Minimally Important Difference in the Foot and Ankle Outcome Score Among Patients Undergoing Hallux Valgus Surgery

2019 ◽  
Vol 40 (6) ◽  
pp. 694-701 ◽  
Author(s):  
Sameer Desai ◽  
Alexander C. Peterson ◽  
Kevin Wing ◽  
Alastair Younger ◽  
Trafford Crump ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Hallux Valgus ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Minimally Important Difference ◽  
Foot And Ankle ◽  
Outcome Score ◽  
Patient Reported ◽  
Bunion Correction ◽  
Correction Surgery

Background: Patient-reported outcomes are increasingly used as measures of effectiveness of interventions. To make the tools more useful, therapeutic thresholds known as minimally important differences have been developed. The objective of this study was to calculate minimally important differences for the domains of the Foot and Ankle Outcome Score for hallux valgus surgery. Methods: The study was based on a retrospective analysis of patients newly scheduled for bunion correction surgery and completing patient-reported outcomes between October 2013 and January 2018. This study used anchor- and distribution-based approaches to calculate the minimally important difference for the instrument’s 5 domains. Confidence intervals were calculated for each approach. There were 91 participants included in the study. Results: Using anchor- and distribution-based approaches, the minimally important difference for the pain domain ranged from 5.8 to 10.2, from 0.3 to 6.9 for the symptoms domain, 8.3 to 10.3 for the activities of daily living domain, 7.4 to 11.1 for the quality of life domain, and from 7.0 to 15.7 for the sports and recreation domain. Small differences in the activities of daily living domain may be more clinically important for patients with better function. Discussion: The range of minimally important difference values for each domain indicate how the Foot and Ankle Outcome Score corresponded to bunion correction surgery. The sports and recreation domain showed considerable variability in the range of values and may be associated with the domain’s lack of responsiveness. Overall, most minimally important difference values for the domains of FAOS ranged from above 4 to below 16. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Delayed access to bunion correction surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0051
Author(s):  
Kevin Wing ◽  
Jason Sutherland ◽  
Alastair Younger ◽  
Andrea Veljkovic ◽  
Trafford crump ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Patient Reported Outcomes ◽  
Economic Status ◽  
Corrective Osteotomy ◽  
Wait Time ◽  
Foot And Ankle ◽  
Linear Regression Models ◽  
Patient Reported ◽  
Bunion Correction ◽  
Correction Surgery

Category: Bunion Introduction/Purpose: Little is known about the effect of delayed access to bunion correction (Hallux Valgus) surgery on patient-reported outcomes. The objective of this study is to measure the association between delayed access to bunion correction surgery and post-operative patient-reported outcomes. Methods: This study prospectively recruited patients to complete pre-operative patient-reported outcomes measuring pain, depression and foot and ankle health. Patients complete the same patient-reported outcomes six months post-operatively. Linear regression models measured outcomes, adjusting for baseline health, age category, sex, comorbidities and socio-economic status. Results: This study included 74 participants, a response rate of 53% among eligible patients. Among participants, 58.9% underwent a Lapidus procedure, the remainder underwent a corrective osteotomy. There was no relationship between post-operative depression and pain scores with duration of wait time, adjusting for patient characteristics. Longer waits for bunion correction surgery, adjusting for other factors, were associated with smaller gains in health in four of the five domains of measurement of foot and ankle health. Conclusion: At the six-month post-operative time point, prolonged wait times were detrimental to foot and ankle outcomes in four of the five domains of the foot and ankle specific PRO. Policies for expediting access for symptomatic hallux valgus are warranted to mitigate poorer long-term outcomes.

Relationship of Duration of Wait for Surgery and Postoperative Patient-Reported Outcomes for Hallux Valgus Surgery

2018 ◽  
Vol 40 (3) ◽  
pp. 259-267 ◽  
Author(s):  
Jason M. Sutherland ◽  
Kevin Wing ◽  
Alastair Younger ◽  
Murray Penner ◽  
Andrea Veljkovic ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Patient Reported Outcomes ◽  
Wait Time ◽  
Patient Characteristics ◽  
Foot And Ankle ◽  
Postoperative Patient ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Bunion Correction ◽  
Correction Surgery

