Matching Patient Expectations after Ankle Fusion Based on Patient Reported Outcome Measures

Category: Ankle Arthritis Introduction/Purpose: Much research on outcomes after ankle fusion focuses on gait changes, progression of adjacent joint arthritis, and other clinical measures, but little has been reported on the patient’s perspective. The purpose of this study was to determine the change in physical function and pain after undergoing ankle arthrodesis as determined by patient reported outcomes (PROs). Methods: This was a retrospective review of prospectively collected patient reported outcomes data in 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS computerized adaptive test at 6 months and 1 year post- operatively. Descriptive data and Spearman correlations were determined for PF and pain at 6 months and 1 year. Results: The mean pre-operative PF T-score was 37, less than the pre-determined threshold value of 42, indicating that this cohort was impaired physically and would respond positively to surgical intervention. The mean pre-operative PI T-score was 63 indicating moderate to high baseline pain and greater than the threshold value of 60, indicating that this patient cohort would have decreased pain after surgical intervention. The meaningful clinically important difference (MCID) was achieved for PI at 6 months and 1 year post-operatively (T-score of 4 and 6, respectively). At 6 months and 1 year, there was a moderate inverse correlation between PF and PI (r=-0.49, r=-0.61 respectively) suggesting less pain and more function. Demographic data, mean follow-up time, and mean PROMIS T-scores are seen in Table 1. Conclusion: The results of this study indicate that patients can expect to have a clinically meaningful improvement in pain after undergoing ankle fusion. Although patients do improve marginally in physical function, it is most likely the improvement in pain that is the greatest benefit to these patients at one year after ankle arthrodesis. This information is important to share with patients to align patient expectations with surgical results.

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PATIENT REPORTED KNEE FUNCTION AND STABILITY IN PATIENTS WITH FIBULAR DEFICIENCY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00158 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0015

Author(s):

Matthew J. Brown ◽

Lauren Agatstein ◽

Brian Haus ◽

Joel Lerman

Keyword(s):

Standard Deviation ◽

Physical Function ◽

Normal Population ◽

Lysholm Score ◽

Knee Function ◽

Average Score ◽

T Score ◽

Significant Difference ◽

Patient Reported ◽

The Mean

BACKGROUND Fibular deficiency is a common long-bone deficiency with an estimated incidence of 7.4-20 cases per million live births. Absence or hypoplasia of the cruciate ligaments is present in most patients with fibular deficiency. In one series, the anterior cruciate ligament (ACL) was deficient in 95% while the posterior cruciate ligament (PCL) was deficient in 60% of patients with fibular deficiency. Symptomatic instability of the knee is variably present in patients with congenital absence of the ACL including fibular deficiency, with a reported incidence of between 3% and 50%. Despite this reported incidence, limited literature assessing the perceived knee stability in patients with fibular deficiency exists. METHODS Patients diagnosed with fibular hemimelia with congenital absence of the ACL were identified retrospectively at a pediatric hospital. Of the identified patients over the age of 16, 28 agreed to be part of the study and were sent an online survey. They completed Lysholm and Patient-Reported Outcomes Measurement Information System (PROMIS) surveys on knee problems, physical function, pain intensity, and overall health. The PROMIS raw score responses were converted to a T-score, scaled to a mean of 50 points (representative of the mean of the reference population), with a standard deviation of 10 points. Any response more than one standard deviation away from 50 was considered worthy of further review. 18 patients returned surveys, and these individuals comprise the final study group. RESULTS Of the study patients, the average age was 19.8 years (16-24 years), with 7 females and 11 males. 9 patients are amputees and 9 are non-amputees. On the Lysholm Knee Scoring Scale, the highest possible score is 100 points, which relates to normal knee function. Our average Lysholm score was 79.94, with a wide range in scores from 25-100 points, in comparison to the average adult knee score of 94 (Briggs et al). The amputee average Lysholm score was 77.8 and the non-amputee average Lysholm score was 74.1, with no statistically significant difference. For our cohort, the mean Physical Function T-score was 52 (range 27.5-60.1), with a higher score relating to better physical function. The amputee average score was 53.1 and the non-amputee average score was 45.8, with no statistically significant difference. 12 respondents reported normal physical function compared to the general population, with 8 more than 1 standard deviation (SD) above a T-score of 50. Of the 6 respondents with a physical function score lower than 50, 4 reported mild functional impairment (.5 – 1.0 SD), 1 moderate impairment (1.6 SD), and 1 severe impairment (2.25 SD). The severe impairment was reported by an amputee and the moderate physical impairment reported by a non-amputee. For the PROMIS Global Physical Health domain, the mean T-score was 52.6 (range 29 -63.3). There was no significant difference between the average scores of the amputee (54.8) and non-amputee (50.3) groups. 13 respondents had no difference or had better health than the normal population mean, with 8 being amputees and 5 being non-amputees. 5 respondents had the highest possible score of 63.3, which is 1.33 standard deviations better than the normal average (2 non-amputees and 3 amputees). Of the 5 patients (4 non-amputees and 1 amputee) reporting worse health, only 1 respondent reported severe health impairments (2.1 SD). All PROMIS subject areas measure whether more of the domain occurs. For Physical Function and Global Health, a higher score indicates improved function. In the Pain Intensity realm, a higher score relates to more pain. In this study population, the mean pain T-score was 40.15 (range 30.7 – 60.5). The amputee average score was 38.98 and the non-amputee average score was 41.3, with no significant difference between them. 16 patients had less pain or normal pain levels compared to the population mean. Of the two patients reporting worse pain than the normal population, the amputee patient had mild pain (within 1 SD of 50) and the non-amputee had moderate pain (1.05 SD). CONCLUSIONS The only previously published report on knee function in adults with fibular deficiency contained 11 patients; our 18 patients substantially expands data available on knee function in these patients. Previously, Crawford, et al, obtained Lysholm and Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) scores on nine patients treated since 1928. Their data demonstrated an average Lysholm score of 90.2, compared to ours of 79.94. The majority of our patients demonstrated excellent PROMIS responses, with 12-15 demonstrating average or above pain, physical function, and global health scores. Amputees tended to self-report better health than the non-amputees. Overall, in the young adult cohort, we demonstrate that the majority of patients with fibular deficiency function well and have a stable knee, although a small subset of patients do have challenges with knee function.

