Validation and Generalizability of Preoperative PROMIS Scores to Predict Postoperative Success in Foot and Ankle Patients

Background: A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically unique patient population. Methods: Prospective PROMIS PF and PI scores of consecutive patient visits to a tertiary foot and ankle clinic were obtained between January 2014 and November 2016. Patients undergoing elective foot and ankle surgery were identified and PROMIS values obtained at initial and follow-up visits (average, 7.9 months). Analysis of variance was used to assess differences in PROMIS scores before and after surgery. The distributive method was used to estimate a minimal clinically important difference (MCID). Receiver operating characteristic curve analysis was used to determine thresholds for achieving and failing to achieve MCID. To assess the validity and generalizability of these threshold values, they were compared with previously published threshold values for accuracy using likelihood ratios and pre- and posttest probabilities, and the percentages of patients identified as achieving and failing to achieve MCID were evaluated using χ2 analysis. Results: There were significant improvements in PF ( P < .001) and PI ( P < .001) after surgery. The area under the curve for PF (0.77) was significant ( P < .01), and the thresholds for achieving MCID and not achieving MCID were similar to those in the prior study. A significant proportion of patients (88.9%) identified as not likely to achieve MCID failed to achieve MCID ( P = .03). A significant proportion of patients (84.2%) identified as likely to achieve MCID did achieve MCID ( P < .01). The area under the curve for PROMIS PI was not significant. Conclusions: PROMIS PF threshold scores from published data were successful in classifying patients from a different patient and geographic population who would improve with surgery. If functional improvement is the goal, these thresholds could be used to help identify patients who will benefit from surgery and, most important, those who will not, adding value to foot and ankle health care. Level of evidence: Level II, Prospective Comparative Study

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Normative Values for Commonly Reported Outcome Measures in the Foot and Ankle

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00011 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0001 ◽

Cited By ~ 5

Author(s):

Lauren Matheny ◽

Thomas Clanton ◽

Kevin Gittner ◽

Justin Harding

Keyword(s):

Outcome Measures ◽

Normal Population ◽

The United States ◽

Functional Improvement ◽

Normative Values ◽

Activity Levels ◽

Foot And Ankle ◽

Ankle Surgery ◽

Significant Difference ◽

Patient Reported

Category: Ankle Introduction/Purpose: There has been increased attention regarding normative values for patient reported outcomes. Differences in population demographics and factors such as previous surgery, could influence functional improvement, obfuscating generalizability among previous studies. To determine realistic patient outcomes, it is important to establish normative values for commonly reported foot and ankle outcome measures, while accounting for population effects. The primary purpose of this study was to determine normative values for the Foot and Ankle Ability Measure(FAAM) Activities of Daily Living(ADL) subscale, FAAM Sport subscale, Tegner activity scale, and SF-12 Physical Component Summary(PCS) and Mental Component Summary(MCS), in individuals who are representative of the “normal” adult population in the United States(US). Methods: This study was approved by an institutional review board. The target population was adults, >18 years old, in the “normal” population. Normal was defined as previously done by AAOS, which is the random sample of individuals from the general US population. Individuals were only excluded if younger than 18 years old. There were 271 people in this study (101 females, 170 males) with an average age of 31.4 (SD=15.1; range 18–77) years. Average BMI was 25.9 (SD=5.9; range 16.5–44.9). The questionnaire included demographics: age, sex and BMI and outcome measures: FAAM ADL, FAAM Sport, Tegner and SF-12 PCS and MCS. Mean outcome scores were determined for each cohort and tested for differences in each variable of interest using analysis of variance (ANOVA) and independent t-tests. Results: The average FAAM ADL was 92.3 (SD=12.3; range 32.1–100.0). The average FAAM Sport was 85.1 (SD=20.2; range 0.0– 100.0). The average SF-12 PCS was 48.6 (SD=8.2; range 20.2–64.1). The average SF-12 MCS was 47.6 (SD=11.0; range 17.2–65.1). Median Tegner was 4 (SD=2.1; range 0–10). There was no significant difference in FAAM ADL between females and males(P=.256) or FAAM Sport(P=.050). Females had significantly higher SF-12 PCS(P=.001). Males had significantly higher SF-12 MCS(P<.001) and Tegner(P=.024). FAAM ADL, FAAM Sport and SF-12 PCS scores were significantly higher in people who did not have previous ankle surgery. Younger people with lower BMI values tended to have significantly higher ankle function. Conclusion: Normative values of foot and ankle outcome measures differed by sex, previous ankle surgery, age and BMI. Younger individuals, with lower BMI, with no previous ankle surgery, had higher functional and activity levels. Males had significantly higher activity levels and mental health. Females had significantly greater general health. Average outcomes in the normal population did not reflect 100% for each score, but rather somewhat less. This information is valuable for patient expectations counseling. With normative data serving as a reference, physicians can assess whether baseline measurements differ from population norms, and whether patients have returned to “normal” levels following treatment.