Background: Little is known about the effect of delayed access to bunion correction (hallux valgus) surgery on patient-reported outcomes. The objective of this study was to measure the association between preoperative wait time for bunion correction surgery and postoperative patient-reported outcomes. Methods: This study prospectively recruited patients to complete preoperative patient-reported outcomes measuring depression, pain, and foot and ankle health, including the Patient Health Questionnaire–9 (PHQ-9); the pain intensity (P), interference with enjoyment (E) of life and general (G) instrument (ie, PEG); and the Foot and Ankle Outcome Score (FAOS), a condition-specific instrument. Patients complete the same patient-reported outcomes 6 months postoperatively. Regression models measured patient-reported outcomes as a function of wait time, adjusting for baseline health, age category, sex, comorbidities, and socioeconomic status. This study included 87 participants, a response rate of 53% among eligible patients. Results: Longer waits for bunion correction surgery, adjusting for other factors, were associated with smaller gains in health in 4 of the 5 domains of the FAOS. There was no relationship between postoperative depression and pain scores with duration of wait time, adjusting for patient characteristics. Conclusion: At the 6-month postoperative time point, prolonged preoperative wait times were detrimental to foot and ankle outcomes in 4 of the 5 domains of the foot and ankle–specific PRO. Policies for expediting access for symptomatic hallux valgus are warranted to mitigate poorer postoperative outcomes. Further study is required to understand if failure to improve is a permanent finding in the postoperative period. Level of Evidence: Level II, prospective comparative study.

scholarly journals Prospective Randomized Comparison of Capsule Management Techniques During Hip Arthroscopy

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0020 ◽  
Author(s):  
Kostas John Economopoulos ◽  
Christopher Y. Kweon
Keyword(s):  
Activities Of Daily Living ◽  
Hip Arthroscopy ◽  
Daily Living ◽  
Alpha Angle ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Patient Reported ◽  
Management Techniques

Objectives: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. The purpose of this study was to perform a prospective randomized trial to comparatively assess three commonly performed capsule management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes compared to non-closing capsulotomy management techniques. Methods: Patients undergoing hip arthroscopy were randomly assigned into three groups at the time of surgery: 1) T-capsulotomy without closure (TC), 2) interportal capsulotomy without closure (IC), and 3) interportal capsulotomy with closure (CC). Inclusion criteria included patients with labral tear on advanced imaging, cam lesion with alpha angle greater than 55 degrees, center-edge angle less than 40 degrees, and Tönnis grade 0 or 1. Patients younger than 18, older than 55, or those with signs of clinical hip hypermobility or radiographic dysplasia were excluded from the trial. All patients underwent labral repair and femoral osteoplasty. Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) was obtained preoperatively and at intervals up to 2 years. Other outcomes obtained included need for future hip surgery. Results: 50 patients were randomly allocated into each group. Patient demographics, preoperative patient-reported outcomes (PROs) and radiographic measures of impingement were similar between all three groups. Revision hip arthroscopy was performed in 5 TC patients, 2 IC patients and 0 CC patients (p=0.17). Conversion to hip arthroplasty occurred in 4 patients in the TC group, none in the IC or CC groups (p=0.48). All three groups showed increased PRO scores postoperatively compared to preoperative values (p<0.01). The CC group when compared to the TC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (74.4 vs 65.3) at the final 2 year follow up (p<0.001). The IC group demonstrated more modest improvements in outcomes compared to the TC group. The CC group showed greater improvement in HOS-SSS compared to the IC group at early follow up (65.6 vs 55.1, p>.001) that was not maintained at 2 years (74.4 vs 71.4, p=.28). Conclusion: Patients undergoing capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes compared to those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsule management technique, especially in respect to optimizing postoperative activities of daily living.

scholarly journals Assessment of patient-reported outcomes after polytrauma: protocol for a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017571 ◽  
Author(s):  
Irmela Gnass ◽  
Michaela Ritschel ◽  
Silke Andrich ◽  
Silke Kuske ◽  
Kai Moschinski ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Short Term ◽  
Patient Reported

