Preoperative Anxiety Effect on Patient-Reported Outcomes Following Foot and Ankle Surgery

2019 ◽  
Vol 40 (9) ◽  
pp. 1007-1011 ◽  
Author(s):  
Devon C. Nixon ◽  
Kevin A. Schafer ◽  
Brian Cusworth ◽  
Jeremy J. McCormick ◽  
Jeffrey Johnson ◽  
...  
Keyword(s):  
Physical Function ◽  
Emotional Distress ◽  
Patient Reported Outcomes ◽  
Functional Disability ◽  
Preoperative Anxiety ◽  
Foot And Ankle ◽  
Preoperative Pain ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Patient Reported

Background: Preoperative emotional distress has been shown to negatively influence joint arthroplasty and spine surgery, but limited data exist for foot and ankle outcomes. Emotional distress can be captured through modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) anxiety domain. We hypothesized that patients with greater preoperative PROMIS anxiety scores would report greater pain and less function after foot and ankle surgery than patients with lower preoperative anxiety levels. Methods: Elective foot and ankle surgeries from May 2016 to December 2017 were retrospectively identified. PROMIS anxiety, pain interference (PI), and physical function (PF) scores were collected before and after surgery. Patients were grouped based on preoperative PROMIS scores greater or less than 59.4. A cutoff of PROMIS anxiety above 59.4 was selected as the threshold that corresponds to traditional measures of anxiety. Results: Compared to patients with less preoperative anxiety (average: 47.2, n=146), patients with higher preoperative anxiety (average: 63.9, n=59) had greater preoperative pain (PROMIS PI: 63.5 vs 59.1, P < .001) and lower physical function (PROMIS PF: 37.9 vs 42.0, P = .001). Postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.6 vs 52.9, P < .001; PROMIS PF: 39.8 vs 44.4, P < .001; respectively). Conclusion: Our evidence showed that preoperative emotional anxiety predicted worse pain and function at early operative follow-up. Measures of preoperative anxiety could be useful in identifying patients at risk for poorer operative outcomes, but continued study is necessary. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Preoperative Emotional Distress Negatively Impacts Patient-reported Outcomes Following Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006 ◽  
Author(s):  
Sandra Klein ◽  
Devon Nixon ◽  
Brian Cusworth ◽  
Jeremy McCormick ◽  
Jeffrey Johnson
Keyword(s):  
Emotional Distress ◽  
Patient Reported Outcomes ◽  
Functional Disability ◽  
Preoperative Anxiety ◽  
Foot And Ankle ◽  
Preoperative Pain ◽  
Residual Pain ◽  
Ankle Surgery ◽  
Patient Reported

Category: Other Introduction/Purpose: Prior work has demonstrated that greater preoperative emotional distress leads to worse outcomes in joint arthroplasty and spine surgery. However, there is limited data on the influence of impaired preoperative psychological function on foot and ankle outcomes. Modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) can capture data such as emotional distress via the PROMIS anxiety domain. PROMIS anxiety queries symptoms of fearfulness, panic, and nervousness with scores strongly correlating to multiple legacy measures of anxiety. However, PROMIS anxiety as a surrogate for emotional distress has not been utilized in orthopedic research. We hypothesized that patients with greater preoperative emotional distress (i.e. higher PROMIS anxiety scores) would exhibit greater pain and less function than patients with lower anxiety following foot and ankle surgery. Methods: Elective foot and ankle surgeries from May 2016 – December 2016 were retrospectively identified. Patients with diabetes as well as those undergoing surgery for infection, trauma, or routine hardware removal were all excluded. PROMIS anxiety, pain interference (PI), physical function (PF), and depression scores were collected – data closest to surgery preoperatively and furthest from surgery postoperatively were used for analysis. Our study population was then grouped based on preoperative PROMIS anxiety, with scores greater than 60 indicating higher levels of emotional distress and scores below 60 indicating less impairment. A cutoff of PROMIS anxiety above 60 was selected as earlier studies have shown that threshold corresponds to clinically-significant amounts of anxiety based on traditional anxiety outcome measures. Additionally, PROMIS anxiety scores above 60 signify anxiety values one standard deviation or more away from the population average. Results: Patients with higher preoperative anxiety (average: 64.8, n=25) had greater preoperative pain and less function as compared to patients with less preoperative anxiety (average: 47.1, n=63) (PROMIS PI: 63.6 versus 59.1, P<0.01; PROMIS PF: 37.9 versus 41.7, P<0.05; respectively). Both groups of patients (i.e. high and low preoperative anxiety) demonstrated similar changes (P>0.1) in PROMIS PI and PF following surgery (? PROMIS PI: 5.1 versus 7.3;? PROMIS PF: 1.5 versus 3.0; respectively) at equivalent follow-up (5.7 versus 6.3 months, respectively). However, postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.5 versus 51.8, P<0.001; PROMIS PF: 39.4 versus 44.7, P<0.001; respectively). Conclusion: Evidence of preoperative emotional distress – as assessed by the PROMIS anxiety instrument – predicted worse pain and function at early surgical follow-up. Detecting patients at-risk for poorer surgical outcomes remains a topic of interest in orthopedics. Our data suggest that the PROMIS anxiety tool could be useful in identifying such patients. It would be helpful, then, to counsel individuals with higher preoperative emotional distress that – despite significant improvements – residual pain and functional disability may persist after surgery. Continued surveillance will be necessary to determine if these between-group differences remain at longer-term follow-up.

