scholarly journals Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110407
Author(s):  
Manish P. Mehta ◽  
Mitesh P. Mehta ◽  
Alain E. Sherman ◽  
Muhammad Y. Mutawakkil ◽  
Raheem Bell ◽  
...  
Keyword(s):  
Physical Function ◽  
Outcome Measurement ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Care Facility ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Tertiary Care Facility ◽  
Patient Reported ◽  
Hindfoot Arthrodesis

Background: Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). Methods: Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI T scores were analyzed with paired t tests. The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling. Results: The sample had mean age of 57.69 years; 48% were male, and 55% were obese. Patients who underwent ankle and hindfoot arthrodesis had statistically significant improvements from preoperative to 12 months postoperative in mean PF (36.26±7.85 vs 39.38±6.46, P = .03) and PI (61.07±7.75 vs 56.62±9.81, P = .02). Triple arthrodesis saw the greatest increases in physical function (▵PF = 7.22±7.31, P = .01) and reductions in pain (▵PI = –9.17±8.31, P = .01), achieving minimal clinically important difference (MCID). Patients who underwent tibiotalar fusion had significant improvement in physical function (▵PF = 4.18±5.68, P = .04) and pain reduction that approached statistical significance (▵PI = –6.24±8.50, P = .09), achieving MCID. Older age (≥60 years ) was associated with greater improvements in PF ( β = 0.20, P = .07) and PI ( β = –0.29, P = .04). Preoperative PF and PI T scores were significantly associated with the 12-month change in PF and PI T scores, respectively ( β = –0.74, P < .01; β = –0.61, P < .01). Conclusion: Hindfoot and ankle fusions are procedures with favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation. Level of Evidence: Level II, prospective comparative study.

Prospective Patient Reported Outcomes (PRO) Study Assessing Outcomes of Surgically Managed Ankle Fractures

2019 ◽  
Vol 41 (2) ◽  
pp. 206-210
Author(s):  
Jasen Gilley ◽  
Raheem Bell ◽  
Mateus Lima ◽  
Bennet Butler ◽  
Joshua E. Barrett ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Outcome Measurement ◽  
Patient Reported Outcome ◽  
Ankle Fractures ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Mean Values ◽  
Population Mean ◽  
Patient Reported ◽  
Nonnormal Distribution

Background: Ankle fractures are a common cause of morbidity that have increased in incidence over the past decade. The purpose of this study was to compare the outcomes and prognosis of various fracture subtypes by using 2 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: Twelve-month postoperative PF and PI CATs were collected for 126 ankle fracture patients presenting between 2014 and 2017. Patients were stratified by ankle fracture subtype and refined by the presence/absence of concomitant deltoid injury or posterior malleolar fracture. Patients defined as members of vulnerable populations and patients presenting more than 2 weeks from time of injury or with prior acute ipsilateral fracture were excluded. The distribution of PF and PI T scores were assessed via a Shapiro-Wilk test and a 1-way analysis of variance. If significant differences were found between groups, pairwise comparisons were tested via Dwass, Steel, and Critchlow-Fligner multiple comparison analysis. Results: Mean values for the PROMIS PF and PI for each fracture subtype were calculated and compared to reference population mean (SD) T scores of 50 (10): isolated lateral malleolar (PF: 50/PI: 51), isolated medial malleolar (PF: 52/PI: 49), bimalleolar (PF: 48/PI: 50), trimalleoar (PF: 47/PI: 51), isolated posterior malleolar (PF: 53/PI: 44), and isolated syndesmotic injury (PF: 60/PI: 46). Shapiro-Wilk test indicated a nonnormal distribution for the postoperative PROMIS PF T scores across all fracture patients ( P = .0421). Conclusion: Operative fixation of an ankle fracture was able to return most patients to the population mean with regard to PROMIS function and pain regardless of fracture type. Level of Evidence: Level II, prospective comparative study.