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Are Sicker Patients Less Likely to Improve after Ankle Fusion?

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00252 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0025

Author(s):

Jessica M. Kohring ◽

Jeffrey R. Houck ◽

Sam Flemister ◽

John P. Ketz ◽

Irvin Oh ◽

...

Keyword(s):

Physical Function ◽

Demographic Data ◽

Ankle Arthrodesis ◽

Routine Care ◽

Computerized Adaptive Test ◽

Asa Score ◽

Ankle Fusion ◽

Patient Reported ◽

One Year ◽

The Impact

Category: Ankle Arthritis Introduction/Purpose: The influence of pre-existing medical conditions on post-operative patient reported outcomes are important to consider when selecting and preparing a patient for surgery. The purpose of this study was to determine the impact of medical comorbidities on post-operative physical function and pain in patients undergoing ankle arthrodesis. Methods: This was a Global IRB approved retrospective review of 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS PF and PI computerized adaptive test. A chart review was performed to determine the Charlson Comorbidities Index (CCI), ASA scores, and demographic data. A multivariate analysis predicting pre- and post-operative PROMIS PF based on PI, ASA score, and CCI was performed. Spearman correlations for CCI, ASA, pre- and post-operative PROMIS T- scores for PF and PI were calculated. Results: The ASA score and CCI were not associated with pre-operative PI, although the CCI was predictive of pre-operative physical function (p=0.06), indicating that patients with a higher CCI had lower pre-operative PF. Pre-operative PF and ASA were the best individual predictors of physical function at 6 months post-operatively (r=0.51). At 6 months after undergoing ankle arthrodesis, there was no correlation between CCI and post-operative PROMIS PF and PI outcome T-scores (r=0.02, r=-0.06, respectively), this continued at 1 year post-operatively (r=-0.17, r=0.04, respectively). Demographic data, ASA, CCI, and mean PROMIS T-scores are included in Table 1. Conclusion: Sicker patients (ASA score=3) and those with lower pre-operative function recovered more slowly as indicated by lower physical function at 6 months and obtained less physical function benefit from ankle fusion than healthier patients at one year. The results of this study can assist surgeons with risk stratification and educating patients about surgical expectations as pre- operative physical function and ASA score appear to influence post-operative physical function after undergoing ankle arthrodesis.