scholarly journals Preoperative Emotional Distress Negatively Impacts Foot and Ankle Outcomes

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0001
Author(s):  
Devon Nixon ◽  
Jeremy J. McCormick ◽  
Sandra Klein ◽  
Brian Cusworth ◽  
Jeffrey Johnson
Keyword(s):  
Emotional Distress ◽  
Functional Disability ◽  
Preoperative Anxiety ◽  
Foot And Ankle ◽  
Preoperative Pain ◽  
Residual Pain ◽  
Patient Reported ◽  
Patients With Diabetes ◽  
Patients At Risk

Category: Outcomes Research Introduction/Purpose: Prior work has demonstrated that greater preoperative emotional distress leads to worse outcomes in joint arthroplasty and spine surgery. However, there is limited data on the influence of impaired preoperative psychological function on foot and ankle outcomes. Modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) can capture data on emotional distress via the PROMIS anxiety domain. PROMIS anxiety queries symptoms of fearfulness, panic, and nervousness with scores strongly correlating to multiple legacy measures of anxiety. However, PROMIS anxiety as a surrogate for emotional distress has not been utilized in orthopedic research. Here, we hypothesized that patients with greater preoperative emotional distress (i.e. higher PROMIS anxiety scores) would exhibit greater pain and less function than patients with lower anxiety following foot and ankle surgery. Methods: Elective foot and ankle surgeries from May 2016 – December 2016 were retrospectively identified. Patients with diabetes as well as those undergoing surgery for infection, trauma, or routine hardware removal were all excluded. PROMIS anxiety, pain interference (PI), physical function (PF), and depression scores were collected – data closest to surgery preoperatively and furthest from surgery postoperatively were used for analysis. Our study population was then grouped based on preoperative PROMIS anxiety, with scores greater than 60 indicating higher levels of emotional distress and scores below 60 indicating less impairment. A cutoff of PROMIS anxiety above 60 was selected as earlier studies have shown that threshold corresponds to clinically-significant amounts of anxiety based on traditional anxiety outcome measures. Additionally, PROMIS anxiety scores above 60 signify anxiety values one standard deviation or more away from the population average. Results: Patients with higher preoperative anxiety (average: 64.8, n=25) had greater preoperative pain and less function compared to patients with less preoperative anxiety (average: 47.1, n=63) (PROMIS PI: 63.6 versus 59.1, P<0.01; PROMIS PF: 37.9 versus 41.7, P<0.05; respectively). There was a strong correlation between preoperative PROMIS anxiety and depression scores (r=0.86, P<0.001). Both groups (i.e. high and low preoperative anxiety) demonstrated similar changes (P>0.1) in PROMIS PI and PF following surgery (Delta PROMIS PI: 5.1 versus 7.3; Delta PROMIS PF: 1.5 versus 3.0) at equivalent follow-up (5.7 versus 6.3 months). However, postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability compared to patients with less preoperative emotional distress (PROMIS PI: 58.5 versus 51.8, P<0.001; PROMIS PF: 39.4 versus 44.7, P<0.001). Conclusion: Evidence of preoperative emotional distress – as assessed by the PROMIS anxiety instrument – predicted worse pain and function at early surgical follow-up. Detecting patients at-risk for poorer surgical outcomes remains a topic of interest in orthopedics. Our data suggest that the PROMIS anxiety tool could be useful in identifying such patients. It would be helpful, then, to counsel individuals with higher preoperative emotional distress that – despite significant improvements – residual pain and functional disability may persist after surgery. Continued surveillance will be necessary to determine if these between-group differences remain at longer-term follow-up.

