scholarly journals Patient-Reported Outcomes in Foot and Ankle Orthopedics

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141985293 ◽  
Author(s):  
Eric Lakey ◽  
Kenneth J. Hunt
Keyword(s):  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Health Care Quality ◽  
Care Quality ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Future Outcomes ◽  
Near Future ◽  
Patient Burden

Patient-reported outcomes (PROs) are a measure of health care quality that reflect the patient’s perceptions of their own health status. Recently, there has been a renewed interest in implementation of PROs into everyday clinical practice. There are many dozens of PROs available to foot and ankle surgeons with little consensus on which measures are most appropriate for a given condition. These measures vary widely in length, validity, and content. When integrating PROs into clinical practice, we recommend that clinicians should collect, at a minimum, validated PRO scores that assess pain, function, and general health. Furthermore, concise instruments should be used wherever possible to minimize patient burden, maximize patient engagement, and ensure meaningful data are collected. In the near future, outcomes registries employing computer adaptive testing will facilitate the routine collection of PRO data from all patients. Level of Evidence: Level V, expert opinion.

Relationship of Press Ganey Satisfaction and PROMIS Function and Pain in Foot and Ankle Patients

2020 ◽  
Vol 41 (10) ◽  
pp. 1206-1211
Author(s):  
Devon C. Nixon ◽  
Chong Zhang ◽  
Maxwell W. Weinberg ◽  
Angela P. Presson ◽  
Florian Nickisch
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Experience ◽  
Care Provider ◽  
Patient Reported Outcomes ◽  
Health Care Quality ◽  
Care Quality ◽  
Satisfaction With Care ◽  
Foot And Ankle ◽  
Patient Reported

Background: Patient satisfaction has garnered interest as a tool to measure health care quality. However, orthopedic studies in total joint arthroplasty, spine, and hand patients have offered conflicting relationships between Press Ganey (PG) satisfaction metrics and patient-reported outcome (PRO) measures. No prior study has assessed the relationship between PG and PROs in foot and ankle patients. Whether satisfaction and outcomes instruments, though, measure similar or differing aspects of the patient experience is unclear. Here, we tested if there was an association between Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes and PG satisfaction scores. Methods: PG and PROMIS outcomes data for new patient visits to an orthopedic foot and ankle clinic between 2015 and 2017 were retrospectively analyzed. Patients that completed PG satisfaction surveys were included for study. All patients who completed PG surveys and completed one or both PROMIS physical function (PF) or pain interference (PI) metrics administered by computerized adaptive testing were included. Negative binomial regressions were used to compare PRO scores to PG overall satisfaction and PG satisfaction with care provider, adjusting for patient characteristics. Results were reported as dissatisfaction score ratios, which represented the amount of PG dissatisfaction associated with a 10-point increase in PROMIS PF or PI. Of the 3984 new patient visits, only 441 completed the PG survey (11.3% response rate). Results: Ceiling effects were seen with PG data: 64% of patients reported perfect satisfaction with care provider and 27% had perfect overall satisfaction. Higher function on the PROMIS PF was weakly associated with increased overall satisfaction (ratio = 0.82, 95% CI: 0.68-0.99, P = .039) and increased satisfaction with care provider (ratio = 0.60, 95% CI: 0.40-0.92, P = .019). However, pain (PROMIS PI) was not associated with overall satisfaction or with satisfaction with care provider. Conclusions: Based on our data here, patient satisfaction was weakly related to patient-reported function but not pain interference among this subset of new patients presenting to a foot and ankle clinic. Given our essentially negative findings, further study is needed to determine which aspects of the PG satisfaction and PROMIS scores track similarly. Further, our findings add to the growing literature showcasing limitations of the PG tool, including low response rates and notable ceiling effects. If satisfaction metrics and patient-reported outcomes capture differing aspects of the patient experience, we need to better understand how that influences the measurement of health care quality and value. Level of Evidence: Level III, comparative 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.

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.

