No abstract

The relationships shown here between PROMIS and FAAM scores further support the use of PROMIS tools in outcomes-based research. In patients with hallux valgus, pain-related disability appears to be a central feature of the patient-experience. Future studies should assess the association of various outcome domains on other common foot and ankle diagnoses.

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.

Level III, comparative series.

Level III.

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.

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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.