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POS0128 PHYSICIAN AND PATIENT PERCEPTIONS OF SURGICAL PROCEDURES FOR KNEE OA ACROSS JAPAN, THE US AND 5 EU COUNTRIES: RESULTS OF A REAL-WORLD STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2510 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 275.2-276

Author(s):

N. Fukui ◽

P. G. Conaghan ◽

K. Togo ◽

N. Ebata ◽

L. Abraham ◽

...

Keyword(s):

Surgical Procedures ◽

Primary Care Physicians ◽

Total Joint Replacement ◽

Functional Improvement ◽

Published Data ◽

Knee Oa ◽

Obesity And Diabetes ◽

Patient Reported ◽

The Us ◽

Effective Option

Background:Patients with knee osteoarthritis (OA) who do not achieve adequate pain relief and functional improvement with a combination of non-pharmacologic and pharmacologic therapies are recommended an arthroplasty as an effective option to relieve severe pain and functional limitations. However, some patients are reluctant to undergo surgical interventions, and clinicians may choose to avoid or delay surgery due to safety risks and/or the financial cost. It is of interest to understand if the use and perception of surgery differs between countries, however, few published data exist.Objectives:To demonstrate how surgery and the use of surgical procedures differs across Japan, United States of America (US) and 5 major European countries (EU5) and to evaluate patient perception towards surgery.Methods:Data were drawn from the Adelphi OA Disease Specific Programme (2017-18), a point-in-time survey of primary care physicians (PCP), rheumatologists (rheums), orthopaedic surgeons (orthos) and their OA patients. Patients with physician-diagnosed knee OA were included and segmented into two categories: had previous surgery (PS) and never had surgery (NS). A Fisher’s exact test was performed on the two groups. Physicians reported on patient demographics; whether patients had undergone surgery; type of surgery; success of surgery; how success was defined; and reasons for wanting to delay surgery. Patients reported their willingness to undergo surgery; reasons for not wanting surgery; how successful their surgery was; and how they defined this success.Results:Physician/patient reported data were available for 302,230 (Japan), 527,283 (US) and 1487,726 (EU5) patients with diagnosed knee OA. Patients were categorised by their physicians as mild (40% Japan; 34% US; 24% EU5), moderate (49% Japan; 49% US; 56% EU5) or severe (9% Japan; 17% US; 19% EU5). Patients in Japan were more likely to be female (78% vs 54% US; 58% EU5), older (73 vs 65 US; 66 EU5) and have a lower BMI than patients in the US and EU5. Obesity and diabetes were much less prevalent among patients in Japan. One in ten patients in Japan had undergone a surgery (10%), far fewer than in the US (22%) or EU5 (17%). When surgery was performed, this was more likely to be a total joint replacement (TJR) in Japan, whereas in the EU and US, arthroscopic washout was more commonly performed.For over half of Japanese patients (56%), successful surgery was more likely to be defined as having no more pain (vs. 35% US; 14% EU5). Improved mobility and a reduction in pain were also commonly reported reasons. Physicians (in each region) were more likely to suggest pain reduction, rather than no pain, and improved mobility as markers of success. Patients in Japan were much more likely to say they would not agree to surgery if recommended by their doctor, or were unsure (84% vs. 68% US; 62% EU5). The main reason for patient reluctance in Japan was fear of surgery, whereas in the US and EU5 the main reason given was that surgery was not needed. This finding was also evident among physicians in Japan, who frequently reported that patient reluctance was a key reason for delaying surgery. Physicians in Japan, do however, report that patient request was one of their main triggers for recommending surgery (45% vs 20% US; 16% EU5).Conclusion:Although surgery can be an effective option for those with OA who have exhausted other treatment options, some patients are reluctant to undergo surgery out of fear, especially in Japan, possibly due to the higher patient age. Physicians aiming to delay surgery were driven by patient reluctance in Japan, whereas cost to patient was a bigger factor in the US and EU5. The higher level of TJR vs. other surgery options among patients in Japan may suggest physicians are looking for higher levels of efficacy.Disclosure of Interests:Naoshi Fukui Speakers bureau: Pfizer, Consultant of: Pfizer, Philip G Conaghan Speakers bureau: Abbvie, Novartis, Consultant of: AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer, Kanae Togo Shareholder of: Pfizer, Employee of: Pfizer, Nozomi Ebata Shareholder of: Pfizer, Employee of: Pfizer, Lucy Abraham Shareholder of: Pfizer, Employee of: Pfizer, James Jackson: None declared, Jessica Jackson: None declared, Mia Berry: None declared, Hemant Pandit Paid instructor for: Bristol Myers Squibb, Consultant of: Johnson and Johnson, Grant/research support from: GSK