Appraisal of Candidate Instruments for Assessment of the Physical Function Domain in Patients with Psoriatic Arthritis

2020 ◽  
Vol 48 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Ying Ying Leung ◽  
Ana-Maria Orbai ◽  
Alexis Ogdie ◽  
Pil Hojgaard ◽  
Richard Holland ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Physical Function ◽  
Outcome Measures ◽  
Physical Functioning ◽  
Working Group ◽  
Short Form ◽  
Outcome Measurement ◽  
Patient Reported Outcome Measures ◽  
Measurement Information ◽  
Patient Reported

Objective.Numerous patient-reported outcome measures (PROM) exist for the measurement of physical function for psoriatic arthritis (PsA), but only a few are validated comprehensively. The objective of this project was to prioritize PROM for measuring physical function for potential incorporation into a standardized outcome measurement set for PsA.Methods.A working group of 13 members including 2 patient research partners was formed. PROM measuring physical function in PsA were identified through a systematic literature review and recommendations by the working group. The rationale for inclusion and exclusion from the original list of existing PROM was thoroughly discussed and 2 rounds of Delphi exercises were conducted to achieve consensus.Results.Twelve PROM were reviewed and discussed. Six PROM were prioritized: Health Assessment Questionnaire (HAQ) and 4 modifications (HAQ-Disability Index, HAQ-Spondyloarthritis, modified HAQ, multidimensional HAQ), Medical Outcomes Study 36-item Short Form survey physical functioning domain, and the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning module.Conclusion.Through discussion and Delphi exercises, we achieved consensus to prioritize 6 physical function PROM for PsA. These 6 PROM will undergo further appraisal using the Outcome Measures in Rheumatology (OMERACT) Filter 2.1.

scholarly journals FAAM ADL Scores Correlate with PROMIS Physical Function, Pain Interference, and Depression Outcomes

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0001 ◽  
Author(s):  
Devon Nixon ◽  
Jeremy McCormick ◽  
Jeffrey Johnson ◽  
Sandra Klein
Keyword(s):  
Lower Extremity ◽  
Physical Function ◽  
Multivariate Analyses ◽  
Smoking Status ◽  
Outcome Measurement ◽  
Patient Reported Outcome ◽  
Pain Interference ◽  
Measurement Information ◽  
Significant Group ◽  
Patient Reported

Category: Midfoot/Forefoot Introduction/Purpose: Legacy patient-reported outcome instruments like the FAAM Activities of Daily Living (ADL) quantify patient disability but are often limited by responder burden and incomplete questionnaires. The Patient-Reported Outcome Measurement Information System (PROMIS) overcomes such obstacles through computer-adaptive technology to collect data on various health domains including Physical Function (PF), Pain Interference (PI), and Depression. Few reports, though, have examined PROMIS tools in lower extremity patients, and no study has examined PROMIS psychosocial outcomes like PI and Depression in foot and ankle conditions. We investigated the relationship between FAAM ADL and PROMIS measures, hypothesizing that FAAM ADL and PROMIS scores would correlate. Methods: All new patients with either a primary or secondary diagnosis of hallux valgus based on clinic billing codes from July, 2015 – February, 2016 were retrospectively identified. Patients with complete FAAM ADL paper-based surveys and electronic PROMIS questionnaires for PF, PI, and Depression were included. Spearman rho correlations were performed between FAAM ADL and PROMIS scores. Bivariate and multivariate analyses were then performed to identify differences in FAAM ADL and PROMIS PF measures based on select demographic variables (gender, comorbidities, marital status, employment status, prior foot and/or ankle surgery, and smoking status). Significant variables (P < 0.1) from bivariate and multivariate analyses were then entered into stepwise linear regressions to determine which variable(s) determined variance in FAAM ADL and PROMIS PF scores. Results: Eighty-five patients were identified (13 males, 72 females). FAAM scores significantly correlated with PROMIS PF (r = 0.70, P < 0.001), PI (r = 0.65, P < 0.001), and Depression (r = 0.35, P < 0.001) outcomes. Bivariate and multivariate analyses revealed significantly lower FAAM ADL scores in men (P = 0.02) and active smokers (P = 0.1). No significant group differences were detected for PROMIS PF scores (P > 0.1). Regression analyses demonstrated that PROMIS PI scores alone accounted for significant portions of the variance in FAAM ADL (R2 = 0.44, P < 0.001) and PROMIS PF (R2 = 0.57, P < 0.001) measures. Conclusion: PROMIS PF, PI, and Depression scores all correlated with FAAM ADL scores, highlighting the importance of understanding functional and psychosocial disability when assessing outcomes in lower extremity patients. Further, PROMIS PI results predicted significant portions of FAAM ADL and PROMIS PF scores, suggesting that function and pain are interrelated when measured by either traditional or modern outcomes instruments.