IntroductionSurvivors of polytrauma experience long-term and short-term burden that influences their lives. The patients’ view of relevant short-term and long-term outcomes should be captured in instruments that measure quality of life and other patient-reported outcomes (PROs) after a polytrauma. The aim of this systematic review is to (1) collect instruments that assess PROs (quality of life, social participation and activities of daily living) during follow-up after polytrauma, (2) describe the instruments’ application (eg, duration of period of follow-up) and (3) investigate other relevant PROs that are also assessed in the included studies (pain, depression, anxiety and cognitive function).Methods and analysisThe systematic review protocol is developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials and the trials registers ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be searched. Keywords, for example, ‘polytrauma’, ‘multiple trauma’, ‘quality of life’, ‘activities of daily living’ or ‘pain’ will be used. Publications published between January 2005 and the most recent date (currently: August 2016) will be included. In order to present the latest possible results, an update of the search is conducted before publication. The data extraction and a content analysis will be carried out systematically. A critical appraisal will be performed.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be published in a peer-reviewed publication.PROSPERO registration numberCRD42017060825.

scholarly journals Does the Method of Administration Affect Reliability of the Foot and Ankle Ability Measure?

2020 ◽  
Vol 29 (7) ◽  
pp. 1038-1041
Author(s):  
Christopher J. Burcal ◽  
Sunghoon Chung ◽  
Madison L. Johnston ◽  
Adam B. Rosen
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Rehabilitation Medicine ◽  
Foot And Ankle ◽  
Specific Patient ◽  
Retest Reliability ◽  
Digital Version ◽  
Patient Reported ◽  
Test Retest Reliability ◽  
Ability Measure

Background: Region-specific patient-reported outcomes (PROs) are commonly used in rehabilitation medicine. Digital versions of PROs may be implemented into electronic medical records and are also commonly used in research, but the validity of this method of administration (MOA) must be established. Purpose: To determine the agreement between and compare the test–retest reliability of a paper version (FAAM-P) and digital version (FAAM-D) of the Foot and Ankle Ability Measure (FAAM). Study Design: Randomized, nonblinded, crossover observational study. Methods: A total of 90 adults were randomized to complete the FAAM-P or FAAM-D first, and then completed the second MOA (first day [D1]). The FAAM-D was a digital adaptation of both FAAM-P subscales on Qualtrics. Identical test procedures were completed 1 week later (D2). Data were removed if a participant scored 100% on both MOA, reported injury between D1 and D2, or did not complete both MOA. Agreement was assessed on 46 participants between the 2 MOA using intraclass correlation coefficients (ICC) at D1. There was good-to-excellent test–retest reliability for the FAAM activities of daily living. Results: The authors observed good agreement between the FAAM-P and FAAM-D for the activities of daily living (ICC = .88) and sport scales (ICC = .87). Test–retest reliability was good-to-excellent for the FAAM activities of daily living (FAAM-P: ICC = .87; FAAM-D: ICC = .89) and sport (FAAM-P: ICC = .71; FAAM-D: ICC = .91). Conclusions: The MOA does not appear to affect the responses on the FAAM; however, the authors observed slightly higher reliability on the FAAM-D. The FAAM-D is sufficient to be used for generating practice-based evidence in rehabilitation medicine.

Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases

2020 ◽  
pp. 036354652092285
Author(s):  
Ahmed K. Emara ◽  
Daniel Grits ◽  
Linsen T. Samuel ◽  
Alexander J. Acuña ◽  
James T. Rosneck ◽  
...  
Keyword(s):  
Systematic Review ◽  
Activities Of Daily Living ◽  
Hip Arthroscopy ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Complication Rates ◽  
Patient Reported ◽  
Modified Harris Hip Score

Background: Although the negative effects of smoking have been documented for other types of arthroscopic procedures, there is limited information regarding its influence on hip arthroscopy outcomes. Purpose: To examine the effect of smoking on the following outcomes after hip arthroscopy: patient-reported outcomes (PROs), the degree of improvement in PROs relative to baseline, complication rates, and rates of revision arthroscopy and/or conversion to total hip arthroplasty (THA). Study Design: Systematic review. Methods: The PubMed, Embase, and Cochrane Library databases were queried for studies published between January 1, 1985, and January 14, 2020, comparing the outcomes of hip arthroscopy between smokers and nonsmokers. Case reports, basic science studies, and studies investigating pediatric patients or lacking a description of outcomes were excluded. Included outcome tools were the modified Harris Hip Score, the visual analog scale (VAS) for pain and satisfaction, and the Hip Outcome Score (HOS)–Sports Specific and HOS–Activities of Daily Living. Preoperative characteristics and operative indications were also recorded. Results: Postoperative combined means (± SD) were better in nonsmokers versus smokers for the modified Harris Hip Score (75.67 ± 20.88 vs 82.32 ± 15.5; P = .001), the VAS pain (3.13 ± 2.79 vs 2.13 ± 2.21; P < .001), and the HOS–Sports Specific (62.54 ± 25.38 vs 71.7 ± 23.3; P < .001). There was no difference between groups in VAS satisfaction ( P = .23) or HOS–Activities of Daily Living ( P = .13). The extent of PRO score improvement relative to baseline values was similar in smokers and nonsmokers in all PRO measures ( P > .05 for all). Smokers demonstrated higher rates of postoperative thromboembolic ( P = .0177) and infectious ( P = .006) complications. There was no difference between rates of revision arthroscopy ( P = .47) and THA conversion ( P = .31). Conclusion: Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.

