Another bl....y outcome measure for the foot

NewsBot · May 3, 2011

Validation of the American College of Foot and Ankle Surgeons Scoring Scales.
Cook JJ, Cook EA, Rosenblum BI, Landsman AS, Roukis TS.
J Foot Ankle Surg. 2011 Apr 27. [Epub ahead of print]

The American College of Foot and Ankle Surgeons (ACFAS) assembled a task force to develop a scoring scale that could be used by the membership and practitioners-at-large. The original publication that introduced the scale focused primarily on use of the scale and provided only brief background on the development of the health measurement instrument. Concerns regarding the validity and reliability of the scale were raised within the professional community, and ACFAS assembled a task force to address these concerns. The purpose of this article is to address the issues raised by reporting the detailed methods used in the development of the ACFAS Scoring Scales. The authors who constitute this task force reviewed the body of work previously conducted and applied standards that serve to evaluate the scoring scale for: 1) validity, 2) reliability, and 3) sensitivity to change. The results showed that a systematic and comprehensive approach was used in the development of the scoring scales, and the task force concluded that the statistical methods and instrument development process for all 4 modules of the scoring scales were conducted in an appropriate manner. Furthermore, modules 1 and 2 have been rigorously assessed and the elements of these modules have been shown to meet standards for validity, reliability, and sensitivity to change.
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Brian A. Rothbart · May 4, 2011

Measuring the Rothbarts Foot

Here is a double blind randomized study at Georgia State University to determine the accuracy of measuring the Rothbarts Foot:

Discussion: Orthosis prescription for forefoot posting is commonly based upon measures of the forefoot performed on a non-weight bearing foot. However, the relationship of measures of the unloaded foot to determine orthosis prescription for compensatory forefoot function during gait is still in question. Another approach [originally introduced by Dr Brian A Rothbart] to determine orthosis prescription is to, [using microwedges], measure the height of forefoot posting necessary to prevent excessive pronation of the subtalar joint during weight bearing.

Purpose: The purpose of this study was to determine the intrarater, interrater and day-to-day reliability of forefoot measures during an active, weight bearing movement. Methodology:

Study: Thirty-two volunteers, 18 females (mean age 38.9 ± 15.3 yr) and 18 males (mean age 44.8 ± 20.6 yr) participated in the study. Four examiners performed repeated forefoot measures on both feet using the weight bearing technique during two test sessions separated by a week. Intrarater and interrater reliability (ICC (3,1)) ranged from 0.90 to 0.95 and 0.87 to 0.94, respectively. Day-to-day reliability (ICC (1,1)) ranged from 0.84 to 0.88 for all measures.

Conclusion: The weight bearing method used in this study to determine forefoot posting is reliable. The acceptable reliability of this method justifies the need for future investigations of the validity and the clinical efficacy of this technique for orthosis prescription.

The Cummings study was an, independent, double blind study. It established the accuracy and inter/intra-rater reliability of the PMSv measurements. This same measuring technique is used today in the differential diagnosis for the differential diagnosis of Rothbarts Foot.

Cummings GS, Higbie, EJ 1997 A weight bearing method for determining forefoot posting for orthotic fabrication. Physiotherapy Research International, Vol 2(1):42-50. [This study was funded by a grant from the College of Health Sciences at Georgia State University]

Griff · May 4, 2011

Re: Measuring the Rothbarts Foot

Brian A. Rothbart said: ↑

Here is a double blind randomized study at Georgia State University to determine the accuracy of measuring the Rothbarts Foot:

Discussion: Orthosis prescription for forefoot posting is commonly based upon measures of the forefoot performed on a non-weight bearing foot. However, the relationship of measures of the unloaded foot to determine orthosis prescription for compensatory forefoot function during gait is still in question. Another approach [originally introduced by Dr Brian A Rothbart] to determine orthosis prescription is to, [using microwedges], measure the height of forefoot posting necessary to prevent excessive pronation of the subtalar joint during weight bearing.

Purpose: The purpose of this study was to determine the intrarater, interrater and day-to-day reliability of forefoot measures during an active, weight bearing movement. Methodology:

Study: Thirty-two volunteers, 18 females (mean age 38.9 ± 15.3 yr) and 18 males (mean age 44.8 ± 20.6 yr) participated in the study. Four examiners performed repeated forefoot measures on both feet using the weight bearing technique during two test sessions separated by a week. Intrarater and interrater reliability (ICC (3,1)) ranged from 0.90 to 0.95 and 0.87 to 0.94, respectively. Day-to-day reliability (ICC (1,1)) ranged from 0.84 to 0.88 for all measures.