Patient-Reported Allergies Do Not Predict Poorer PROMIS Function, Pain, and Depression Scores Following Foot and Ankle Surgery

2018 ◽  
Vol 39 (8) ◽  
pp. 949-953 ◽  
Author(s):  
Devon C. Nixon ◽  
Brian M. Cusworth ◽  
Jeremy J. McCormick ◽  
Jeffrey E. Johnson ◽  
Sandra E. Klein
Keyword(s):  
Physical Function ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Patient Reported Outcome ◽  
Pain Interference ◽  
Foot And Ankle ◽  
Operative Outcomes ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Outcome Scores

Background: Identifying preoperative risk factors that may portend poorer operative outcomes remains a topic of current interest. In hip and knee arthroplasty patients, the presence of patient-reported allergies (PRAs) has been associated with worse pain and function after joint replacement. However, these results have not been replicated across studies, including in shoulder arthroplasty cases. The impact of PRAs on foot and ankle outcomes has yet to be studied. The purpose of our study was to evaluate whether PRAs influence patient-reported outcome in foot and ankle surgery. Methods: To determine if PRAs are linked to poorer operative outcomes, we retrospectively identified 159 patients who underwent elective foot and ankle surgery. PRA data were obtained via chart review, and patient-reported outcomes were assessed preoperatively and postoperatively via multiple domains, including Patient Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, and depression measures. Consistent with prior methodology, we compared outcome measures (preoperative, postoperative, and the change in outcome scores) between patients without self-reported allergies to patients with at least 1 PRA. Results: There were 159 patients studied; 79 patients had no allergies listed, and 80 patients had at least 1 PRA. Of the 80 patients with at least 1 PRA, there were a total of 170 possible allergies. There were no differences in preoperative, postoperative, or the change in outcome scores for all PROMIS measures (physical function, pain interference, and depression; P > .05) between patients with at least 1 PRA and those patients without any listed PRAs. Conclusions: We were unable to prove our hypothesis that PRAs were linked to poorer patient-reported outcomes following foot and ankle surgery. Closer review of the published reports linking PRAs to worse total joint arthroplasty outcomes revealed data that, while statistically significant, are likely not clinically relevant. Our negative findings, then, may in fact parallel prior studies on hip, knee, and shoulder arthroplasty patients. The presence of PRAs does not appear to be a risk factor for suboptimal outcomes in foot and ankle surgery. Level of Evidence: Level III, comparative series.

scholarly journals Comparison of Patient-Reported Outcomes for Major Pathologies of the Forefoot, Midfoot, Hindfoot, and Achilles Using PROMIS

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142095905
Author(s):  
Daniel A. Hu ◽  
Rusheel Nayak ◽  
Elijah O. Ogunkoya ◽  
Milap S. Patel ◽  
Anish R. Kadakia
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Medical Center ◽  
Postoperative Outcomes ◽  
Measurement Information ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Pain Outcomes