Lumbosacral Transitional Vertebrae Predict Inferior Patient-Reported Outcomes After Hip Arthroscopy

2020 ◽  
Vol 48 (13) ◽  
pp. 3272-3279 ◽  
Author(s):  
Braiden M. Heaps ◽  
Jacob D. Feingold ◽  
Erica Swartwout ◽  
Sava Turcan ◽  
Harry G. Greditzer ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Hip Arthroscopy ◽  
Daily Living ◽  
Equation Modeling ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Significant Difference ◽  
Patient Reported ◽  
Lumbosacral Transitional Vertebrae ◽  
Radiographic Data

Background: While the association between spinal disease and hip arthroplasty outcomes has been well studied, there is less known about the effect of spinal pathology in hip arthroscopy (HA) outcomes. Lumbosacral transitional vertebrae (LSTV) are anatomic variations where caudal vertebrae articulate or fuse with the sacrum or ilium. Hypothesis: LSTV can lead to inferior outcomes after HA for treatment of femoroacetabular impingement. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the prospectively collected Hip Arthroscopy Database at our institution for patients with LSTV who underwent HA between 2010 and 2017. A total of 62 patients with LSTV were identified and then matched to controls. Patient-reported outcome measures (PROMs) were collected, including the modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports, and the 33-item International Hip Outcome Tool. They were collected at 4 time points: preoperatively and 5 to 11 months, 12 to 23 months, and 24 to 35 months postoperatively. Longitudinal analysis of the PROMs was done using generalized estimating equation modeling. Additionally, alpha angles were measured from preoperative radiographic data. Results: Preoperatively, there was no significant difference between patients with and without LSTV on 3 of the 4 PROMs; however, patients with LSTV did have significantly lower preoperative scores than controls for the Hip Outcome Score–Activities of Daily Living ( P = .029). Patients with LSTV reported significantly lower scores on all 4 PROMs at each postoperative time point. Radiographic data showed no significant difference in alpha angles across cohorts. When LSTV were compared by Castellvi type, types 3 and 4 tended to have lower scores than types 1 and 2; however, these comparisons were not significant. Conclusion: The data support our hypothesis that HA has less benefit in patients with LSTV as compared with patients without LSTV. In patients with LSTV, careful evaluation of the anomaly is recommended to help guide surgical counseling and manage expectations.

Abstract 112: One Year Later: Patient-reported Outcomes Among Survivors of In-hospital Cardiac Arrest in Veterans Administration Hospitals

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Elizabeth M Viglianti ◽  
Kaitlyn Hanisko ◽  
Rachel Bucy ◽  
Lee Ewing ◽  
Bradley Youles ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Veterans Administration ◽  
Instrumental Activities ◽  
Number Of Patients ◽  
Patient Reported

