farm Program Modernization: Farm Service Agency Needs to Demonstrate the Capacity to Manage IT Initiatives
GAO-15-506: Published: Jun 18, 2015. Publicly Released: Jun 18, 2015.
The key factors that led to the decision to halt the Modernize and Innovate the Delivery of Agricultural Systems (MIDAS) program were poor program performance and uncertainty regarding future plans. The Farm Service Agency (FSA) experienced significant cost overruns and schedule delays, deferred the majority of the envisioned features, skipped key tests, and deployed software in April 2013 that wa...
Federal Software Licenses: Most Agencies Have Reported Planned Actions to Address Our Prior Recommendations on Software License Management
GAO-14-835R: Published: Sep 23, 2014. Publicly Released: Sep 23, 2014.
As of August 2014, the majority of agencies that have provided information reported that they plan to address most of the recommendations GAO made to them. Specifically, 21 agencies plan to fully address all recommendations. For example, the Department of Education stated that in response to the weakness GAO identified, a department-wide directive that establishes guidelines for software acquisiti...
Information Technology: HUD's Expenditure Plan Satisfied Statutory Conditions; Sustained Controls and Modernization Approach Needed
GAO-14-283: Published: Feb 12, 2014. Publicly Released: Feb 12, 2014.
The Department of Housing and Urban Development's (HUD) fiscal year 2013 information technology (IT) expenditure plan satisfied the two sets of statutory conditions contained in the appropriations act. Regarding the first set of conditions, the plan identified for each project the functional and performance capabilities to be delivered, mission benefits, life-cycle costs, and key milestones. For e...
OPM Retirement Modernization: Longstanding Information Technology Management Weaknesses Need to Be Addressed
GAO-12-226T: Published: Nov 15, 2011. Publicly Released: Nov 15, 2011.
The Office of Personnel Management (OPM) is the central human resources agency for the federal government and, as such, is tasked with ensuring the government has an effective civilian workforce. As part of its mission, OPM defines recruiting and hiring processes and procedures; provides federal employees with various benefits, such as health benefits; and administers the retirement program for fe...
Data Center Consolidation: Agencies Need to Complete Inventories and Plans to Achieve Expected Savings
GAO-11-565: Published: Jul 19, 2011. Publicly Released: Jul 26, 2011.
Over time, the federal government's demand for information technology has led to a dramatic rise in the number of federal data centers and an increase in operational costs. Recognizing this increase, the Office of Management and Budget (OMB) has launched a governmentwide initiative to consolidate data centers. GAO was asked to (1) assess whether agency consolidation documents include adequate deta...


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Praise the LORD!!
Dear Bros. / Sis.
By HIS grace we are back in activities now. Thanks for all your support so far in our ministry. We love our GOD and though it is being tough to manage and maintain the burden of music ministry with self funded. We request you all to support us and encourage us and you be a part of this ministry by purchasing ORIGINAL albums from your near by christian book stalls.