Background: Patient-Reported Outcomes Measurement Information System (PROMIS) is a newly developed patient-reported outcome that has been validated for the general foot and ankle population and has been applied to a variety of specific foot and ankle procedures. However, there is little data regarding clinical outcomes of patients at a more intermediate subgroup level. Thus, our study utilized PROMIS to provide normative data on pathologic conditions of the foot and ankle and assess postoperative outcomes based on anatomical location. Methods: Preoperative and 1-year postoperative PROMIS Physical Function (PF) and Pain Interference (PI) surveys were prospectively collected from a cohort of patients undergoing a foot and ankle procedure at a tertiary medical center. The cohort was split into forefoot (n = 136), midfoot (n = 44), hindfoot (n = 109), and Achilles (n = 62) procedure groups. Paired-t tests were used to compare preoperative versus postoperative outcomes within operative groups, while a 1-way analysis of variance (ANOVA) was used to detect differences in PROMIS scores between anatomic subgroups. Results: Paired t tests indicated that all 4 operative groups had significantly improved PROMIS PF and PI scores preoperatively versus 1 year postoperatively (all P < .001). One-way ANOVA demonstrated that there were no differences in postoperative PROMIS PF and PI scores between anatomic subgroups. A majority of patients achieved the minimal clinically important difference level of improvement in PROMIS PF and PI scores following surgery. Conclusions: All 4 operative groups had improvement in physical function and pain outcomes. Additionally, there were no differences in physical function and pain outcomes between operative groups. Level of Evidence: Level III, retrospective cohort study.

scholarly journals PROMIS and FAAM Minimal Clinically Important Differences in Foot and Ankle Orthopedics

2018 ◽  
Vol 40 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Maren W. Voss ◽  
Jerry Bounsanga ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Minimum Clinically Important Difference ◽  
Measurement Information ◽  
Diagnostic Study ◽  
Foot And Ankle ◽  
Meaningful Change ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Level I

Background: Establishing score points that reflect meaningful change from the patient perspective is important for interpreting patient-reported outcomes. This study estimated the minimum clinically important difference (MCID) values of 2 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Foot and Ankle Ability Measure (FAAM) Sports subscale within a foot and ankle orthopedic population. Methods: Patients seen for foot and ankle conditions at an orthopedic clinic were administered the PROMIS Physical Function (PF) v1.2, the PROMIS Pain Interference (PI) v1.1, and the FAAM Sports at baseline and all follow-up visits. MCID estimation was conducted using anchor-based and distribution-based methods. Results: A total of 3069 patients, mean age of 51 years (range = 18-94), were included. The MCIDs for the PROMIS PF ranged from approximately 3 to 30 points (median = 11.3) depending on the methods being used. The MCIDs ranged from 3 to 25 points (median = 8.9) for the PROMIS PI, and from 9 to 77 points (median = 32.5) for the FAAM Sports. Conclusions: This study established a range of MCIDs in the PROMIS PF, PROMIS PI, and FAAM Sports indicating meaningful change in patient condition. MCID values were consistent across follow-up periods, but were different across methods. Values below the 25th percentile of MCIDs may be useful for low-risk clinical decisions. Midrange values (eg, near the median) should be used for high stakes decisions in clinical practice (ie, surgery referrals). The MCID values within the interquartile range should be utilized for most decision making. Level of Evidence: Level I, diagnostic study, testing of previously developed diagnostic measure on consecutive patients with reference standard applied.

scholarly journals Patient-Reported Outcomes after Exosym Bracing (Intrepid Dynamic Exoskeletal Orthosis (IDEO)) in the Civilian Population

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0019
Author(s):  
Ryan Hadden ◽  
James Meeker ◽  
Jason Weiss ◽  
Austin Thompson
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Pain Modulation ◽  
Pain Interference ◽  
Average Score ◽  
Foot And Ankle ◽  
Kinetic Chain ◽  
Civilian Population ◽  
Patients Âgés ◽  
Patient Reported