Comparison Between Polyvinyl Alcohol Implant and Cheilectomy With Moberg Osteotomy for Hallux Rigidus

2020 ◽  
Vol 41 (9) ◽  
pp. 1031-1040 ◽  
Author(s):  
Bopha Chrea ◽  
Stephanie K. Eble ◽  
Jonathan Day ◽  
Scott J. Ellis ◽  
Mark C. Drakos ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Polyvinyl Alcohol ◽  
Pain Intensity ◽  
Physical Function ◽  
Patient Reported Outcomes ◽  
Hallux Rigidus ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Patient Reported

Background: In 2016, the US Food and Drug Administration (FDA) approved the use of a polyvinyl alcohol (PVA) hydrogel implant for the surgical management of hallux rigidus. Though recent studies have evaluated the safety and efficacy of the implant, no study has compared outcomes following PVA implantation with those following traditional joint-preserving procedures for hallux rigidus, such as cheilectomy with Moberg osteotomy. The purpose of this study was to compare clinical and patient-reported outcomes for patients undergoing cheilectomy and Moberg osteotomy, with or without PVA implant, at a single multisurgeon academic center. Our hypothesis was that the addition of the PVA implant would result in superior clinical and patient-reported outcomes. Methods: In total, 166 patients were identified who underwent cheilectomy and Moberg osteotomy with (PVACM; n = 72) or without (CM; n = 94) a PVA implant between January 2016 and December 2018 by 1 of 8 foot and ankle fellowship-trained orthopedic surgeons at our institution. Of these patients, 60 PVACM and 73 CM patients had both baseline and minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. The average time to survey follow-up was 14.5 months for PVACM patients and 15.6 months for CM patients. Retrospective chart review was performed to assess the incidence of postoperative complications and reoperations, with an average clinical follow-up of 27.7 (range, 16.0-46.4) months for PVACM patients and 36.6 (range, 18.6-47.8) months for CM patients. Results: Both PVACM and CM cohorts demonstrated significant improvement in the PROMIS Physical Function, Pain Interference, Pain Intensity, and Global Physical Health domains when comparing preoperative and postoperative scores within each group ( P < .01). When comparing scores between the PVACM and CM cohorts, preoperative scores were similar, while CM patients demonstrated significantly higher postoperative Physical Function (51.8 ± 8.7 vs 48.8 ± 8.0; P = .04) and significantly lower Pain Intensity (39.9 ± 8.3 vs 43.4 ± 8.7; P = .02) scores. The pre- to postoperative change in Physical Function was also significantly greater for CM patients (7.1 ± 8.5 vs 3.6 ± 6.2; P = .011). In the PVACM group, there were 3 revisions (5%), 1 reimplantation, 1 conversion to arthrodesis, and 1 revision to correct hyperdorsiflexion. In the CM group, there was 1 revision (1.4%), a conversion to arthrodesis ( P = .21). Other postoperative complications included persistent pain (7 out of 60 PVACM patients [11.7%] and 8 out of 73 CM patients [11.0%]; P = .90) and infection in 3 PVACM patients (5%) and no CM patients ( P = .05). Conclusion: Though our results generally support the safety and utility of the PVA implant as previously established by the clinical trial, at 1 to 2 years of follow-up, CM without a PVA implant may provide equivalent or better relief compared with a PVACM procedure, while avoiding potential risks associated with the implant. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Outcomes of Idiopathic Flexible Flatfoot Deformity Reconstruction in the Young Patient

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093798 ◽  
Author(s):  
Jonathan Day ◽  
Jaeyoung Kim ◽  
Matthew S. Conti ◽  
Nicholas Williams ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Physical Function ◽  
Age Groups ◽  
Measurement Information ◽  
Posterior Tibial Tendon ◽  
Level Of Evidence ◽  
Younger Patients ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Flexible Flatfoot ◽  
Patient Reported