Conclusion: The weight bearing method used in this study to determine forefoot posting is reliable. The acceptable reliability of this method justifies the need for future investigations of the validity and the clinical efficacy of this technique for orthosis prescription.
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Brian,

I think you are confused - the above is not a double blind randomised study. It is a reliability study.

Ian

Brian A. Rothbart · May 4, 2011

Dear Ian,

Thanks for the correction. It is a reliability study. Also, forgot to give the publication of the study (see below).

Cummings GS, Higbie, EJ 1997 A weight bearing method for determining forefoot posting for orthotic fabrication. Physiotherapy Research International, Vol 2(1):42-50. [This study was funded by a grant from the College of Health Sciences at Georgia State University]

NewsBot · May 10, 2011

Responsiveness of the foot and ankle ability measure (FAAM) in individuals with diabetes.
Kivlan BR, Martin RL, Wukich DK.
Foot (Edinb). 2011 May 6. [Epub ahead of print]

BACKGROUND:
The impact of diabetes on physical function pose a challenge in assessing clinical outcomes.

OBJECTIVE:
The purpose of this study was to provide evidence of responsiveness for the foot and ankle ability measures (FAAM) in individuals with diabetes mellitus.

METHODS:
The two most recent FAAM scores of 155 diabetic patients treated for foot/ankle pathology were analyzed. Based on physical component summary (PCS) scores of the SF-36, subjects were categorized as improved (>7-point positive change), worsened (>7-point negative change), or unchanged (<7-point change). Analyses of the worsened and improved groups were compared to the unchanged group using two-way repeated measures ANOVAs and ROC curve analyses.

RESULTS:
The ANOVAs demonstrated a significant difference between groups (P=0.001). ROC curves analysis for detecting an improvement or decline in status were 0.73 (95% CI 0.62-0.84) and 0.70 (95% CI 0.59-0.81), respectively. An increase in FAAM score of 9 points represented the minimal clinically important difference (MCID) with 0.64 sensitivity and 0.78 specificity. A decrease in FAAM score of 2 points represented a MCID with 0.65 sensitivity and 0.61 specificity.

CONCLUSIONS:
The FAAM demonstrated responsiveness to change in individuals with orthopedic foot and ankle dysfunction complicated by diabetes and can be used to measure patient outcomes over a 6-month period.
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NewsBot · May 24, 2011

The MOXFQ patient-reported questionnaire: Assessment of data quality, reliability and validity in relation to foot and ankle surgery.
Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, Jenkinson C.
Foot (Edinb). 2011 May 20. [Epub ahead of print]

Previously validated for hallux valgus surgery, the Manchester-Oxford Foot Questionnaire (MOXFQ) is here evaluated for use with different regions of the foot and ankle. The study recruited 671 consecutive patients (87.8% of those eligible), mean age 52.8years, 64% female, who completed the MOXFQ and SF-36 general health survey before foot or ankle surgery. Surgeons completed the American Orthopaedic Foot & Ankle Society (AOFAS) scales and indicated that the patients' main regions for surgery were: Hallux 210 (31.3%), Lesser toes 119 (17.7%), Mid foot 22 (3.3%), Ankle/hind foot 311 (46.3%), Multiple/whole foot 9 (1.3%). Individual MOXFQ items were assessed in terms of response rate and floor/ceiling effects, with the validity of the three MOXFQ scales (Walking/standing, Pain, and Social interaction) being assessed in terms of item-total correlations, internal and test-retest reliability, and construct validity. MOXFQ item response rates were high (all >98%). Cronbach's alphas of >0.7 confirmed internal consistency of all three scales. Test-retest ICCs were all ≥0.89. Correlations of >0.4 obtained with related SF-36 and AOFAS scales supported a priori hypotheses. Good measurement properties are confirmed for the MOXFQ in the context of baseline assessment of patients receiving surgery for a variety of foot or ankle problems.
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NewsBot · Jun 3, 2011

NewsBot said: ↑

Evaluation of two self-referent foot health instruments
In Press, Corrected Proof, Available online 30 August 2010
Robert Trevethan
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The Foot Heath Status Questionnaire—Correct scale score calculation
Paul Bennett
Volume 21, Issue 2, Page 106 (June 2011)

This letter is in response to the recently published article “Evaluation of two self-referent foot health instruments” by Robert Trevethan (RT) and is in regard to the scale scores he derived when using the quality of life measure, the Foot Health Status Questionnaire . Unfortunately, the journal reviewers and editor did not identify, or address, a fundamental flaw in the methodology of this paper. Subsequently, the inference drawn from this paper could, in all reasonableness, mislead the reader.
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NewsBot · Jul 17, 2011

Development of the patient-based outcome instrument for the foot and ankle. Part 1: project description and evaluation of the outcome instrument version 1.
Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y, Takao M, Tanaka Y.
J Orthop Sci. 2011 Jul 14. [Epub ahead of print]

BACKGROUND:
The Clinical Outcomes Committee of the Japanese Society for Surgery of the Foot conducted a field survey using a novel foot and ankle outcome instrument. We report the development and evaluation of the Outcome Instrument version 1.