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Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

Foot and Ankle Surgery ◽

10.1016/j.fas.2020.02.003 ◽

2021 ◽

Vol 27 (1) ◽

pp. 52-59 ◽

Cited By ~ 1

Author(s):

Mikko M. Uimonen ◽

Ville T. Ponkilainen ◽

Alar Toom ◽

Mikko Miettinen ◽

Arja H. Häkkinen ◽

...

Keyword(s):

Patient Reported Outcome ◽

Foot And Ankle ◽

Ankle Surgery ◽

Patient Reported

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Role of Patient-Reported Outcome Measures on Predicting Outcome of Bunion Surgery

Foot & Ankle International ◽

10.1177/1071100719886286 ◽

2019 ◽

Vol 41 (2) ◽

pp. 133-139 ◽

Cited By ~ 4

Author(s):

Ashlee MacDonald ◽

Jeff Houck ◽

Judith F. Baumhauer

Keyword(s):

Likelihood Ratio ◽

Area Under The Curve ◽

Roc Curves ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Measurement Information ◽

Level Of Evidence ◽

Meaningful Improvement ◽

Patient Reported ◽

Threshold Score

Background: Prior studies have suggested preoperative patient-reported outcome scores could predict patients who would achieve a clinically meaningful improvement with hallux valgus surgery. Our goal was to determine bunionectomy-specific thresholds using Patient-Reported Outcomes Measurement Information System (PROMIS) values to predict patients who would or would not benefit from bunion surgery. Methods: PROMIS physical function (PF), pain interference (PI), and depression assessments were prospectively collected. Forty-two patients were included in the study. Using preoperative and final follow-up visit scores, minimally clinically important differences (MCID), receiver operating characteristic (ROC) curves, and area under the curve (AUC) analyses were performed to determine if preoperative PROMIS scores predicted achieving MCID with 95% specificity or failing to achieve an MCID with 95% sensitivity. Results: PROMIS PF demonstrated a significant AUC and likelihood ratio. The preoperative threshold score for failing to achieve MCID for PF was 49.6 with 95% sensitivity. The likelihood ratio was 0.14 (confidence interval, 0.02-0.94). The posttest probability of failure to achieve an MCID for PF was 94.1%. PI and depression AUCs were not significant, and thus thresholds were not determined. Conclusion: We identified a PF threshold of 49.6, which was nearly 1 standard deviation higher than previously published. If a patient is hoping to improve PF, a patient with a preoperative t score >49.6 may not benefit from surgery. This study also suggests the need for additional research to delineate procedure-specific thresholds. Level of Evidence: Level III, retrospective comparative series.

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Association Between Baseline PROMIS Scores, Patient-Provider Communication Factors, and Musculoskeletal Health Literacy on Patient and Surgeon Expectations in Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100720959017 ◽

2020 ◽

pp. 107110072095901

Author(s):

Aoife MacMahon ◽

Elizabeth A. Cody ◽

Kristin Caolo ◽

Jensen K. Henry ◽

Mark C. Drakos ◽

...