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Publication Name: Cedar Rapids Gazette
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Cedar Rapids Gazette (Newspaper) - May 24, 1974, Cedar Rapids, Iowa <tUr (fI'tlnr ltnpida tf'ttieWf- 1$ Captured Hoarded man with shoulder-length hair is in police* custody in New York City after lit* hijacked a helicopter at gunpoint Thursday and deniandt*d $2 million in ransom, rile hijacker forced tlie* craft s pilot and co pilot to fly it to an abandoned helicopter pad atop the fan Am building in the borough of Manhattan, where In was apprehended Helicopter hijacker is led out of the fan Xiii building iii New A ork following his rooftop capture' by police The man, identified as |)a\ id frank Kamaiko, about 25, barefoot, with long hair and torn jeans, was subdued on the building's heliport. UCI TelephotoFreed Marie Sossi, district attorney of (ienoa. Italy, is hugged by his wife (ira/ie, left, and his mother shortly after his return home* to (ienoa Thursday night. He had been kidnaped five weeks ago by clandestine leftist organization Hee Brigades. There was no word on tin* fate of eight imprisoned leftist terrorists whom the court had agreed to set fret' in exchange for Si(ssl s lite UPI TclrphptrPrisoner After Shootout Isl at li troops lead away blindfolded ( usbar ( alban, one of two Arab guerillas captured during a shootout I hursduy Six guerillas were killed by the Israelis as the band attempted to cut across the (iolan Heights on a mission against settlements iii Israel Family Group ai/i AU* Mhotos by I lib ft AA* I lo Louise Is a accounts for this par k /oo \t left bit (ament shy concerning her new tubs which long lens picture, right taken Thursday at the Bever is the |ti oud lather Loo Loo is ti and Louise is ii The IWM culls »iti' (irs! nMh«'<l curly Tm,lay May in ,hl. ........ ( ' <1.0 Itapids ;


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Building resilience on the roof of the world 2012
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Very ethical doctor at beginning I was every skeptical about the procedure because it was the first surgen I had but Dr. Knoetgen guide me through everything and I felt in very good hands!
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Portable Magnetic Dry Erase Board
Our finest portable magnetic dry erase board with a contemporary powder coated frame.
The writing surface is a 50 year warrantied porcelain on steel, magnetic dry erase board. That's the best in the industry bar none! The writing surface resist ghosting and erases clean time and time again and because its manufactured with a porcelain material over a steel surface you can also use any kind of magnets or magnetic accessories that you want. So now you can use pre-printed materials such as posters or other types of printouts in your presentation.
There are three standard board sizes available including 3' Tall x 4' Wide, 3.5' Tall x 5' Wide or the most popular size of 4' Tall x 6' Wide.
Each unit has a marker tray, four casters and the exclusive locking mechanism at the bottom of the board to keep the board from moving around while you're trying to write on the writing surface.
|Item Code
|Board Size
|3' x 4'
|3½' x 5'
|4' x 6'
Product Specifications:
- Contemporary Reversible Boards
- Porcelain Steel Magnetic Dry Erase Writing Surface
- Also available with a cork surface on one side - contact customer service
- 50 year warranty on the writing surface
- Exclusive lockpin system keeps board firmly in place
- Wide tray for ample storage
- Ships with assembly tools and hardware
- Castor wheel locks
- Powder coated finish
- Colors: Etched Stone, Tuxedo Black
- Board Sizes: 3' x 4', 3.5' x 5', 4' x 6'
- Steel constructed legs built to last
- Made in the U.S.A.
- School Purchase Orders Accepted
- Lead-time: 10-12 working days


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The Pop! Vinyl figure comes in a displayable window box! It stands approx. 9 cm tall.
Thank you for visiting Elder Scrolls V: Skyrim Whiterun Guard Limited Edition Exclusive Pop! Vinyl Figure on hundredsofgiftideas.co.uk
We bring the products from many websites to one website for you to search, save and compare.


text:
Tested Operating System List for Intel® Server Board S1600JP Family
This page contains a list of the tested operating systems for the Intel® Server Board S1600JP Family. Operating systems not listed below are not supported by this Intel® Server Board or System.
|Related topics
|Intel® Server Products - Microsoft* WHQL information
|Linux* and UNIX* certification test submission reports


text: See water Also, click to see other meanings of this dream.Wet Unfinished; see "towel'Wet 1. Trying to cleanse oneself of painful emotions. 2. Spiritually reaching.Wet Nurse 1. One seeks to return to childhood. 2. If one imagines that one is a wet nurse, it may indicate that one feels she is in a relationship with someone who has a childish personality.Wet Sand Unstable balancing.