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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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Can Patient Reported Outcomes Guide Therapy Needs in Foot and Ankle Patients?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00250 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0025

Author(s):

Jeff Houck ◽

Jillian Santer ◽

Judith Baumhauer

Keyword(s):

Physical Function ◽

Patient Reported Outcomes ◽

Predictive Ability ◽

Pain Interference ◽

Measurement Information ◽

Foot And Ankle ◽

Data Set ◽

T Score ◽

Patient Reported ◽

Health Domains

Category: Other Introduction/Purpose: The patient acceptable symptom state (PASS) is a validated question establishing if patients activity and symptoms are at a satisfactory low level for pain and function. Surprisingly, ~20% of foot and ankle patients at their initial visit present for care with an acceptable symptom state (i.e. PASS yes). These patients are important to identify to prevent over treatment and avoid excessive cost. It is also unclear what health domains (Pain Interference (PI), Physical Function (PF), or Depression (Dep)) influence a patients judgement of their PASS state (i.e. why they are seeking treatment). The purpose of this analysis is to document the prevalance of PASS state and determine the health domains that discriminate PASS patients and predict PASS state at the initiation of rehabilitation. Methods: Patient reported outcomes measurement information system (PROMIS) computer adaptive test (CAT) scales PF, pain PIand Dep and PASS ratings starting in summer 2017 were routinely collected for patient care. Of 746 unique patients in this data set, 114 patients had ICD-10 codes that were specific to the foot and ankle. Average age was 51years (±18) and 54.4% were female. Patients were seen an average of 19.8(±15.9) days from their referral and were billed as low (51.7%), moderate (44.7%) and high complexity (2.7%) evaluations per current procedural code (CPT) visits. ANOVA models were used to evaluate differences in PROMIS scales by PASS state (Yes/No). The area under receiver operator curve (AUC) was used to determine the predictive ability of each PROMIS scale to determine a PASS state. Thresholds for near 95% specificity were also calculated for a PASS Yes state for each PROMIS scale. Results: The prevalance of PASS Yes patients was 13.2% (15/114). Pass Yes patients were significantly better by an average of 7.2 to 8.0 points across all PROMIS health domains compared to PASS No patients (Table 1). ROC analysis suggested that Dep (AUC=0.73(0.07) p=0.005) was the highest predictor of PASS status followed by PI (AUC=0.70(0.08) p=0.012) and PF (AUC=0.69(0.07) p=0.18). The threshold PROMIS t-score values for determining PASS Yes with nearest 95% specificity were PF = 51.9, PI = 50.6, and Dep = 34. Conclusion: Surprising, yet consistent with previous data, 13.2% of patients at their initial physical therapy consultation rated themselves at an acceptable level of activity and symptoms. Health domains of physical function, pain interference, and depression were better in these patients and showed moderate ability (AUC~0.7) to identify these patients. The PROMIS thresholds suggest patients are identified by pain and physical function equal to the average of the US population (PROMIS T-Score ~50) and extremely low depression scores (34). Clinically it is important to recognize these patients and purposefully provide treatments that reinforce their self efficacy and prevent unnecessary costly treatments.

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Biologic Augmentation of Tibiotalocalcaneal Arthrodesis with Autologous Bone Block is Associated with High Rates of Fusion

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00439 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0043

Author(s):