MATERIALS AND METHODS:
A total of 108 potential questions were extracted from literature published in the interval between 1990 and 2006. Tentative subscales proposed were "Degree of Foot Pain," "Foot Pain-related," "Physical Functioning and Daily Living," "Social Functioning" and "General Health and Well-being." After pre-testing in two different groups of patients, the Outcome Instrument version 1, which was composed of 46 items selected from the 108 questions, was administered to 256 patients (111 men and 145 women) with foot-and-ankle-related pathologic conditions and 243 healthy volunteers (125 men and 118 women). Cronbach's alpha coefficients were used for assessment of internal consistency of the instrument. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were utilized for evaluation of construct validity.

RESULTS:
Neither a ceiling nor floor effect was observed in the responses from the patients. Significant differences were found in the responses to all of the questions between the patients and volunteers (P < 0.01 each). The Cronbach's alpha coefficients for each of the expected subscales indicated high reliability for most of the items and subscales. However, EFA extracted an additional subscale that should be interpreted as something related to shoe or shoe-fit. Further, both EFA and CFA indicated that "Degree of Foot Pain" and "Foot Pain-related" subscales were barely discernable with a factor correlation coefficient of 0.927.

CONCLUSIONS:
The Committee partly revised the instrument, and the new subscales are as follows: "Foot Pain and Pain-related," "Physical Functioning and Daily Living," "Social Functioning," "General Health and Well-being" and "Shoe-related." Evaluation of the Outcome Instrument version 2 will be reported in the following paper.
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Development of the patient-based outcome instrument for foot and ankle: part 2: results from the second field survey: validity of the outcome instrument for the foot and ankle version 2.
Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y, Takao M, Tanaka Y.
J Orthop Sci. 2011 Jul 14. [Epub ahead of print]

BACKGROUND:
The Clinical Outcomes Committee of the Japanese Society for Surgery of the Foot (JSSF) has conducted the second Field Survey of the Outcome Instrument for the Foot and Ankle version 2.

METHODS:
The survey of the Outcome Instrument version 2, which was composed of 43 items, was performed in 313 patients (154 men and 159 women) who had pathological conditions related to the foot and ankle. Optional sports items in the Outcome Instrument version 2 were analyzed in 123 patients. Internal consistency and construct validity of the Outcome Instrument version 2 were assessed. Correlation of the Outcome Instrument version 2 score with Short Form 36 (SF36) and JSSF scores was analyzed to evaluate criterion validity.

RESULTS:
Both the EFA and CFA demonstrated good alignment of questionnaire items with their intended subscales in most cases. Sports items were not clearly classified into subgroups. Therefore, it seemed reasonable to use those as a set of questions in a single subscale. The present subscales, having similar names as the SF36 subscales, were closely correlated with the respective subscales. In those cases, the magnitude of the correlation coefficient was >0.6 (p < 0.001) except the present subscale called General Health and Well-being. Comparison of the present scores with JSSF evaluation scores showed satisfactory results except in patients with rheumatoid arthritis.

CONCLUSIONS:
The Outcome Instrument version 2 demonstrated acceptable psychometric performances as outcome measures for patients with pathological conditions related to the foot and ankle. This outcome instrument would be helpful to evaluate patients with foot and/or ankle impairment. However, the analyses of the test-retest reliability and the influence of background factors such as age and gender, etc., on Outcome Instrument version 2 are needed in the third field survey.
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NewsBot · Jul 22, 2011

Normative data of the Visual Analogue Scale Foot and Ankle (VAS FA) for pathological conditions
Foot and Ankle Surgery Volume 17, Issue 3, September 2011, Pages 166-172

Background
The purpose of this study was to analyze the Visual Analogue Scale Foot and Ankle (VAS FA) in patients to obtain normative data for pathological conditions.

Methods
The VAS FA was consecutively obtained in a foot and ankle outpatient clinic. The score results were categorized into different pathological foot and ankle conditions.

Results
414 patients were evaluated. Overall scores and score categories of all pathology groups differed from non-pathological data (n = 121). Within the different groups, no score differences occurred. Score standards were defined for these groups with sufficient statistical power (>.8): isolated Hallux valgus, Hallux valgus and claw toes, forefoot other pathology, midfoot other pathology, hindfoot pathology and ankle deformity. No standards were defined for other pathology groups.