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Women's FashionHome
Enter your Email Address and click 'Continue' Example: email@example.com Submit Cancel Forgot Password Close /GarnetHill/US/Global/Popups/forgot_password Enter your email address
false pdp {"scheme":"product1_cr"}
false pdp {"scheme":"product2_cr"}
Hanky Panky Retro Lace High-Waisted V-Kini is rated out of 5 by 61.
Rated 5 out of 5 by Dreamgirl from Lovely Lacies Lovely, soft and beautifully fitting panties! But they sure are expensive....
Date published: 2016-09-26
Rated 5 out of 5 by Roodie from Great fit It's hard to find underwear that doesn't sag below your belly (if one is somewhat full-figured); this one stays up.
Date published: 2015-10-25
Rated 5 out of 5 by Harriet from Style that suits me My daughter has been enthusiastic about Hanky Pankys, so I thought I'd give them a try. I like this cut very much, below my navel, fairly high leg cut, trim, with slight compression, and very comfortable. Despite their size categorizations, XL is a very good fit on me and I am an 18. I'd say the fit is very generous. I think they are made in the USA too!
Date published: 2015-10-04
Rated 5 out of 5 by MaryLennox from Wonderful! As a woman of a certain age, who has had children and the resulting body changes, I'm always on the look out for attractive, comfortable underwear that doesn't slip down, ride up, or look like bloomers. I finally overlooked the price because of the comments, and ordered three pair. They are so wonderful that I immediately ordered three more! Worth every penny to me.
Date published: 2015-09-28
Rated 5 out of 5 by Bibby from Love these undies I am 68 years old, 5' 7" and weigh 140 lbs. Had three kids....you know how it goes! I love these cause they fit and don't slide down. Absolutely no panty line so I love them. Have 5 pairs and will order some more. They're the best.
Date published: 2015-04-23
Rated 5 out of 5 by Aceviv from Sexy and Practical These are fabulous panties. They last wash after wash and help keep things looking smooth under dresses and pants alike. The lace top makes them sexy while holding the tummy in a bit.
Date published: 2015-03-21
Is the price $34 for 3 pairs or one?
These are sold individually.
Date published: 2014-07-01
Product:23735-Hanky Panky Retro Lace High-Waisted V-Kini


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Asked by Anonymous at 5:30 PM on Dec. 6, 2012 in Money & Work
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Nursery Fur Animal Slippers
- Overview
Keep little feet warm with a favorite creature. Each animal design features a soft, plush exterior with sweetly styled face and ears.
- Polyester fur.
- Features a plush animal-head design with embroidery at the front of the slipper.
- Faux leather non-slip sole.
- Available in one size to fit children up to 12 months.
- Machine wash.
- Imported.
- Dimensions & Care
- One size only, fitting children up to 12 months old.
- Machine wash in cold water, gentle cycle.
- Use only non-chlorine bleach, if needed.
- Tumble dry low.
- Shipping & Return Info
This is a general shipping item. In-stock items will usually ship within 7-10 business days for the cities listed below.
- San Francisco, Los Angeles, Dallas, Chicago, Detroit, Columbus, New York City, Baltimore, Boston, Cromwell, Atlanta, Raleigh, Charlotte, Tampa, Fort Meyers, Orlando, Miami, Fort Lauderdale
For other areas, your items will be delivered within 2-3 weeks.
View Our Shipping Information
At Pottery Barn Kids, we take great pride in the quality and craftsmanship of our products. Attention to design, materials, safety and construction is our priority. We carefully inspect your order prior to shipment; upon receipt, please inspect your purchase and notify us of any damage. We will arrange for a prompt replacement. If, within 7 days for Quick Ship upholstery and 30 days for all other products, you are dissatisfied for any reason, you may return your purchase for a refund of the merchandise value.
If your return for Merchandise Credit Cards is greater than $10,000, we will issue $10,000 in Merchandise Credit Cards to you that day, and then mail additional Merchandise Credit Card(s) for the amount in excess of $10,000 to you.