Alain E. Sherman ◽

Mitesh P. Mehta ◽

Rusheel Nayak ◽

Anish R. Kadakia

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Patient Reported Outcomes ◽

Bone Marrow Aspirate ◽

Bone Block ◽

T Score ◽

Patient Reported ◽

Foot Function ◽

The Mean ◽

Tissue Defects

Category: Ankle; Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is an established salvage procedure for severe deformities of the hindfoot. Despite its prevalence, end-stage pathology, systemic comorbidities, and the physical demands of surgery often precipitate unsuccessful outcomes, with nonunion rates as high as 85% in medically complex patients. Given the considerable morbidity associated with TTC arthrodesis, there has been recent interest in maximizing the physiologic potential of fusion by means of surgical technique, osteoinductive and osteoconductive biological agents, and vascularized bone flaps. Here, we present a novel approach to TTC arthrodesis using femoral head allograft bone block, bone marrow aspirate, and demineralized bone matrix (DBM) in the absence of tourniquet. Additionally, we explore the role of the medial femoral condyle (MFC) free flap as a reconstructive adjunct to arthrodesis. Methods: The sample consisted of 14 patients presenting to a tertiary care facility for reconstructive limb salvage. TTC arthrodesis was performed without tourniquet and biologically augmented with fresh-frozen femoral head allograft, pelvic bone marrow aspirate, and DBM. Three patients with severe soft tissue defects also underwent vascularized osseous reconstruction with MFC free flap. Recovery protocol included three months of prolonged non-weightbearing mechanical stabilization followed by conversion to weightbearing AFO boot for one year. Post-operative plain radiographs and computed tomography (CT) scans were assessed for fusion at regular follow-up. After fusion, participants completed a survey on patient-reported outcomes, which included the modified Foot Function Index (FFI) and Patient-Reported Outcomes Measurement Information System (PROMIS) scales for pain and physical function. Results: Successful TTC fusion was documented on plain radiograph in 13 patients (92.9%) and confirmed via CT in 10 patients (90.9%). The mean time-to-fusion was 183.2 +- 83.2 days. One patient (7.1%) failed to achieve fusion and underwent amputation secondary to infectious wound complications. Patients who underwent vascularized bone grafting had more robust healing and significantly shorter time-to-fusion (112.3 +- 31.7 days vs. 204.4 +- 82.7 days, p = 0.05). The mean patient-reported FFI score was found to be 40.96% +- 23.08%, indicating mild-to-moderate impairment in foot function. Similarly, PROMIS data revealed that patients who underwent TTC arthrodesis had a pain T-score of 58.34 (z = 0.83) and a physical function T-score of 39.00 (z = - 1.10), corresponding to mild pain and moderate impairment, respectively. Conclusion: We sought to biologically optimize the osteoinductive and osteoconductive potential of TTC arthrodesis using femoral head allograft bone block, bone marrow aspirate, and DBM in the absence of tourniquet. This approach resulted in excellent rates of fusion with minimal pain and preserved function of the lower extremity. Osseous healing was significantly enhanced by MFC flap in patients with soft tissue defects. We, therefore, recommend biologic augmentation of TTC arthrodesis as a viable salvage option for patients facing amputation or other undesirable outcomes.

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Patient-Reported Outcomes in Systemic Light-Chain Amyloidosis

Blood ◽

10.1182/blood-2018-99-111570 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4832-4832

Author(s):