Category: Ankle Arthritis, Orthosis Introduction/Purpose: When it comes to ambulation, the dynamic interplay of anatomy at the foot and ankle affords weight acceptance, stability and force production. The outcome is gait efficiency. Various musculoskeletal injuries challenge gait biomechanics. While surgical management may address the fault in kinetic chain, it may not fully address the problem of pain, functional outcome and patient satisfaction. Non-surgical interventions such as bracing using ankle foot orthoses (AFO) aim to assist, restore and redirect weightbearing forces with immobility in mind. As an energy-storing AFO, however, the IDEO was created to improve functional performance in veterans after limb salvage procedures. The goal of the study was to evaluate outcomes following use of Exosym (or IDEO) bracing for foot and ankle pathologies in the civilian population. Methods: Through review of one institution’s electronic medical record, 29 patients ages 18 years or older who were prescribed the Exosym brace by a single foot and ankle surgeon over a 5-year period were identified. A composite questionnaire including patient-reported outcomes of PROMIS SF Physical Function, PROMIS SF Pain Interference, Brace Use, and EQ-5D was obtained over the phone or by email. Results: A total of 29 patients were prescribed the brace over a 5-year period with only 18 patients receiving the brace. Insurance denying coverage was the most common reason (n=7) for patients not receiving the brace. Of the 18 patients that received the brace, 17 of them were willing to answer the questionnaire. The average age of patients with the Exosym brace was 42.3 (sd=13.8) years old with 6 (35%) being female. Patients with the Exosym brace reported an average score of 47.2 (sd=6.0) for the PROMIS Physical Function and 53.6 (sd=8.4) for the PROMIS Pain Interference. The average satisfaction with the Exosym brace was 65.5 (sd=17.6) out of a possible 100. Conclusion: Exosym bracing in various foot and ankle pathologies provides functionality and pain modulation in the civilian population that rivals respective subpopulation norms. One of the acknowledged limitations of the study is that not obtaining pre- bracing patient reported outcomes precluded evaluation of a minimum clinically important difference. However, the study was not designed to provide such data. It did, however, provide impetus to pursue a follow-up study evaluating plantar pressure changes with and without brace use, which is currently ongoing. Such knowledge may help identify which injuries would be best suited for Exosym bracing.

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

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.

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

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]

scholarly journals Pain Assessment in Foot and Ankle Patients

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Meghan Kelly ◽  
David Bernstein ◽  
Ashlee MacDonald ◽  
John Ketz ◽  
Adolph Flemister ◽  
...  
Keyword(s):  
Pain Management ◽  
Physical Function ◽  
Patient Reported Outcomes ◽  
Pearson Correlation ◽  
Pain Level ◽  
Foot And Ankle ◽  
Moderate Correlation ◽  
Patient Reported ◽  
And Function

Category: Other Introduction/Purpose: The ability to accurately quantify a patient’s pain pre-operatively is advantageous in the preparation of post-operative expectations and pain management. The Numeric Pain Rating Scale (NPRS) is a popular method to identify patient pain level. Other patient reported outcomes are being collected, such as the Patient Reported Outcomes Measurement Information System (PROMIS) and has been suggested to be more accurate in measuring pain as well as physical function. The aim of this study was to 1) determine whether NPRS or PROMIS Pain Interference (PI) demonstrates a stronger association with physical function as determined by PROMIS Physical Function (PF) and 2) to determine which method better predicts post-surgical pain in a population of elective surgical foot and ankle patients. Methods: Prospective PROMIS PF, PI and NPRS (0-10) data was obtained for common foot and ankle elective surgical procedures (CPT codes 27698, 27870, 28285, 28289, 28300, 28705, 28730, 28750) from a multi-surgeon foot and ankle clinic between February 2015 until November 2017. Pearson correlation coefficients were used to determine the relationship between NPRS (0-10) and PROMIS domains (PI, PF) pre and post-operatively. Correlations were considered high (> 0.7), high moderate (0.6-0.69), moderate (0.4-0.6) or weak (<0.4). Results: A total of 502 patients found to have complete data sets and > 6 month follow up were evaluated (74% women, mean age 54+/- SD, mean follow-up 14.4 months, range 6-34 months). Pearson correlation evaluation of NPRS and PI revealed a moderate correlation in the pre- and postoperative setting. There was a high moderate negative correlation between PI and PF t-scores pre and postoperatively suggesting more pain and less function. However, the negative correlation between NPRS and PF pre- and postoperatively was weak indicating a poor relationship between NPRS pain assessment and function. There was a moderate correlation between pre- and postoperative scores in all domains of PROMIS while the correlation between pre- and postoperative NPRS scores was weak. Conclusion: In a population of elective surgical foot and ankle patients, the use of both NPRS and PROMIS can be utilized to assess pain level, however the PROMIS PI domain demonstrated a stronger relationship with PROMIS PF than NPRS. Furthermore, only the PROMIS domains demonstrated at least a moderate correlation between pre- and post-operative scores. PROMIS PI provides superior assessment of pre- and post-operative physical function and prediction of post-operative pain. PROMIS PI can be used to gauge a patient’s pre-operative level of pain and function and aid the surgeon in guiding post-operative patient expectations and pain management.

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

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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