Conclusions
The obtained data is normative for different pathological conditions of the earlier validated VAS FA. The obtained data is normative for different pathological conditions of the earlier validated VAS FA. This data could serve as a basis for assessment patient scoring before, during and after treatment which has to then to be proved by ongoing research.
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Jonathan · Jul 22, 2011

NewsBot -

Stop it - go buy yourself a beer and relax

NewsBot · Aug 26, 2011

Visual analogue scale foot and ankle: validity and reliability of Thai version of the new outcome score in subjective form.
Angthong C, Chernchujit B, Suntharapa T, Harnroongroj T.
J Med Assoc Thai. 2011 Aug;94(8):952-7.

BACKGROUND:
Nowadays, measuring score in the form ofsubjective questionnaires is the important toolfor clinical evaluation ofthe foot and ankle-related problems. VisualAnalogue Scale-Foot and Ankle (VAS-FA) is the newly developed subjective questionnaire, which has sufficiency ofvalidity and reliability from a previous study

OBJECTIVE:
Translate the original English version of VAS-FA into the Thai version and evaluate the validity and reliability of Thai VAS-FA in patients with foot and ankle-related problems.

MATERIAL AND METHOD:
According to the forward-backward translation protocol, original VAS-FA was translated into the Thai version. Thai VAS-FA and validated Thai Short Form-36 (SF-36) questionnaires were distributed to 42 Thai patients to complete. For validation, Thai VAS-FA scores were correlated with SF-36 scores. For reliability, the test-retest reliability and internal consistency were analyzed.

RESULTS:
Thai VAS-FA score demonstrated the sufficient correlations with physical functioning (PF), role physical (RP), bodily pain (BP) domains, and total score of SF-36 (statistically significant with p < 0.001 level and r > 0.5 values). The result of reliability revealed highly intra-class correlation coefficient as 0.995 from test-retest study. The internal consistency was excellent with Cronbach alpha: 0.995.

CONCLUSION:
The original VAS-FA score is a well-validated, subjective, visual-analogue-scale based outcome score. The Thai version of VAS-FA form maintained the validity and reliability of the original version. This newly translated-validated score can be distributed for the evaluation of the functions, symptoms, and limitation of activities in Thai patients with foot and ankle problems.
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NewsBot · Jan 1, 2012

Lower Limb Functional Index: Development and Clinimetric Properties
Charles Philip Gabel, Markus Melloh, Brendan Burkett and Lori A. Michener
Physical Therapy January 2012 vol. 92 no. 1 98-110

Background Existing lower-limb, region-specific, patient-reported outcome measures have clinimetric limitations, including limitations in psychometric characteristics (eg, lack of internal consistency, lack of responsiveness, measurement error) and the lack of reported practical and general characteristics. A new patient-reported outcome measure, the Lower Limb Functional Index (LLFI), was developed to address these limitations.

Objective The purpose of this study was to overcome recognized deficiencies in existing lower-limb, region-specific, patient-reported outcome measures through: (1) development of a new lower-extremity outcome scale (ie, the LLFI) and (2) evaluation of the clinimetric properties of the LLFI using the Lower Extremity Functional Scale (LEFS) as a criterion measure.

Design This was a prospective observational study.

Methods The LLFI was developed in a 3-stage process of: (1) item generation, (2) item reduction with an expert panel, and (3) pilot field testing (n=18) for reliability, responsiveness, and sample size requirements for a larger study. The main study used a convenience sample (n=127) from 10 physical therapy clinics. Participants completed the LLFI and LEFS every 2 weeks for 6 weeks and then every 4 weeks until discharge. Data were used to assess the psychometric, practical, and general characteristics of the LLFI and the LEFS. The characteristics also were evaluated for overall performance using the Measurement of Outcome Measures and Bot clinimetric assessment scales.

Results The LLFI and LEFS demonstrated a single-factor structure, comparable reliability (intraclass correlation coefficient [2,1]=.97), scale width, and high criterion validity (Pearson r=.88, with 95% confidence interval [CI]). Clinimetric performance was higher for the LLFI compared with the LEFS on the Measurement of Outcome Measures scale (96% and 95%, respectively) and the Bot scale (100% and 83%, respectively). The LLFI, compared with the LEFS, had improved responsiveness (standardized response mean=1.75 and 1.64, respectively), minimal detectable change with 90% CI (6.6% and 8.1%, respectively), and internal consistency (α=.91 and .95, respectively), as well as readability with reduced user error and completion and scoring times.