Background: Short term mortality following in-hospital cardiac arrests (IHCA) is well understood. However, little is known about long term patient-reported outcomes - such as activities of daily living, cognitive function, and depression among survivors of IHCA. Objective: To assess the patient-reported outcomes in IHCA survivors 12-months after cardiac arrest. Methods: Veteran survivors of IHCA (ICD-9-CM codes 99.60, 99.63 or 427.5) who were discharged alive from a U.S. Veterans Administration Medical Center from September 1, 2013 to October 31, 2013 were identified. After confirmation of eligibility by medical record review, they were mailed a research information packet. Those who did not opt-out were contacted by phone two weeks later. Veterans who consented were surveyed by phone or mail. The survey encompassed Katz Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADLs), self-reported depressive symptoms (via the PHQ-9) and an assessment of cognition (via the modified Telephone Interview for Cognitive Status (mTICS) as used by the Health and Retirement Study). Results: Among 50 IHCA survivors, 37 (74%) completed surveys; survey operations are detailed in another abstract. Among those 37 who completed the survey, answers to all patient-reported outcomes items were obtained from 29 (78%). Respondents’ median age was 66 years old (range 38 to 87) and 95% were male. The survivors self-reported health assessment of their health was poor, with 8% and 40% describing their health as “poor” or fair” respectively, but only 5% saying “very good” and none reporting “excellent”. Similarly, 27% reported having 4 or more health-related difficulties in their basic and instrumental activities of daily living, 24% reported 1-3, and 46% none. On the PHQ-9, 19% had scores consistent with severe depression. Of those tested for cognitive impairment, 32% were at risk for at least some cognitive impairment. Conclusion: Among survivors of IHCA, we found that few patients at 12-months reported an overall sense of good health, and a significant number of patients had high-levels of disability, cognitive impairment and depression. There is an urgent need to understand the epidemiology and trajectory of this poor health, and develop interventions to improve the long term outcomes of IHCA.

scholarly journals Identifying Foot and Ankle Patients at Risk to Fall Based on Patient Reported Outcomes Assessments

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002
Author(s):  
Judith Baumhauer ◽  
Jack Teitel ◽  
Allison McIntyre ◽  
David Mitten ◽  
Jeff Houck
Keyword(s):  
At Risk ◽  
Effect Size ◽  
Fall Risk ◽  
Patient Reported Outcomes ◽  
The United States ◽  
Foot And Ankle ◽  
Falls Risk ◽  
Orthopaedic Patients ◽  
Patient Reported ◽  
Patients At Risk

Category: Other Introduction/Purpose: Each year approximately 30-40% of people over the age of 65 fall. Approximately one half of these falls result in an injury with the estimated annual direct medical costs of $30 billion. Pain, mobility issues, neuropathy and post-operative weight bearing limitations make foot and ankle patients particularly vulnerable to falls. Current approaches to determine at risk patients are cumbersome and time consuming requiring performance testing and “hands on” clinical assessment. The efficiency of obtaining PRO, such as PROMIS, in the clinical arena has been well documented. The purpose of this study is determine if patient reported outcomes (PROMIS) can identify orthopaedic and specifically foot and ankle patients at risk to fall. Methods: Prospective patient reported outcomes (PROMIS CAT physical function, pain interference and depression and CMS fall risk assessment questions) and patient demographics were collected for all patients at each clinic visit from an academic orthopaedic multi-specialty practice between January 2015 and November 2017. Standardized yes/no validated self-reported fall risk questions include: “Have you fallen in the last year?” and “Do you feel you are at risk of falling?” Histograms, t-tests, confidence intervals and effect size were used to determine the fall risk “YES” patients were different than the “NO” for ALL orthopaedic patients and specifically foot and ankle patients. Logistic Regression was used to determine if age, gender, height, weight, and PROMIS scales predicted self-reported falls risk. Results: 94,761 orthopaedic patients comprising 315,273 visits (44% male, mean age 53.7+/-17 years) and 13,720 foot/ankle patients comprising 33,480 visits (37% male, mean age 52.7+/-16.1 years) had complete data for analysis. Table 1 provides the means/SD/p-values/effect sizes for patient self-identifying at risk to fall stratified by PROMIS PF/ PI/Dep t-scores. Although all PROMIS scores demonstrated significant impairment between patients at risk designation (yes/no), PROMIS PF had the largest effect size for ALL Ortho and FOOT AND ANKLE patients (0.8 and 0.7 respectively). Patients who are at risk to fall have PROMIS PF t-scores >1.5 lower than the United States normative population while the patients not at risk are less <1 SD. In the adjusted regression models gender and PROMIS PF had the largest coefficients. Conclusion: Falls are a major threat to quality of life and independence yet prevention/treatment strategies are difficult to implement across a health system. There is also a tremendous societal cost with orthopaedic surgeons often the recipient of these debilitated patients. PROMIS assessments are part of the AOFAS OFAR initiative to track patient recovery with treatment and can additional be used to fulfill a quality indicator requirement by CMS. This study demonstrates these assessments (PROMIS threshold values) can also be linked to self-report falls risk (yes/no) and may identify patients at risk with no face to face time required from the provider.

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