For returns of items purchased from your Pottery Barn Kids registry, we will gladly provide a refund or exchange for the merchandise within 90 days of your event or within 90 days of purchase, whichever date is later.
Delivery fees are non-refundable and prior purchases are not eligible for a price adjustment. The following items are non-eligible for returns or exchanges:
- Personalized/Monogrammed items
- Mattresses
- Gift cards
- Special-order items (including made-to-order upholstery and custom order rugs)
- Final Sale items (identified by a price ending in $.97 or $.99)
- Items damaged through normal wear and tear.
Questions? See our full Returns Policy.
International Returns: Online returns are available only for items that were shipped to the United States. If you would like to return items that were shipped outside the US, please see International Returns and Exceptions.
- Our Safety and Quality Commitment
Our Commitment
At Pottery Barn Kids, we have a firm commitment to safety and quality. We take great pride in our timeless designs, premium materials and expert craftsmanship.
Designed In-house
Nearly all of our products are imagined and designed in our San Francisco studios. Our artists hand-create prototypes for everything from furniture to bedding to lighting. From there, we work with talented craftsmen and fabric industry leaders to build long-lasting products designed to last your family for years to come.
Free Interior Design Services
Need design help? We offer free, no-strings-attached Interior Design Services. Get advice and inspiration from our specialists in-store, over the phone or by email. Designers will even make in-home visits, where they can take measurements, discuss color options and give tips on any room.


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Kevin Pietersen's continued good form helped England to a thrilling five-run victory and 2-1 Twenty20 series success over Pakistan to conclude their tough tour of the United Arab Emirates tonight.
Pietersen's unbeaten 62 underpinned only a vulnerable 129 for six, and although Pakistan looked sure to complete the chase with ease at one stage, England's bowlers dug in to sneak the spoils.
Saeed Ajmal's four for 23, and the economical back-up spin of Mohammad Hafeez and Shahid Afridi, stalled England's momentum after Stuart Broad chose to bat first on an awkward surface at the Zayed Stadium.
Their total lacked a double-figure score between numbers three and six as Ajmal, their scourge throughout here, finished his eight weeks' work with 39 wickets.
It was only in company with fellow opener Craig Kieswetter and then Samit Patel that Pietersen managed to dominate, but he nonetheless hit six fours and a six from 52 balls.
He alone struck the ball with any regularity and authority as England's batsmen struggled to cope with conditions, and it transpired he had done just enough to help finish an arduous trip on a high.
It was clear Pakistan did not have an easy chase, but knowing their target and that England had only eight overs of frontline spin seemed a major advantage.
Hafeez was caught-and-bowled by Jade Dernbach for a first-ball duck in the second over, and Awais Zia was unluckily lbw to a delivery from Graeme Swann which turned very sharply from round the wicket but pitched outside leg.
Asad Shafiq's sensible batting got Pakistan within striking distance, though, by the time he was run out unable to scamper an unwise second to deep midwicket.
Two other run-out opportunities evaded England, Zia and Umar Akmal the men to survive.
But Akmal and Misbah-ul-Haq's pursuit then ran out out steam as Broad in particular put the squeeze on, and the Pakistan captain was last out for 28, bowled by Dernbach trying in vain to heave the six needed from the final ball of the innings.
Kieswetter and Pietersen had got England off to a handy start for the third match running, until the former was well-caught at wide long-on by Shoaib Malik in Ajmal's first over.
Kieswetter was already responsible for clubbing 12 runs, culminating in a straight six, from Umar Gul's first three deliveries.
But neither Ravi Bopara nor Eoin Morgan could get started.
Bopara edged a very good ball from Aizaz Cheema to diving wicketkeeper Akmal.
Then Morgan's nightmare tour ended with one of his worst innings. He somehow managed an acceptable nine from 11 balls, but could easily have been out twice as he mistimed or simply missed before a mix-up with Pietersen saw him run out, sent back for a single.