Keyword(s):

Health Literacy ◽

Pain Intensity ◽

Physical Function ◽

Mental Status ◽

Patient Perceptions ◽

Pain Interference ◽

Foot And Ankle ◽

Musculoskeletal Health ◽

Ankle Surgery ◽

Patient Reported

Background: Various factors may affect differences between patient and surgeon expectations. This study aimed to assess associations between patient-reported physical and mental status, patient-surgeon communication, and musculoskeletal health literacy with differences in patient and surgeon expectations of foot and ankle surgery. Methods: Two hundred two patients scheduled to undergo foot or ankle surgery at an academic hospital were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed Patient-Reported Outcomes Measurement Information System (PROMIS) scores in Physical Function, Pain Interference, Pain Intensity, Depression, and Global Health. Patient-surgeon communication and musculoskeletal health literacy were assessed via the modified Patients’ Perceived Involvement in Care Scale (PICS) and Literacy in Musculoskeletal Problems (LiMP) questionnaire, respectively. Results: Greater differences in patient and surgeon overall expectations scores were associated with worse scores in Physical Function ( P = .003), Pain Interference ( P = .001), Pain Intensity ( P = .009), Global Physical Health ( P < .001), and Depression ( P = .009). A greater difference in the number of expectations between patients and surgeons was associated with all of the above ( P ≤ .003) and with worse Global Mental Health ( P = .003). Patient perceptions of higher surgeons’ partnership building were associated with a greater number of patient than surgeon expectations ( P = .017). There were no associations found between musculoskeletal health literacy and differences in expectations. Conclusion: Worse baseline patient physical and mental status and higher patient perceptions of provider partnership building were associated with higher patient than surgeon expectations. It may be beneficial for surgeons to set more realistic expectations with patients who have greater disability and in those whom they have stronger partnerships with. Further studies are warranted to understand how modifications in patient and surgeon interactions and patient health literacy affect agreement in expectations of foot and ankle surgery. Level of Evidence: Level II, prospective comparative series.

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Determining Success or Failure After Foot and Ankle Surgery Using Patient Acceptable Symptom State (PASS) and Patient Reported Outcome Information System (PROMIS)

Foot & Ankle International ◽

10.1177/1071100718769666 ◽

2018 ◽

Vol 39 (8) ◽

pp. 894-902 ◽

Cited By ~ 15

Author(s):

Michael R. Anderson ◽

Judith F. Baumhauer ◽

Benedict F. DiGiovanni ◽

Sam Flemister ◽

John P. Ketz ◽

...

Keyword(s):

Patient Outcome ◽

Patient Outcomes ◽

Roc Analysis ◽

Patient Reported Outcome ◽

Foot And Ankle ◽

Chi Square ◽

Ankle Surgery ◽

Patient Reported ◽

Patient Acceptable Symptom State ◽

Chi Square Analysis

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery. Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = 88). Patient outcome as determined by phone interviews included PASS and patients’ judgment of whether their surgery was a S/F. Assessment also included PROMIS physical function (PF), pain interference (PI), and depression (D) scales. The association between S/F and PASS outcomes was evaluated by chi-square analysis. A 2-way analysis of variance (ANOVA) evaluated the ability of PROMIS to discriminate PASS and/or S/F outcomes. Receiver operator curve (ROC) analysis was used to evaluate the ability of pre- (n = 63) and postoperative (n = 88) PROMIS scores to predict patient outcomes (S/F and PASS). Finally, the proportion of individuals classified by the identified thresholds were evaluated using chi-square analysis. Results: There was a strong association between PASS and S/F after surgery (chi-square <0.01). Two-way ANOVA demonstrated that PROMIS t scores discriminate whether patients experienced positive or negative outcome for PASS ( P < .001) and S/F ( P < .001). The ROC analysis showed significant accuracy (area under the curve > 0.7) for postoperative but not preoperative PROMIS t scores in determining patient outcome for both PASS and S/F. The proportion of patients classified by applying the ROC analysis thresholds using PROMIS varied from 43.0% to 58.8 % for PASS and S/F. Conclusions: Patients who found their symptoms and activity at a satisfactory level (ie, PASS yes) also considered their surgery a success. However, patients who did not consider their symptoms and activity at a satisfactory level did not consistently consider their surgery a failure. PROMIS t scores for physical function and pain demonstrated the ability to discriminate and accurately predict patient outcome after foot and ankle surgery for 43.0% to 58.8% of participants. These data improve the clinical utility of PROMIS scales by suggesting thresholds for positive and negative patient outcomes independent of other factors. Level of Evidence: II, prospective comparative series.

