scholarly journals Patient reported outcome of 33 operatively treated talar fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Patrick Pflüger ◽  
Michael Zyskowski ◽  
Anne Weber ◽  
Katharina Gleisenberg ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Functional Outcome ◽  
Avascular Necrosis ◽  
Patient Reported Outcome ◽  
Timing Of Surgery ◽  
Foot And Ankle ◽  
Concomitant Injuries ◽  
Concomitant Injury ◽  
Patient Reported ◽  
Talar Fractures

Abstract Background Management of talar fractures remains to be one of the most challenging aspects in trauma surgery. Unfortunately, the evidence regarding the correct treatment of these fractures is mainly based on retrospective case series, while studies assessing the patient-reported outcome are rare. Therefore, the aim of this trial was to analyze the patient reported outcome in context of trauma mechanism and concomitant injuries following operative treatment of talar fractures. Methods A retrospective outcome study of patients with operatively treated talar fractures between 2003 and 2015 was conducted. The fractures were classified according to AO-/Hawkins classification system and to the Marti-Weber classification. Data was collected via patient registry, radiographs and a validated patient-reported outcome measure (PROM) for foot and ankle pathologies (Foot and Ankle Outcome Score = FOAS). An analysis regarding the functional outcome, concomitant injury and timing of surgery using the nonparametric Mann-Whitney U test and Spearman`s rank correlation was performed. Results In total the functional outcome of 32 patients suffering from fractures to the talus were analyzed. The median age of the study cohort was 35±12.2 years, including 9 female (28 %) and 23 male (72 %) patients. The median FAOS score was 72±22.7 (range 13–94). Patients with an isolated talar fracture had an FAOS of 87±20 and with concomitant injury a score of 60±23.4 (p = 0.016). Patients with a closed talar fracture without emergency operation due to dislocation or polytrauma, showed no correlation between timing of surgery and FAOS (r= -0.17, p = 0.43). 10 % of the patients developed an avascular necrosis and 25 % showed signs of a posttraumatic arthritis. The follow-up time was 41 months (range: 16–145). Conclusions Talar fractures were typically caused by high-energy trauma often associated with additional injuries of the lower extremity. The majority of the patients showed a fair to poor functional long-term outcome. Concomitant injuries of the lower extremity led to a lower FAOS. In closed talar fractures without the necessity of an emergency surgical intervention, time to surgery did not influence the patient reported outcome. Relating to the presented data, delayed surgery after soft tissue consolidation was not associated with a higher risk of developing an avascular necrosis.

scholarly journals Minimal Clinically Important Difference of Patient Reported Outcome Measures of Lower Extremity Injuries in Orthopedics

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0007 ◽  
Author(s):  
Derya Çelik ◽  
Özge Çoban ◽  
Önder Kılıçoğlu
Keyword(s):  
Lower Extremity ◽  
Outcome Measures ◽  
Minimal Clinically Important Difference ◽  
Rating Scale ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Foot And Ankle ◽  
Clinically Important Difference ◽  
Outcome Score ◽  
Patient Reported