Jonny Bairstow, hero of the series-levelling win in Dubai two days ago, was also all at sea in the desert this time as Ajmal and Afridi took control.
Ajmal bowled Bairstow, trying to cut the wrong ball. But it was Afridi who dried up the runs most effectively, as England failed to score from 12 of the 24 balls the leg-spinner bowled.
Pietersen lost the strike, facing only 14 of 40 deliveries at one stage, and - until Patel joined him - it was all too much for a succession of new men to the wicket.
Patel struck 12 runs, again including a straight six, from the first three balls of Ajmal's last over. But the off-spinner had the last word, when Patel was stumped, and even Pietersen could not get England significantly above six-an-over until Cheema served him a full-toss which disappeared over midwicket for a maximum from the last ball of the innings.
It was to prove a crucial blow too, one Misbah was singularly unable to match when his team needed it two hours later.
- More about:
- Cricket
- Dubai
- Ian Bell
- Imran Khan
- South Asia
- Stuart Broad
- United Arab Emirates


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Sort by: Viator Recommends | Traveler Rating | Most Recent
Outdoor Activities in Ocho Rios
By Viator, August 2015
Ocho Rios is a Jamaican travel destination that offers more than just the usual resort getaways of lush tropical jungles and pristine beaches (though, honestly, these are splendid in their own ... Read more
3 Days in Ocho Rios: Suggested Itineraries
By Viator, January 2015
Once a tiny fishing village, Ocho Rios is now a lively tourist hub and a must visit long-weekend getaway. Here are some ideas on how to make the most of your stay in this charming place. Day 1: ... Read more
Jamaica Bobsled Experience
By IslandGirl, USA, July 2013
This experience took alot of travel time before getting to Mystic Mountain. Spent 2 hours driving to different hotels in the Montego Bay area picking up other people, then took 2 more hours to get ... Read more


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The Empress
141 Leman Street, London, E1 8EY +44 2035512378
- Average
- Main course: £8
- Food spend: £24
Great choice of food, with a friendly and helpful staff.
Rob Wilkins
10 May 2016
from Southampton
Voted East London's best Indian restaurant for 3 years running, The Empress in Whitechapel has been serving authentic Indian and Bangladeshi food since 1993. Classic curry house favourites and regional specialities burst with aromatic flavours, with the Empress chefs exhibiting a selection of dishes from their home towns.
The diverse Empress menu features traditional north Indian dishes like hot garlic chilli chicken and lamb rezala. Tandoori classics include marinated king prawns, while duck and vegetable join the meaty choice of biryanis.
Tempting, fresh sides of spinach, okra and chickpeas are given spicy twists, with tasty chutneys and breads also accompany your meal. Personal recommendations from the Empress team include salmon korma and slow cooked Khala lamb bhuna.
Simply decorated and subtly lit, the wooden floored Empress restaurant is an inviting venue to enjoy fine Indian cuisine. Easy to spot on Leman Street, The Empress in London is a 6-minute walk from Aldgate East Tube Station.
The Empress
141 Leman Street, London, E1 8EY
See all restaurants in London
See all restaurants in Whitechapel
Customer reviews for The Empress
- Food
- Value
- Ambience
- Location
- Service
- Drinks
((((* 29 October 2016 by Bart Vriesema from Geleen
We love Indian food and our trip to London had to include a visit to an Indian restaurant. We were not disappointed at the Empress. Great food, friendly staff and located close to our hotel.
((((* 24 May 2016 by Perrine from London
Excellent food. Very good value. Lot of choice except for desserts (only very few ice creams and no fruits)
((((( 10 May 2016 by Rob Wilkins from Southampton
Great choice of food, with a friendly and helpful staff.
((((( 25 April 2016 by Paolo Degioanni from Cuneo
Wonderful indian cuisine
((((* 28 March 2016 by Andrew Dent from Oxford
Excellent dining experience
((((* 29 February 2016 by Emyr Roberts from Cardigf
Excellent food, very friendly and accommodating staff.