Background: Operative correction of flatfoot deformity has been well studied in the older population. There is a subset of younger patients without congenital foot deformity that also develop a collapsing flatfoot. However, assessment of outcomes across age groups is limited, especially in the young demographic. The purpose of our study was to compare operative outcomes of flatfoot reconstruction between these 2 age groups. Methods: Seventy-six feet (41 left, 35 right) in 71 patients who underwent flexible flatfoot reconstruction were divided into 2 groups based on age: ≤30 years (n = 22) and >30 years (n = 54). Exclusion criteria included congenital causes of flatfoot (tarsal coalition, vertical talus, overcorrected clubfoot). Average age was 20.8 years (range, 14-30) and 55.4 years (range, 35-74) in the younger and older cohorts, respectively. Preoperative and minimum 2-year postoperative Patient-Reported Outcomes Measurement Information Systems (PROMIS) scores were compared. Five radiographic parameters were assessed pre- and postoperatively: talonavicular coverage angle, lateral talo–first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, and hindfoot moment arm. Procedures performed and incidence of minor (removal of symptomatic hardware) and major (revision) reoperations were compared. Results: Younger patients were less likely to undergo flexor digitorum longus transfer, first tarsometatarsal fusion, spring ligament repair, and posterior tibial tendon repair (all P < .05). Both younger and older cohorts demonstrated significant improvement in multiple PROMIS domains at an average follow-up of 30.6 (range, 24-44) and 26.8 (range, 24-45) months, respectively ( P = .07). Younger patients demonstrated significantly higher pre- and postoperative Physical Function (mean difference postoperatively, 4.6; 95% confidence interval, 1.5-7.8; P = .03). There were no differences in radiographic parameters postoperatively. There were 8 (36.4%) reoperations (all minor) in the younger group, and 21 (38.9%) reoperations (6 major, 15 minor) in the older group ( P = .84). Conclusion: Our data suggest that age may play a role in clinical outcomes, procedures indicated, and subsequent corrective reoperations. Younger patients maintained greater physical function with comparable radiographic correction, with less frequent indication for tendon transfers, arthrodesis, and additional corrective surgeries. Level of Evidence: Level III, retrospective comparative study.

Generating the American Shoulder and Elbow Surgeons Score Using Multivariable Predictive Models and Computer Adaptive Testing to Reduce Survey Burden

2021 ◽  
Vol 49 (3) ◽  
pp. 764-772
Author(s):  
Matthew S. Tenan ◽  
Joseph W. Galvin ◽  
Timothy C. Mauntel ◽  
John M. Tokish ◽  
James R. Bailey ◽  
...  
Keyword(s):  
Physical Function ◽  
Predictive Model ◽  
Predictive Models ◽  
Patient Reported Outcomes ◽  
Patient Survey ◽  
Patient Reported Outcome ◽  
Pain Interference ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Patient Reported

Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. Purpose: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative variables. Patients in MOTION research who underwent shoulder surgery and completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at varying time points were included in the present analysis. Nonlinear multivariable predictive models were created to establish an ASES index score and then validated using “leave 1 out” techniques and minimal clinically important difference /substantial clinical benefit (MCID/SCB) analysis. Results: A total of 909 patients completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at presurgery, 6 weeks, 6 months, and 1 year after surgery, providing 1502 complete observations. The PROMIS CAT predictive model was strongly validated to predict the ASES (Pearson coefficient = 0.76-0.78; R2 = 0.57-0.62; root mean square error = 13.3-14.1). The MCID/SCB for the ASES was 21.7, and the best ASES index MCID/SCB was 19.4, suggesting that the derived ASES index is effective and can reliably re-create ASES scores. Conclusion: The PROMIS CAT predictive models are able to approximate the ASES score within 13 to 14 points, which is 7 points more accurate than the ASES MCID/SCB derived from the sample. Our ASES index algorithm, which is freely available online ( https://osf.io/ctmnd/ ), has a lower MCID/SCB than the ASES itself. This algorithm can be used to decrease patient survey burden by 11 questions and provide a reliable ASES analog to clinicians.