Rajshekhar Chakraborty ◽

Lisa Rybicki ◽

Christy J. Samaras ◽

Beth M. Faiman ◽

Jason Valent ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Well Being ◽

Al Amyloidosis ◽

First Line ◽

T Score ◽

First Line Therapy ◽

Outpatient Visits ◽

Line Therapy ◽

Patient Reported ◽

The Mean

Abstract Background: Patients with systemic light-chain (AL) amyloidosis have a high symptom burden which can negatively impact their health-related quality of life (HRQoL). However, there is a lack of data on patient-reported outcomes (PROs) in this population in the current era of effective plasma cell directed therapies. The primary objectives of our study were to assess baseline HRQoL using FACT-G (Functional Assessment of Cancer Therapy-General) and PROMIS-GH (Patient Reported Outcomes Measurement Information System-Global Health), evaluate the degree of correlation between FACT-G and PROMIS-GH, and compare HRQoL by hematologic response to first-line therapy in systemic AL amyloidosis. Method: This was an observational study using the Cleveland Clinic Knowledge Program database, which contains HRQoL data captured at outpatient visits. FACT-G was administered every 90 days since its implementation on September 2012. PROMIS-GH was implemented in October 2015, initially administered every 30 days and subsequently every 90 days since July 2017. Results: A total of 81 patients with systemic AL amyloidosis diagnosed between September 2012 and December 2017 and ≥1 HRQoL measurement were included in our analysis. The median age at diagnosis was 64 years. Cardiac involvement at diagnosis was present in 49% of patients. The most common induction therapy was Bortezomib-Cyclophosphamide-Dexamethasone (86%). Autologous stem cell transplantation was performed in 38% of patients. Data on HRQoL at baseline (≤2 months from diagnosis) using FACT-G was available for 43 patients. The mean FACT-G total score at baseline was 74 (standard deviation [S.D.] ±15). In comparison, the mean FACT-G total score for general US population is 80.1 (±18.1) and that of US cancer patients is 79.3 (±17.0) [Normative data from Pearman et al; Cancer. 2014]. Maximal HRQoL deficit was seen in the functional well-being (FWB) domain of FACT-G, with the mean score being >0.5 S.D. below that of the general population (Table 1). Data on HRQoL at baseline using PROMIS-GH was available for 18 patients. There was a significant deficit in global physical health (GPH) compared to the general population, with a mean T-score of 37.7 (±7.8) [Mean T-score in general US population being 50±10]. The mean T-score for global mental health (GMH) was 44.4 (±6.7). A total of 72 patients had 128 outpatient visits where FACT-G and PROMIS-GH were captured concurrently (range, 1-4 visits per patient). Using Cohen's criterion, GPH domain of PROMIS-GH had a large and statistically significant correlation with FACT-G total (r=0.66), physical well being (PWB) (r=0.77) and FWB (r=0.66) scores. PROMIS GMH domain also had a strong and statistically significant correlation with FACT-G total (r=0.73), PWB (r=0.60), emotional well-being (EWB) (r=0.64) and FWB (r=0.73) scores. The scatterplots for correlation between PROMIS-GH domains and FACT-G total score is shown in Figure I. At follow-up, a total of 50 patients had data on best hematologic response and HRQoL assessment. Patients achieving a complete response (CR) to first-line therapy had a significantly superior FACT-G score at all domains compared to those with less than CR or no response. Maximal benefit in complete responders was noted in the FWB domain of FACT-G (Mean score ≥2 S.D. higher than patients with less than CR or no response; P=0.002). Conclusion: Patients with AL amyloidosis have a worse HRQoL at diagnosis compared to US cancer and general adult population. Deficit in HRQoL was most prominent in the FWB domain of FACT-G and GPH domain of PROMIS-GH. Most domains of FACT-G and PROMIS-GH had strong and significant correlation. Patients achieving a CR to first-line therapy had significantly superior HRQoL at all FACT-G domains. Clinical trials in AL amyloidosis should include patient-reported HRQoL as a key endpoint and focus on the domains of physical health and functioning to assess meaningful benefit of novel therapies. Psychometric validation of FACT-G and PROMIS-GH in AL amyloidosis would be helpful in generating robust PRO data in future studies. Disclosures Majhail: Anthem, Inc.: Consultancy; Incyte: Honoraria; Atara: Honoraria.

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Evaluating Prospective Patient-Reported Pain and Function Outcomes after Ankle and Hindfoot Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00353 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0035

Author(s):

Mitesh P. Mehta ◽

Alain E. Sherman ◽

Anish R. Kadakia

Keyword(s):