((((( 19 February 2016 by Mayya Bondarevskaya from London
Booked last minute for a large group and the staff was very accommodating. Fantastic service, very friendly staff, awesome food. Could not have chosen a better place to eat out!
((((( 29 November 2015 by Aaron Bevan from Newquay
Giot a warm welcoming on arrival.. Waiting staff were friendly and very helpful and knowledgeable. Food was great. Good value and lots of it. Would definitely recommend this place to friends visiting Central London
((((( 25 September 2014 by Eileen Bennett from Cambridge
I find most menus at Indian restaurants serve similar dishes. This one is different. Some very interesting dishes available. Staff polite and attentive.
((((( 23 May 2012 by limping lloyd from london
First business lunch time at The Empress in leman street started with their mixed starter which consisted of lamb chop garlic prawnand a to die for chicken ?????////?(i cannot remember the name) mains was just too good nan bread was light and fresh restaurant was very full but calm, service was top class very friendly and to top it off........ bill was much loweer than expected for the quality of food and level of service offered, will probably make it my weekly spot
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Discount Factory Direct Blinds | Delta Blinds - Awnings & Shutters Sydney
Shutters, Discount Factory Direct Blinds, Awnings Sales & Installation, Canvas Awnings, Factory Price Shutters, Blind Cleaning Inner West Sydney | Parramatta | Sutherland | Blacktown | Hornsby | Kellyville
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Delta Blinds | Discount Factory Direct Blinds, Awnings, Roller Shutters Sydney | Inner West | Parramatta
Delta Blinds Sydney service throughout the Parramatta region and Western Suburbs including Kellyville, Blacktown, Castle Hill, Quakers Hill and down through to Liverpool.
Delta Blinds also provide blind and awning sales and installation throughout the North Shore, Hornsby and Chatswood areas.
Ultrasonic Blind Cleaning & Repairs Parramatta
Delta Blinds are a family run business and are well known throughout Sydney for their outstanding service and great prices.
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Why pay full retail price when you can get pay wholesale?
With Delta Blinds you receive discount factory direct blinds delivered and installed throughout Sydney.
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Elta Welch on 12th May 2012
Andrew Peterson on 30th May 2011
Mark Berlage on 7th May 2011
Australian Awning Systems
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Accent Blinds
"Ths short version is they took around 2 months
3 appointment times to come do the job, made me take time off work for no reason, the 3rd time they did it on 7.30pm!! Complained and nothing, do yourself a favour and dont come here, you'll definately get a unwanted headache dealing with these people
Blind Cleaning Illawarra
"Am very satisfied with the cleaning of my vertical blinds. It had been years since they had been cleaned and was totally surprised on how clean they came out.
Also had a few small repairs done. The service was friendly at the same time professional.
Won't hesitate on using Smart Blinds again"
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Blind Cleaning Illawarra
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Inspired Window Coverings
"My experience with Inspired Window coverings was so good. The staff members were knowledgeable at their work. They have good products with different types of varieties of product. I would highly recommend Inspired Window Coverings for anyone those who are looking for good coverings."
Blinds Bentleigh East
"Unbeatable service. "
Cost Less Decor Blinds
"Great local family owned company to do business with very friendly staff who go out of there way to ensure you are 100% Happy every step of the way, and no pressure which is something I love. I placed an order and 3 weeks later my blinds were professionally installed giving my home a new modern look .
Sydney Blinds & Screens
"I visited the showroom as I was bit nervous about spending a large amount of money online without seeing quality - no pushy sales person, good range, great quality. Just spent less for an entire house (5 large windows), with free measurement for a no worry fits and free installation! A much better option for me."