Association of First Metatarsal Pronation Correction With Patient-Reported Outcomes and Recurrence Rates in Hallux Valgus

2021 ◽  
pp. 107110072110469
Author(s):  
Matthew S. Conti ◽  
Tamanna J. Patel ◽  
Jiaqi Zhu ◽  
Andrew J. Elliott ◽  
Stephen F. Conti ◽  
...  
Keyword(s):  
Physical Function ◽  
Hallux Valgus ◽  
Patient Reported Outcomes ◽  
Measurement Information ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
First Metatarsal ◽  
Patient Reported ◽  
Multivariable Regression

Background: The purpose of this study was to determine if a postoperative decrease in first metatarsal pronation on 3-dimensional imaging was associated with changes in patient-reported outcomes as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity domains or recurrence rates in patients with hallux valgus (HV) who undergo a first tarsometatarsal fusion (modified Lapidus procedure). Methods: Thirty-nine consecutive HV patients who met the inclusion criteria and underwent a modified Lapidus procedure had preoperative and ≥2-year postoperative PROMIS scores and had first metatarsal pronation measured on preoperative and at least 5-month postoperative weightbearing CT scans were included. Multivariable regression analyses were used to investigate differences in the change in PROMIS domains preoperatively and 2 years postoperatively between patients with “no change/increased first metatarsal pronation” and “decreased first metatarsal pronation.” A log-binomial regression analysis was performed to identify if a decrease in first metatarsal pronation was associated with recurrence of the HV deformity. Results: The decreased first metatarsal pronation group had a significantly greater improvement in the PROMIS physical function scale by 7.2 points ( P = .007) compared with the no change/increased first metatarsal pronation group. Recurrence rates were significantly lower in the decreased first metatarsal pronation group when compared to the no change/increased first metatarsal pronation group (risk ratio 0.25, P = .025). Conclusion: Detailed review of this limited cohort of patients who underwent a modified Lapidus procedure suggests that the rotational component of the HV deformity may play an important role in outcomes and recurrence rates following the modified Lapidus procedure. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Do Patient Reported Outcome Measurement Information System (PROMIS) Scales Demonstrate Responsiveness as Well as Disease-Specific Scales in Patients Undergoing Knee Arthroscopy?

2019 ◽  
Vol 47 (6) ◽  
pp. 1396-1403 ◽  
Author(s):  
Raymond J. Kenney ◽  
Jeff Houck ◽  
Brian D. Giordano ◽  
Judith F. Baumhauer ◽  
Meghan Herbert ◽  
...  
Keyword(s):  
Information System ◽  
Convergent Validity ◽  
Knee Arthroscopy ◽  
Outcome Measurement ◽  
International Knee Documentation Committee ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Disease Specific

Background: The Patient Reported Outcomes Information System (PROMIS) is an efficient metric able to detect changes in global health. Purpose: To assess the responsiveness, convergent validity, and clinically important difference (CID) of PROMIS compared with disease-specific scales after knee arthroscopy. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: A prospective institutional review board–approved study collected PROMIS Physical Function (PF), PROMIS Pain Interference (PI), International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) results in patients undergoing knee arthroscopy. The change from preoperative to longest follow-up was used in analyses performed to determine responsiveness, convergent validity, and minimal and moderate CID using the IKDC scale as the anchor. Results: Of the 100 patients enrolled, 76 were included. Values of the effect size index (ESI) ranged from near 0 to 1.69 across time points and were comparable across scales. Correlations of the change in KOOS and PROMIS with IKDC ranged from r values of 0.61 to 0.79. The minimal CID for KOOS varied from 12.5 to 17.5. PROMIS PF and PI minimal CID were 3.3 and −3.2. KOOS moderate CID varied from 14.3 to 18.8. PROMIS PF and PI moderate CID were 5.0 and −5.8. Conclusion: The PROMIS PF and PI showed similar responsiveness and CID compared with disease-specific scales in patients after knee arthroscopy. PROMIS PI, PROMIS PF, and KOOS correlations with IKDC demonstrate that these scales are measuring a similar construct. The ESIs of PROMIS PF and PI were similar to those of KOOS and IKDC, suggesting similar responsiveness at 6 months or longer (ESI >1.0). Minimum and moderate CID values calculated for PROMIS PF and PI using IKDC as an anchor were sufficiently low to suggest clinical usefulness. Clinical Relevance: PROMIS PF and PI can be accurately used to determine improvement or lack thereof with clinically important changes after knee arthroscopy.

Sign in / Sign up

Export Citation Format

Share Document