Purpose: MCID scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. To conduct a systematic review of the quality and content of the the minimal clinically important difference (MCID) relating to 16 patient-rated outcome measures (PROM) used in lower extremity. Methods: We conducted a systematic literature review on articles reporting MCID in lower extremity outcome measures and orthopedics from January 1, 1980, to May 10, 2016. We evaluated MCID of the 16 patient reported outcome measures (PROM) which were Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), The International Knee Documentation Committee Subjective Knee Form (IKDC), The Lysholm Scale, The Western Ontario Meniscal Evaluation Tool (WOMET), The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL), The Lower Extremity Functional Scale (LEFS), The Western Ontario and Mcmaster Universities Index (WOMAC), Knee İnjury And Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale, The Victorian Institute of Sports Assessment Patellar Tendinosis (Jumper’s Knee) (VİSA-P), Tegner Activity Rating Scale, Marx Activity Rating Scale, Foot And Ankle Outcome Score (FAOS), The Foot Function Index (FFI), Foot And Ankle Ability Measure (FAAM), The Foot And Ankle Disability Index Score and Sports Module, Achill Tendon Total Rupture Score(ATRS), The Victorian İnstitute Of Sports Assesment Achilles Questionnaire(VİSA-A), American Orthopaedic Foot and Ankle Society (AOFAS). A search of the PubMed/MEDLINE, PEDro and Cochrane Cen¬tral Register of Controlled Trials and Web of Science databases from the date of inception to May 1, 2016 was conducted. The terms “minimal clinically important difference,” “minimal clinically important change”, “minimal clinically important improvement” “were combined with one of the PROM as mentioned above. Results: A total of 223 abstracts were reviewed and 119 articles chosen for full text review. Thirty articles were included in the final evaluation. The MCID was mostly calculated for WOMAC and frequently reported in knee and hip osteoartritis, knee and hip atrhroplasties, femoraasetabular impingement syndrome and focal cartilage degeneration. In addition, Receiver Operating Characteristic (ROC) analysis was the most used method to report MCID. Conclusions: MCID is an important concept used to determine whether a medical intervention improves perceived outcomes in patients. Despite an abundance of methods reported in the literature, little work in MCID estimation has been done in the PRAM related to lower extremity. There is a need for future studies in this regard.

scholarly journals Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

2021 ◽  
Vol 27 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Mikko M. Uimonen ◽  
Ville T. Ponkilainen ◽  
Alar Toom ◽  
Mikko Miettinen ◽  
Arja H. Häkkinen ◽  
...  
Keyword(s):  
Patient Reported Outcome ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Patient Reported

scholarly journals Determining Success or Failure After Foot and Ankle Surgery Using Patient Acceptable Symptom State (PASS) and Patient Reported Outcome Information System (PROMIS)

2018 ◽  
Vol 39 (8) ◽  
pp. 894-902 ◽  
Author(s):  
Michael R. Anderson ◽  
Judith F. Baumhauer ◽  
Benedict F. DiGiovanni ◽  
Sam Flemister ◽  
John P. Ketz ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Patient Outcomes ◽  
Roc Analysis ◽  
Patient Reported Outcome ◽  
Foot And Ankle ◽  
Chi Square ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Patient Acceptable Symptom State ◽  
Chi Square Analysis

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery. Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = 88). Patient outcome as determined by phone interviews included PASS and patients’ judgment of whether their surgery was a S/F. Assessment also included PROMIS physical function (PF), pain interference (PI), and depression (D) scales. The association between S/F and PASS outcomes was evaluated by chi-square analysis. A 2-way analysis of variance (ANOVA) evaluated the ability of PROMIS to discriminate PASS and/or S/F outcomes. Receiver operator curve (ROC) analysis was used to evaluate the ability of pre- (n = 63) and postoperative (n = 88) PROMIS scores to predict patient outcomes (S/F and PASS). Finally, the proportion of individuals classified by the identified thresholds were evaluated using chi-square analysis. Results: There was a strong association between PASS and S/F after surgery (chi-square <0.01). Two-way ANOVA demonstrated that PROMIS t scores discriminate whether patients experienced positive or negative outcome for PASS ( P < .001) and S/F ( P < .001). The ROC analysis showed significant accuracy (area under the curve > 0.7) for postoperative but not preoperative PROMIS t scores in determining patient outcome for both PASS and S/F. The proportion of patients classified by applying the ROC analysis thresholds using PROMIS varied from 43.0% to 58.8 % for PASS and S/F. Conclusions: Patients who found their symptoms and activity at a satisfactory level (ie, PASS yes) also considered their surgery a success. However, patients who did not consider their symptoms and activity at a satisfactory level did not consistently consider their surgery a failure. PROMIS t scores for physical function and pain demonstrated the ability to discriminate and accurately predict patient outcome after foot and ankle surgery for 43.0% to 58.8% of participants. These data improve the clinical utility of PROMIS scales by suggesting thresholds for positive and negative patient outcomes independent of other factors. Level of Evidence: II, prospective comparative series.