Limitations Limitations of the study were that only participants recruited from outpatient physical therapy clinics were included and that no specific conditions or diagnostic subgroups were investigated.

Conclusion The LLFI demonstrated sound clinimetric properties. There was lower response error, efficient completion and scoring, and improved responsiveness and overall performance compared with the LEFS. The LLFI is suitable for assessment of lower-limb function.
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NewsBot · Feb 9, 2012

Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS).
Cöster M, Karlsson MK, Nilsson JA.
Acta Orthop. 2012 Feb 8.

Background and purpose A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused. Patients and methods The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman's correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach's alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37). Results For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88-0.95), Cronbach's alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00. Interpretation SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery.
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NewsBot · Mar 7, 2012

Lower Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery
J Bone Joint Surg Am. 2012;94(5):468-477 doi:10.2106/JBJS.J.01822
Matthew V. Smith, MD; Sandra E. Klein, MD; John C. Clohisy, MD; Geneva R. Baca, BA; Robert H. Brophy, MD; Rick W. Wright

Outcome measures may be simple questions or complex measures that assess multiple interrelated domains affecting treatment outcomes.

Outcome measures should be relevant to patients, easy to use, reliable, valid, and responsive to clinical changes.

Joint and disease-specific outcome measures have been developed for the hip, knee, and foot and ankle. Many of these measures would benefit from further research into their validity, reliability, and optimal applicability.

General health measures and activity level scores should be included in outcome assessments after treatment for orthopaedic conditions.
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NewsBot · Mar 21, 2012

A scoring system for the foot and ankle that is acceptable, reliable, valid and responsive.
Dawson J, Boller I, Doll H, Jenkinson C, Lavis G, Sharp R, Cooke P.
Foot (Edinb). 2012 Mar 17.

We read with interest the recent paper by Groarke et al. (Quality of life in individuals with chronic foot conditions: a cross sectional observational study. The Foot (2012) doi:10.1016/i.foot.2011.11.007). The paper ended by stating that 'there is no scoring system for the foot and ankle that is valid, repeatable and reliable'. This statement is misleading. The authors could have made reference to the patient-reported Manchester-Oxford Foot Questionnaire (MOXFQ). The MOXFQ has been subjected to more rigorous testing of its measurement properties than is the case for most instruments, and has been demonstrated to be acceptable, reliable, valid and responsive in the context of foot or ankle surgery.
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NewsBot · May 3, 2012

A Comparison of the Readability of Two Patient-reported Outcome Measures Used to Evaluate Foot Surgery
James Alvey, Simon Palmer, Simon Otter,
Journal of Foot and Ankle Surgery

Measuring the outcome of surgical intervention is an integral part of modern-day healthcare provision. The increasing requirement to monitor patient-reported outcomes highlights the need for patients to be able to read and understand health outcomes questionnaires. The present study compared the readability of 2 commonly used, validated, foot surgery outcome questionnaires (the Foot Health Status Questionnaire and the Manchester-Oxford Foot Questionnaire) using the Flesch Reading Ease score and the Flesch-Kincaid grade level score. The Manchester-Oxford Foot Questionnaire had a significantly greater (p < .003) score for reading ease and a significantly lower reading grade score (p < .005) than the Foot Health Status Questionnaire. These findings suggest the Manchester-Oxford Foot Questionnaire is a more suitable instrument in terms of readability and comprehension for a greater proportion of the population undergoing hallux valgus surgery.
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NewsBot · Jul 10, 2012

An analysis of Euroqol EQ-5D and Manchester Oxford Foot Questionnaire scores six months following podiatric surgery
Anthony J Maher and Timothy E Kilmartin
Journal of Foot and Ankle Research 2012, 5:17

Background
In the United Kingdom patient-reported outcome measures (PROMS) have been adopted as a key measure of foot surgery outcomes. The intention of this study was to evaluate the responsiveness of a regional outcome measure; the Manchester Oxford Foot Questionnaire (MOXFQ) and a generic measure; the EuroQol EQ-5D, in the context of day care Podiatric Surgery

Methods
A prospective audit of 375 consecutive day care surgical admissions was undertaken. All patients attending for surgery, who agreed to participate, were included. Pre operation patients completed the MOXFQ and the EQ-5D. Both questionnaires were completed again at 6 months post operation. Additional data was collected on patient demographics, surgical procedures and complications.