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Current Trends in Thromboprophylaxis in Surgery of the Foot and Ankle

Foot & Ankle International ◽

10.3113/fai.2007.1069 ◽

2007 ◽

Vol 28 (10) ◽

pp. 1069-1073 ◽

Cited By ~ 25

Author(s):

Aniruth Gadgil ◽

Rhys H. Thomas

Keyword(s):

Best Practice ◽

Significant Proportion ◽

Foot And Ankle ◽

Thromboembolic Prophylaxis ◽

Current Trends ◽

Published Evidence ◽

Ankle Surgery ◽

Hip And Knee Arthroplasty ◽

Wide Variability ◽

Common Situation

Background: Few studies exist to guide the best practice in thromboprophylaxis after foot and ankle surgery. A survey of foot and ankle surgeons was performed to assess current trends in thromboprophylaxis. Methods: An email-based survey of American and British foot and ankle surgeons was conducted. Surgeons were questioned as to their use and type(s) of thromboprophylaxis as well as reasons for not using prophylaxis. Surgeons also were asked about their use of thromboprophylaxis in hip and knee arthroplasty, if they did these surgeries. Results: Nearly one-fifth (19%, 27) of surgeons routinely used thromboprophylaxis in both elective and trauma foot and ankle surgery. The most common situation for use was in a postoperative patient who was immobilized and nonweightbearing. A lack of published evidence and a low rate of thromboembolism were the most commonly cited reasons for not using thromboprophylaxis. Conclusions: This survey showed a wide variability in thromboembolic prophylaxis. It suggests that despite the literature indicating to the contrary, a significant proportion of foot and ankle surgeons routinely use thromboprophylaxis. Confusion remains regarding the appropriateness of thromboprophylaxis and what type(s)(if any) should be used. This study has identified a need for more in-depth evaluation of the importance of, and possible prophylaxis against, thromboembolic problems after foot and ankle surgery.

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Preoperative and Postoperative PROMIS and FFI Scores Based on Region of Foot Pathology and Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00389 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0038

Author(s):

Charles C. Pitts ◽

Bradley Alexander ◽

Elise M. Greco ◽

Benjamin B. Cage ◽

Spaulding F. Solar ◽

...

Keyword(s):

Physical Function ◽

Surgical Intervention ◽

Activity Limitation ◽

Foot And Ankle ◽

Tertiary Referral Center ◽

Pain Disability ◽

Ankle Surgery ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) has become increasingly utilized in orthopaedic foot and ankle surgery to assess outcomes and better understand patient function, pain, and disability. Similarly, the Foot Function Index (FFI) is used to assess pain, disability, and activity limitation. PROMIS scores have been shown to predict, preoperatively, which patients will benefit most from foot and ankle surgery from a general perspective. It is currently unknown, with regard to chronic foot pathology, which region of the foot has the greatest effect on PROMIS and FFI scores and which region is affected the most by surgical intervention. Methods: PROMIS physical function, pain index, and depression scores along with FFI scoring subsets of pain, disability, and activity limitation were retrospectively reviewed for patients at a tertiary referral center with chronic pathology in either the hindfoot, midfoot, or forefoot that underwent surgery. Scores were obtained preoperatively and at 6 weeks postoperatively, and a preoperative to postoperative difference was calculated. Once the mean of each subcategory was obtained, an analysis of variance (ANOVA) was conducted in order to compare the means and identify statistically significant differences. Significance was set at p < 0.05 and p < 0.10. Results: There was no statistically significant difference between the mean preoperative PROMIS or FFI scores in the forefoot, midfoot, or hindfoot regions. There was also no statistically significant difference between means of PROMIS or FFI categories at 6 weeks postoperatively. However, the mean pre- to postoperative differences between PROMIS physical function scores of the forefoot, midfoot, and hindfoot were statistically significantly different at 9.12, 8.16, and 2.88, respectively (p=0.037). There was no statistically significant difference between the remaining scoring categories. Conclusion: Physical function, pain, depression, disability, and activity limitation are not affected disparately by the location of chronic pathology within the foot. Surgical intervention for problems in the forefoot, midfoot, and hindfoot does not provide differences in outcomes with regard to pain, disability, depression, or activity limitation based on region. Patients who have undergone surgical intervention for forefoot or midfoot pathology may experience greater improvements in physical function postoperatively when compared to patients who have undergone hindfoot surgery. [Table: see text]