The Oxford Ankle Foot Questionnaire for Children: Review of Development and Potential Applications

2010 ◽  
Vol 34 (3) ◽  
pp. 238-244 ◽  
Author(s):  
Christopher Morris ◽  
Helen Doll ◽  
Andrew Wainwright ◽  
Neville Davies ◽  
Tim Theologis ◽  
...  
Keyword(s):  
Development Process ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Clinical Settings ◽  
Foot And Ankle ◽  
Validity And Reliability ◽  
Patient Reported ◽  
Potential Applications ◽  
A Prospective Study ◽  
Longitudinal Validity

There is increasing recognition of the credibility and utility of patient reported outcome measures, both in research and as routine quality indicators. This paper reviews the development of a questionnaire for children with foot or ankle problems and integrates the findings from three previously published studies in a cohesive way for the orthotic community. The Oxford Ankle Foot Questionnaire for Children was designed to evaluate the effectiveness of interventions. The development process was conducted in three phases. First the items were devised through focus groups with children affected by foot and ankle problems, and their parents. Second, test versions of child and parent questionnaires were evaluated to enable scales to be developed and tested for validity and reliability. Finally, findings from a prospective study assessing how scores changed over time and/or with treatment supported the longitudinal validity and responsiveness of the scales. The questionnaire offers an inexpensive and expedient means to evaluate the effectiveness of orthoses and other interventions used to treat children's foot or ankle problems. The Oxford Ankle Foot Questionnaire for Children has broad utility both in routine clinical settings, or applied research to evaluate treatment programmes and interventions used in paediatric orthopaedics, trauma and rheumatology.

scholarly journals Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases

2020 ◽  
Vol 09 (05) ◽  
pp. 388-395
Author(s):  
Marcus Sagerfors ◽  
Eva Lundqvist ◽  
Patrik Bjorling
Keyword(s):  
Functional Outcome ◽  
Distal Radius ◽  
Patient Reported Outcome ◽  
Radiographic Outcome ◽  
Pain Scores ◽  
Hand Grip ◽  
Articular Fractures ◽  
Patient Reported ◽  
Tendon Ruptures ◽  
Type C

Abstract Background The distal radius fracture (DRF) is the most common fracture in adults. For unstable intra-articular fractures, the choice of treatment is often operative. The optimal choice of fixation remains a matter of discussion. Question/Purpose Can combined volar and dorsal plating, using a dorsal frame plate, achieve a good functional and radiographic 1-year outcome in intra-articular DRFs? Methods In a retrospective cohort study, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate. The DRFs were operated between 2016 and 2017 and all cases were AO type C intra-articular fractures. The primary outcome was patient-reported outcome measures including radiographic examination 1 year postoperatively. Secondary outcome measures included wrist range of motion, visual analog scale (VAS) pain scores, and hand grip strength. Results The median patient-rated wrist evaluation score was 18 points; the quick disabilities of the arm, shoulder, and hand score was 14.8 points. The median Batra radiographic score was 88. Wrist extension was 76% of the uninjured side, flexion was 74%, pronation was 94%, and supination was 94%. VAS pain scores were 0 at rest and 2 during activity. Hand grip strength was 82% compared with the uninjured side. The radiographic outcome according to Batra did not correspond to the patient-reported outcome. Patients older than 60 years had significantly better QuickDASH (quick disabilities of the arm, shoulder, and hand) and PRWE scores (patient-rated wrist evaluation scores) and less pain during activity compared with younger patients despite similar radiographic outcome. There were no tendon ruptures; hardware removal was performed in 21 of the 74 patients. Conclusion The radiographic outcome did not correspond to the functional outcome 1 year postoperatively. Older patients report less pain and better functional outcome compared with younger patients. There were no tendon ruptures and the frequency of hardware removal was acceptable. Complex intra-articular DRFs AO type C can be managed with volar and dorsal frame-plate fixation to restore distal radius anatomy and achieve a good functional outcome.

scholarly journals Latarjet as a primary and revision procedure for anterior shoulder instability – A comparative study of survivorship, complications and functional outcomes in the medium to long-term