Results
Few complications were encountered and most patients (84%) returned for a final review 6 months post operation. Mean MOXFQ scores improved for each domain: pain; 51.7 pre-operation, reduced to 16.5 post-operation, walking; 50.2 reduced to 14.1 and social interaction; 45.7 reduced to 10.6. The minimal clinically important differences (MCID) estimates for the pain domain were exceeded by 82.6% of patients, while 74.8% achieved the MCID for walking and 68.5% achieved the MCID for social interaction. A small number of patients (2.9%) deteriorated across all three MOXFQ domains. The EQ-5D Index, summary of health related quality of life, improved from 0.66 pre-operation to 0.86 post operation. The EQ-5D index MCID was exceeded by 79.2% of patients. Index scores deteriorated for 1.8% of patients following surgery. Effect sizes measured following surgery were largest for the MOXFQ domains: Walking; 1.39, Pain; 1.52 and Social Interaction: 1.39. The EQ-5D index effect size was 0.83. The EQ-5D visual analogue scale (VAS) was not influenced by surgery.

Conclusion
Both the MOXFQ and EQ-5D index (but not the VAS) appear sensitive to changes in health status at 6 months following elective foot surgery. Both instruments were particularly responsive to changes in pain, mobility and activity or social interaction following treatment. The MOXFQ was developed specifically for foot surgery and as such appears to be the more sensitive instrument. However the generic EQ-5D may allow comparison of general health states in the wider health community. Both instruments when used together appear well suited to the measurement of change in perceived health status following foot surgery.
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NewsBot · Sep 22, 2012

New paradigm for patient-reported outcomes assessment in foot & ankle research: computerized adaptive testing.
Hung M, Nickisch F, Beals TC, Greene T, Clegg DO, Saltzman CL.
Foot Ankle Int. 2012 Aug;33(8):621-6.

BACKGROUND:
Accurately measuring, reporting and comparing outcomes is essential for improving health care delivery. Current challenges with available health status scales include patient fatigue, floor/ceiling effects and validity/reliability.

METHODS:
This study compared Patient Reported Outcomes Measurement Information System (PROMIS)-based Lower Extremity Physical Function Computerized Adaptive Test (LE CAT) and two legacy scales -the Foot and Function Index (FFI) and the sport module from the Foot and Ankle Ability Measure (spFAAM) -for 287 patients scheduled for elective foot and ankle surgery. We documented the time required by patients to complete the instrument, instrument precision, and the extent to which each instrument covered the full range of physical functioning across the patient sample.

RESULTS:
Average time of test administration: 66 seconds for LE CAT, 130 seconds for spFAAM and 239 seconds for FFI. All three instruments were fairly precise at intermediate physical functioning levels (i.e., Standard Error of Measurement < 0.35), were relatively less precise at the higher trait levels and the LE CAT maintained precision in the lower range while the spFAAM and FFI's had decreased precision. The LE CAT had less floor/ceiling effects than the FFI and the spFAAM.

CONCLUSION:
The LE CAT showed considerable advantage compared to legacy scales for measuring patient-reported outcomes in orthopaedic patients with foot and ankle problems.

CLINICAL RELEVANCE:
A paradigm shift to broader use of PROMIS-based CATs should be considered to improve precision and reduce patient burden with patient-reported outcome measuremen foot and ankle patients.
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NewsBot · Oct 2, 2012

The Swindon Foot and Ankle Questionnaire: Is a Picture Worth a Thousand Words?
Rosemary Waller, Peter Manuel, and Lyn Williamson
ISRN Rheumatology; Volume 2012 (2012), Article ID 105479,

Objectives. Despite increased awareness of the high prevalence and significance of foot and ankle problems in rheumatoid arthritis (RA), feet remain neglected. Reasons may include the perception that feet are difficult to assess, they are not included in the DAS28, and lack of freely available foot screening tools specific for RA.

Methods. The Swindon Foot and Ankle Questionnaire (SFAQ) is a simply worded 10-point foot and ankle screening questionnaire with diagrams of feet and ankles for use in general rheumatology outpatients. All RA patients on our electronic database were invited to complete the questionnaire and attend clinic for assessment. Patients assessed clinically were scored out of 10 using the parameters from the questionnaire. The SFAQ was compared to the Manchester Foot Pain and Disability Index (MFPDI), DAS28, HAQ, HAD, and OSRA scores.

Results. 597 questionnaires were sent, 301 (50%) returned, and 137 seen in clinic. There was good correlation between the postal SFAQ score, clinic score (), and the MFPDI (). Neither of the foot scores correlated with other RA disease outcome measures. 75% patients completed the picture. 73% corresponded to clinical findings. 45% of patients required an intervention following clinical review and trended towards higher scores.