Patient Reported Outcomes as Indicators of Pediatric Health Care Quality

2014 ◽  
Vol 14 (5) ◽  
pp. S90-S96 ◽  
Author(s):  
Katherine B. Bevans ◽  
JeanHee Moon ◽  
Adam C. Carle ◽  
Constance A. Mara ◽  
Jin-Shei Lai ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Reported Outcomes ◽  
Health Care Quality ◽  
Care Quality ◽  
Pediatric Health ◽  
Pediatric Health Care ◽  
Patient Reported

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.

When using patient-reported outcomes in clinical practice, the measure matters: Results from an RCT.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6519-6519
Author(s):  
Claire Frances Snyder ◽  
Joseph M. Herman ◽  
Amanda L. Blackford ◽  
Michael Anthony Carducci ◽  
Albert W. Wu
Keyword(s):  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Short Form ◽  
Controlled Trial ◽  
Care Quality ◽  
Measurement Information ◽  
Care Needs ◽  
Feedback Form ◽  
Patient Reported ◽  
The Impact

6519 Background: Patient-reported outcomes (PRO) assess patients' perspectives on the impact of diseases and treatments. There is increasing interest in having patients complete PRO questionnaires and using the data clinically to identify and address patients' issues. There are many different PRO questionnaires, and this study investigated whether one PRO is more appropriate than others for clinical use. Methods: This controlled trial randomly assigned patients to complete 1 of 3 PRO questionnaires: six domains from the Patient Reported Outcomes Measurement Information System (PROMIS), the EORTC QLQ-C30, or the Supportive Care Needs Survey-Short Form (SCNS). Breast or prostate cancer patients, >=21 years old, undergoing treatment, with oncologist visits at least monthly were eligible. Patients completed their assigned PRO questionnaire via computer either in the clinic or via the web prior to their clinic visits for the duration of active treatment. The results were provided to their clinicians for use during visits. After treatment ended, patients completed a 13-item feedback form to assess the impact of the questionnaire on their care (e.g., easy to complete, promoted communication, improved care quality). We hypothesized that there would be no difference in the proportion of patients who strongly agreed/agreed to all 13 items in the feedback form by questionnaire arm. Results: Of 294 eligible patients approached, 224(76%) enrolled (mean age 66, 78% white, 28% breast, 72% prostate). Of these, 181 patients (81%) responded to the feedback form, with 116 patients (52%) completing all 13 items. Of the 116 patients with complete data, subjects in the QLQ-C30 arm were most likely to strongly agree/agree to all items (82%), followed by PROMIS (62%), and SCNS (56%) [p=.05]. Among the 181 patients with at least partial data, the proportions strongly agreeing/agreeing to all items were 74% for QLQ-C30, 61% for PROMIS, and 52% for SCNS [p=.03]. Conclusions: In a randomized trial comparing the benefits of PROs applied in clinical practice, we found significant differences among the 3 PRO questionnaires. Future applications of PROs for patient care should select the most appropriate PRO measures for the purpose and setting.

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 Funnel plots of patient‐reported outcomes to evaluate health‐care quality: Basic principles, pitfalls and considerations

Nephrology ◽  
2020 ◽  
Author(s):  
Esmee M. Willik ◽  
Erik W. Zwet ◽  
Tiny Hoekstra ◽  
Frans J. Ittersum ◽  
Marc H. Hemmelder ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Reported Outcomes ◽  
Health Care Quality ◽  
Care Quality ◽  
Basic Principles ◽  
Patient Reported ◽  
Funnel Plots

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.

scholarly journals Sex differences in outcomes after arthroscopic bankart repair

2020 ◽  
Vol 6 (1) ◽  
pp. e000965
Author(s):  
Natalie A Lowenstein ◽  
Peter J Ostergaard ◽  
Daniel B Haber ◽  
Kirsten D Garvey ◽  
Elizabeth G Matzkin
Keyword(s):  
Mental Health ◽  
Sex Differences ◽  
Patient Reported Outcomes ◽  
Strength Function ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Patient Reported ◽  
Males And Females

ObjectivesRisk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR.MethodsProspectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females.ResultsNo statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities.ConclusionResults of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females.Level of evidenceRetrospective cohort study; level II.

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