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Evaluating Patients for Elective Outpatient Foot and Ankle Surgery: Insurance as a Predictor of Patient Outcomes

Foot & Ankle Specialist ◽

10.1177/1938640018823070 ◽

2019 ◽

Vol 12 (6) ◽

pp. 522-529

Author(s):

Wajeeh Bakhsh ◽

Sean Childs ◽

Irvin Oh ◽

Sam Flemister ◽

Judy Baumhauer ◽

...

Keyword(s):

Patient Selection ◽

Patient Reported Outcomes ◽

Elective Surgery ◽

Pain Patient ◽

Trauma Patients ◽

Foot And Ankle ◽

Missed Appointments ◽

Ankle Surgery ◽

Patient Reported

Background. Elective surgical procedures necessitate careful patient selection. Insurance level has been associated with postoperative outcomes in trauma patients. This study evaluates the relationship insurance level has with outcomes from elective foot and ankle surgery. Methods. Retrospective chart review was performed on patients who underwent elective surgery at a single center with 1-year follow-up. Patients were classified by insurance: under-/uninsured (Medicaid, Option plans) versus fully insured. Outcomes included narcotic refills, patient-reported outcomes (PROMIS) of pain, function, and mood, and compliance with follow-up visits. Statistical analysis involved mean comparison and multivariate regression modeling, with significance P < .05. Results. Cohort groups included 220 insured and 47 under-/uninsured. Outcomes between the insured and under-/uninsured groups differed significantly in narcotic refills (0.72 vs 1.74 respectively, P < .01), missed appointments (0.13 vs 0.62, P < .01), and PROMIS results (pain 54.5 vs 60.2; function 44.3 vs 39.5; mood 44.6 vs 51.3; P < .01). The change in PROMIS scores from preoperative to 1-year postoperative were different in pain (−7.3 vs −2.5, P = .03) and function (+6.3 vs +1.3, P = .04). Regression results confirm insurance as a significant factor (coefficient 0.27, P < .01). Conclusion. These results establish that under-/uninsured patients have worse pain, patient-reported outcomes, and functional outcomes after elective foot and ankle surgery, which may inform patient selection. Levels of Evidence: Level III: Retrospective cohort study

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Prevalence and Safety of Left-Footed Driving Following Right Foot Surgery Patients Including a Driving Simulation

Foot & Ankle International ◽

10.1177/1071100719839701 ◽

2019 ◽

Vol 40 (7) ◽

pp. 818-825 ◽

Cited By ~ 1

Author(s):

Haley M. McKissack ◽

Yvonne E. Chodaba ◽

Tyler R. Bell ◽

Eva J. Lehtonen ◽

Ibukunoluwa B. Araoye ◽

...

Keyword(s):

Driving Simulator ◽

Recovery Period ◽

Significant Proportion ◽

Case Series ◽

Postoperative Recovery ◽

Foot And Ankle ◽

Foot Surgery ◽

Level Of Evidence ◽

Ankle Surgery ◽

The Right

Background: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study was to describe the driving habits of patients after right-sided foot surgery and assess the safety of left-footed driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via a REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 volunteer subjects to compare characteristics of left- versus right-footed driving. Results: Thirty-six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left-footed driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more ( P < .001) and hit other vehicles more ( P < .026) when driving with the right foot than the left. The time to fully brake and fully release the throttle in response to vehicular hazards was significantly prolonged in left-footed driving compared with right ( P = .019 and P = .034, respectively). Conclusion: A significant proportion of right foot ankle surgery patients engaged in left-footed driving during postoperative recovery. Driving with both the right and left foot presents a risk of compromised safety. This study provides novel objective data regarding the potential risks of unipedal left-footed driving using a standard right-footed console, which indicates that driving with the left foot may prolong brake and throttle release times. Further studies are warranted for physicians to be able to appropriately advise patients about driving after foot and ankle surgery. Level of Evidence: Level IV, case series.

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