Conclusions. The SFAQ was quick to complete and correlated with the MFPDI. Lack of association with standard RA outcome measures suggests that relying on these scores alone may miss foot pathology. The diagrams were a useful complement. This simple screening tool could aid identification of RA foot and ankle problems.
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NewsBot · Oct 12, 2012

Criterion-Related Validity of the Foot Health Status Questionnaire Regarding Strength and Plantar Pressure Measurements in Elderly People
Antonio I. Cuesta-Vargas,
Foot Ankle Spec October 11, 2012

Background. Criterion-related validity of a self-administered questionnaire listed as gold standard requires objective testing. The aim of this study was to analyze the Foot Health Status Questionnaire (FHSQ) using functional variable measures (dynamic plantar pressure and foot strength).

Materials and methods. A total of 22 elderly healthy participants (13 women and 9 men) were screened by interview and physical examination for foot or gait abnormalities. Foot strength, footprint pressure, and foot health status were measured.

Results. All the items of the FHSQ show significant correlation with functional variables, but general foot health shows the highest correlation with the 4 physical variables related to plantar pressure (R2 = 0.741), followed by foot pain (R2 = 0.652).

Conclusion. A set of different, directly measured physical variables related to foot strength and plantar pressure significantly correlate with the FHSQ dimensions.
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NewsBot · Oct 16, 2012

The psychometric properties of the Spanish version of the Foot Health Status Questionnaire.
Cuesta-Vargas A, Bennett P, Jimenez-Cebrian AM, Labajos-Manzanares MT.
Qual Life Res. 2012 Oct 12.

PURPOSE:
Clinical studies suggest that foot pain may be problematic in one-third of patients in early disease. The Foot Health Status Questionnaire (FHSQ) was developed and validated to evaluate the effectiveness of conservative (orthoses, taping, stretching) and surgery interventions. Despite this fact, there are few validated instruments that measure foot health status in Spanish. Thus, the primary aim of the current study was to translate and evaluate psychometrically a Spanish version of FHSQ.

METHODS:
A cross-sectional study was designed in a university community-based podiatric clinic located in south of Spain. All participants (n = 107) recruited consecutively completed a Spanish version of FHSQ and EuroQoL Health Questionnaire 5 dimensions, and 29 participants repeated these same measures 48 h later. Data analysis included test-retest reliability, construct and criterion-related validity and factor analyses.

RESULTS:
Construct validity was appropriate with moderate-to-high corrected item-subscale correlations (α = ≥0.739) for all subscales. Test-retest reliability was satisfactory (ICC > 0.932). Factor analysis revealed four dimensions with 86.6 % of the common variance explained. The confirmatory factor analysis findings demonstrated that the proposed structure was well supported (comparative fit index = 0.92, standardized root mean square = 0.09). The Spanish EuroQoL 5D score negatively correlated with the FHSQ pain (r = -0.445) and positively with general foot health and function (r = 0.261 - 0.579), confirming criterion-related validity.

CONCLUSION:
The clinimetric properties of the Spanish version of FHSQ were satisfactory.
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NewsBot · Nov 2, 2012

Pain Dominates Summed Scores for Hindfoot and Ankle Trauma.
Tornetta BP 3rd, Qadir R, Sanders R.
J Orthop Trauma. 2012 Oct 30

BACKGROUND:: Outcomes in clinical orthopaedic research are often presented as a summed functional score, without the individual component scores. Thus, there is little information about the effect of each component score on the overall score in hindfoot and ankle trauma. The purpose of this study was to determine which subscores were most responsible for the overall variation in summed scores and to evaluate the correlation of multiple scoring systems after foot and ankle fractures or reconstruction.

METHODS:: One hundred and fifty-eight patients were evaluated after ORIF of the calcaneus, ORIF of the plafond, or ankle fusion with the SF36, AOFAS, and Maryland scoring systems. Correlations were made between summed scores using a Pearson correlation matrix and the percentage of overall variation of the summed score that is accounted for by the answer to the pain question within the score.

RESULTS:: For all three subsets of patients, there was strong statistical correlation of the SF36-PCS, AOFAS, and Maryland scores (p < 0.001). The strongest correlation was between the AOFAS and the Maryland scores for each subset: calcaneus (r=0.957, p<0.0001), pilon (r=0.946, p<0.0001), and ankle fusion (r=0.944, p<0.0001). The pain subscore accounted for almost the entire variation in the summed score, being responsible for 80% - 86% of the overall variation. There was minimal change in overall variation when physical exam was factored into the analysis.