Physical Function ◽

Reference Population ◽

Ankle Arthrodesis ◽

Patient Reported Outcome ◽

Population Mean ◽

Fusion Procedure ◽

T Score ◽

Subtalar Arthrodesis ◽

Significant Difference ◽

Patient Reported

Category: Hindfoot; Ankle Introduction/Purpose: Hindfoot and ankle arthritis and deformity constitute a significant disease burden upon affected patients. Surgical hindfoot and ankle arthrodesis procedures are indicated for pain and instability in such patients and include ankle arthrodesis, tibitalocalcaneal (TTC) fusion, subtalar arthrodesis, and triple arthrodesis. Long-term patient-reported outcomes, including postoperative pain, function, and overall satisfaction, of these procedures have not yet been well-studied. The purpose of this study was to assess the outcomes and prognosis of various hindfoot fusion subtypes along with ankle fusion by using two validated patient-reported outcome measures: The Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). Methods: The sample consisted of 68 patients presenting to a tertiary care facility for ankle and hindfoot fusion surgeries, including ankle arthrodesis (n= 16), TTC fusion (n= 9), subtalar arthrodesis (n= 25), and triple fusion (n= 18), who had completed preoperative, 12-month postoperative, and 24-month postoperative PROMIS PF and PI CATs. Differences in CAT T-scores were calculated for each patient to create a prognostic estimation of pain and physical function at one and two years postoperative. Mean absolute T-scores for each procedure were also calculated and compared to PROMIS reference population mean (SD) T- scores of 50 (10). The distribution of PROMIS PF and PI T-scores were assessed via a Shapiro-Wilk test, and then paired t-tests were used to compare mean differences in T-scores. Results: Importantly, no statistically significant difference was found between 12-month mean PI scores for patients undergoing any fusion procedure and PROMIS reference population mean. Moreover, triple fusion patients had significantly decreased pain at 12 (delta-T-score= -11.10, p= 0.02) and 24 months (delta-T-score= -12.72, p= 0.01) relative to preoperative T-scores along with increased physical function at 12 (delta-T-score= 6.67, p= 0.04) and 24 months (delta-T-score= 8.70, p= 0.04). PF differences after 12 months were not statistically significant for ankle (delta-T-score= -1.67, p= 0.73), TTC (delta-T-score= 0.04, p= 0.99), or subtalar arthrodesis (delta-T-score= 0.37, p= 0.72). PI decreased after 12 months for ankle (delta-T-score= -14.57, p= 0.16), TTC (delta-T-score =-4.08, p= 0.21), and subtalar arthrodesis (delta-T-score= -0.64, p= 0.53); however, these differences did not achieve statistical significance. Conclusion: Overall, at 12 months after an ankle or hindfoot arthrodesis, patients experienced a similar level of pain to the reference population mean. Following a triple fusion procedure, patients can be provided with an accurate prognosis that they can expect reduced pain and increased physical function that will progressively improve from 12 to 24 months postoperative. No statistically significant difference in pain or physical function at 12 or 24 months for ankle, TTC, or subtalar arthrodesis was found.

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Long-term Follow-up of Lisfranc Injuries Treated With Open Reduction Internal Fixation Patient-Reported Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/24730114211039496 ◽

2021 ◽

Vol 6 (3) ◽

pp. 247301142110394

Author(s):

Kempland C. Walley ◽

Derek J. Semaan ◽

Ronit Shah ◽

Christopher Robbins ◽

David M. Walton ◽

...

Keyword(s):

Physical Function ◽

Visual Analog Scale ◽

Patient Reported Outcomes ◽

Foot And Ankle ◽

Analog Scale ◽

Patient Reported ◽

The Mean ◽

Lisfranc Injuries

Background: There remains a paucity of data regarding long-term patient-reported outcomes following Lisfranc injuries. We sought to collect long-term clinical outcome data following Lisfranc injuries using PROMIS Physical Function (PROMIS-PF) and visual analog scale–foot and ankle (VAS-FA). Methods: A chart review was performed to identify all patients who had surgical treatment of an acute Lisfranc injury at our institution from 2005 to 2014. Of the 45 patients identified, we were able to recruit 19 for a follow-up clinic visit consisting of physical examination, administration of questionnaires addressing pain and medication usage, radiographs, and completion of outcome surveys including PROMIS-Physical Function and visual analog scale–foot and ankle. Results: There were 14 female and 5 male patients enrolled in the study with a mean time of 6.25 years from the time of injury. Within this cohort, the mean PROMIS-PF score was 52.4±8.2 and the mean VAS–foot and ankle score was 76.6±22.3. Conclusion: We report satisfactory long-term patient-reported outcomes using PROMIS-PF and VAS-FA. Level of Evidence: Level III, retrospective cohort study.

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Impact of Preoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1716358 ◽

2020 ◽

Author(s):

Ali Aneizi ◽

Patrick M. J. Sajak ◽

Aymen Alqazzaz ◽

Tristan Weir ◽

Cameran I. Burt ◽

...

Keyword(s):

Physical Function ◽

Patient Reported Outcomes ◽

Knee Surgery ◽

The Body ◽

Pain Interference ◽

Opioid Use ◽

Opioid Prescription ◽

Social Satisfaction ◽

Patient Reported ◽

Met Expectations

AbstractThe objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.

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Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

Journal of Clinical Medicine ◽

10.3390/jcm10092009 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2009

Author(s):

Joaquín Fernández ◽

Manuel Rodríguez-Vallejo ◽

Javier Martinez ◽

Noemi Burguera ◽

David P. Piñero

Keyword(s):

Intraocular Lens ◽

Patient Reported Outcomes ◽

Phone Call ◽

Distortion Analysis ◽

Patient Reported ◽

Visual Function Questionnaire ◽

Secondary Objective ◽

Defocus Curve ◽

The Mean

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m−1 and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

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