Sydney Blinds & Screens
"I recently bought my roller blinds and timber Venetians from this company. I received them very promptly and found them easy to install and very good quality. I will be happy to recommend Sydney Blinds to all my friends. I am extremely satisfied. Thank you"
Sydney Blinds & Screens
"Price was great and shutters were great. They came very well packaged and a few days early. I ordered cafe style shutters, the process from ordering on the phone through quoting and installation was smooth, they even offered their help in fixing the loose wood outside! They are an eye catching feature. I have recommended you company to friends"
Sydney Blinds & Screens
"These guys were fantastic! We have a very old period home with bay windows. Both windows were not square, as is the case in most older homes. We had several quotes, but Sydney Blinds were the only ones who came up with a good solution to deal with this issue, and their price was very reasonable too. The shutters were installed without a fuss and no mess. We love our new shutters, surely would recommend this company to my friends."
Sydney Blinds & Screens
"Good service, exceptional workmanship and speedy installation! Sydney blinds and screens went meet my expectations, they were able to work within our budget and time schedule. Once the blinds were ordered the overall time to get the custom cut blinds was very good. Their pricing is very competitive and the blinds are of good quality. I would highly recommend their services... AWESOME WORK! "
Accent Blinds
"Accent Blinds gave me A1 service! Staff were friendly and professional. I find their blind products excellent too. It might be affordable, but materials used are not cheap either. Probably the most solid looking product I looked at when doing my research from store to store, till I made up my mind."
Accent Blinds
"Accent Blinds product and service is something you will never regret having. I know that because I just bought my Awnings before at Accent, and I am very much impressed with their product and service."
"I am also not happy with the service Blindfast provided me. I had shutters put in by Blindfast and the siliconing which they did around the shutters to block gaps is very botchy and not smoothed out as it should be. This spoils the appearance of the shutters. I do not recommend Blindfast."
Accent Blinds
Cost Less Decor Blinds
"I was looking to furnish my windows cost effective .
I wanted my home to look good but didn't want to spend too much what I had installed was very modern roller blinds chain operated they look so nice.
I'm so impressed with the service I was given and that personal touch I would recommend cost less decor blinds to all interested in window furnishings they are so professional and they offer a no fuss 5 year guarantee."
Accent Blinds
"My life changed the moment I went to visit Accent Blinds at Penrith. I fell in love with Accent Blinds product. You can definitely instantly see the quality of the materials they use on their product. I never had doubts buying their products. Despite the two week waiting for the product delivery, I was still impressed with their service. Installers were trained well for their job. I'm really glad I decided to buy at Accent Blinds."
Frank Smith on 17th Sep 2016
Elizabeth Wilson on 30th Dec 2015
Joanne on 8th Apr 2015
Diane Fitton on 8th Nov 2014
Joel T on 11th Sep 2014
Rob on 4th Sep 2014
Genie Falkender on 10th Mar 2014
Kim P on 6th Mar 2014
Dawn Reid on 3rd Feb 2014
jo johnson on 23rd Jan 2014
Caron Jean on 4th Dec 2013
John Paterno on 18th Jul 2013
Bob on 18th May 2013
Annie Walter on 2nd May 2013
Sammy Jones on 2nd Apr 2013
Maria Messiter on 25th Mar 2013
Marg1301 White on 24th Mar 2013
James Aux on 1st Feb 2013
Janine Motherwell on 22nd Dec 2012
Harold McCardell on 16th Dec 2012
Pam on 3rd Dec 2012
Eugene Moon on 22nd Nov 2012
Teresa Whiteboard on 21st Nov 2012
Duncan Lessall on 20th Nov 2012


text:
Town Square
Police arrest caretaker for the elderly suspected of defrauding her clients
Original post made on Feb 13, 2012
Read the full story here Web Link posted Monday, February 13, 2012, 12:15 PM
Comments (1)
a resident of Danville
on Feb 13, 2012 at 2:33 pm
What a couple of low-life pieces of excrement. Thank you for publishing their names that society may be forewarned.
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The state water board missed the mark
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