2019 ◽  
Vol 12 (5) ◽  
pp. 338-348
Author(s):  
Liam Z Yapp ◽  
Jamie A Nicholson ◽  
Charlotte McCallum ◽  
Deborah J Macdonald ◽  
C Michael Robinson
Keyword(s):  
Functional Outcome ◽  
Shoulder Instability ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Revision Procedure ◽  
Surgery Patient ◽  
Patient Reported ◽  
Functional Scores

Background This retrospective study aims to compare the outcome of the Latarjet procedure when used as a primary or revision procedure for recurrent anterior gleno-humeral instability. Methods One hundred and ninety-seven patients underwent 205 open Latarjet procedures during the period 2006–2015 (mean follow-up 5.6 years). Sixty shoulders had failure of a previous stabilisation requiring revision to the Latarjet procedure. Outcomes were measured using the Western Ontario Shoulder Instability Index and Quick Disabilities of the Arm, Shoulder and Hand score. Survival analyses were performed using Kaplan–Meier curves, and multiple linear regression modelling was utilised to identify predictors of functional outcome (p < 0.05). Results Two shoulders had recurrent dislocations in the cohort of 205 (1.0%). Six shoulders underwent further surgery for non-instability complications (2.9%). There were no significant differences in the clinical or functional outcome between patients undergoing a primary Latarjet procedure and those who required revision of a failed soft-tissue stabilisation. Ninety-two per cent of patients were satisfied with their shoulder following surgery. Patient-reported instability and satisfaction was significantly associated with poorer functional scores. Discussion The Latarjet procedure successfully prevents recurrent anterior instability and is associated with high levels of satisfaction. Patient-reported outcome measures suggest no difference between primary and revision procedures.

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.

scholarly journals Changes in Patient-Reported Outcome Measures From the Time of Injury to Return to Play in Adolescent Athletes at Secondary Schools With an Athletic Trainer

2019 ◽  
Vol 54 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Janet E. Simon ◽  
Alison R. Snyder Valier ◽  
Zachary Y. Kerr ◽  
Aristarque Djoko ◽  
Stephen W. Marshall ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Outcome Measure ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Return To Play ◽  
Foot And Ankle ◽  
Adolescent Athletes ◽  
Patient Reported ◽  
Ability Measure

Context Typically, athletic trainers rely on clinician-centered measures to evaluate athletes' return-to-play status. However, clinician-centered measures do not provide information regarding patients' perceptions. Objective To determine whether clinically important changes in patient-reported outcomes were observed from the time of lower extremity injury to the time of return to play in adolescent athletes. Design Cross-sectional study. Setting The National Athletic Treatment, Injury and Outcomes Network (NATION) program has captured injury and treatment data in 31 sports from 147 secondary schools across 26 states. A subsample of 24 schools participated in the outcomes study arm during the 2012−2013 and 2013−2014 academic years. Patients or Other Participants To be included in this report, student-athletes must have sustained a knee, lower leg, ankle, or foot injury that restricted participation from sport for at least 3 days. A total of 76 initial assessments were started by athletes; for 69 of those, return-to-play surveys were completed and analyzed. Main Outcome Measure(s) All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] survey, Global Rating of Change scale, and Numeric Pain Rating Scale) and, depending on body region, completed an additional region-specific measure (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure). All applicable surveys were completed at both the initial and return-to-play time points. Means and standard deviations for the total scores of each patient-reported outcome measure at each time point were calculated. Change scores that reflected the difference from the initial to the return-to-play time points were calculated for each participant and compared with established benchmarks for change. Results The greatest improvement in patient-reported outcomes was in the region-specific forms, with scores ranging from 9.92 to 37.73 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure; scores range from 0−100). The region-specific subscales on average still showed a 21.8- to 37.5-point deficit in reported health at return to play. The PROMIS Lower Extremity score increased on average by 13 points; all other PROMIS scales were within normative values after injury. Conclusions Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in patient-reported outcomes over time, but when they returned to play, their outcome scores remained lower than norms from comparable athlete groups.

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