CONCLUSIONS:: Pain dominates the variation in summed scores for hindfoot and ankle trauma and reconstruction. We strongly recommend that when summed scores are used that the individual components are reported.
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NewsBot · Nov 13, 2012

Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS).
Dawson J, Lavis G.
Acta Orthop. 2012 Nov 11.
(no abstract available) Full text

NewsBot · Jan 10, 2013

Validity and reliability of a self-administered foot evaluation questionnaire (SAFE-Q).
Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y, Takao M, Tanaka Y.
J Orthop Sci. 2013 Jan 9

BACKGROUND:
The Japanese Society for Surgery of the Foot (JSSF) is developing a QOL questionnaire instrument for use in pathological conditions related to the foot and ankle. The main body of the outcome instrument (the Self-Administered Foot Evaluation Questionnaire, SAFE-Q version 2) consists of 34 questionnaire items, which provide five subscale scores (1: Pain and Pain-Related; 2: Physical Functioning and Daily Living; 3: Social Functioning; 4: Shoe-Related; and 5: General Health and Well-Being). In addition, the instrument has nine optional questionnaire items that provide a Sports Activity subscale score. The purpose of this study was to evaluate the test-retest reliability of the SAFE-Q.

PATIENTS AND METHODS:
Version 2 of the SAFE-Q was administered to 876 patients and 491 non-patients, and the test-retest reliability was evaluated for 131 patients. In addition, the SF-36 questionnaire and the JSSF Scale scoring form were administered to all of the participants. Subscale scores were scaled such that the final sum of scores ranged between zero (least healthy) to 100 (healthiest).

RESULTS:
The intraclass correlation coefficients were larger than 0.7 for all of the scores. The means of the five subscale scores were between 60 and 75. The five subscales easily separated patients from non-patients. The coefficients for the correlations of the subscale scores with the scores on the JSSF Scale and the SF-36 subscales were all highly statistically significantly greater than zero (p < 0.001). The means for the five JSSF Scale classification groups fell within a relatively narrow range, indicating that the SAFE-Q labels are sufficiently similar to permit their use for all of the JSSF Scale classifications.

CONCLUSION:
The present study revealed that the test-retest reliability is high for each subscale. Consequently, the SAFE-Q is valid and reliable. In the future, it will be beneficial to test the responsiveness of the SAFE-Q.
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NewsBot · Mar 19, 2013

Pain Dominates Foot and Ankle Scoring Outcomes
Paul Tornetta III, MD, Boston, Massachusetts
Rabah Qadir, MD, Metairie, Louisiana
Roy W. Sanders, MD, Tampa, Florida
AAOS Annual Conference 2013

INTRODUCTION: The purpose of this study was to determine which subscores contributed to the overall variation in summed scores, paying particular attention to pain, and to evaluate the correlation of multiple scoring systems for three hindfoot procedures.

MATERIALS: Forty-six pilon fractures, 44 calcaneus fractures and 54 ankle fusions were evaluated at >2 years after injury with the SF36, AOFAS and Maryland scoring systems. Correlations of the summed scores were determined, as was the percentage of the overall variation of the scores related to pain.

RESULTS: The strongest correlation was between the AOFAS and the Maryland scores: calcaneus (r=0.9565, p<0.0001), pilon (r=0.9463, p<0.0001) and ankle fusion (r=0.9436, p<0.0001). There was a strong correlation between the PCS (physical component score of the SF36), AOFAS and Maryland scores (p < 0.001) for all groups. The overall summed scores were markedly affected by the pain score for all of the outcome scores examined. The individual subscale of pain accounted for as much as 86% of the overall variation. (Table #1).

DISCUSSION AND CONCLUSIONS: Summed scores in evaluating outcomes for complex hindfoot and ankle injury and reconstruction show a high degree of correlation. Pain is the dominant factor in the total variation of the scores, representing more than 80% of the variation in the AOFAS and Maryland scores. Summed scores for complex hindfoot and ankle injury and reconstruction may not be needed in comparing outcomes as pain is the single dominant factor. We strongly recommend that when summed scores are used, that the individual components are reported so that surgeons may interpret the raw data.
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NewsBot · Mar 26, 2013

Development and validation of the Sports Athlete Foot and Ankle Score: An instrument for sports-related ankle injuries
M.L.A. Morssinkhof, O. Wang, L. James, H.J.L. van der Heide, I.G. Winson
Foot and Ankle Surgery(in press)

Background
Many existing scoring systems assess ankle function, but there is no evidence that any of them has been validated in a group of patients with a higher demand on their ankle function. Problems include ceiling effects, not being able to detect change or they do not contain a sports-subscale. The aim of this study was to create a validated self-administered scoring system for ankle injuries in the higher performing athlete.

Methods
First, 26 patients were interviewed to solicit opinions needed to create the final score, which is modified from the Foot and Ankle Outcome Score (FAOS). Second, SAFAS was validated in a group of 25 athletes with and 14 athletes without ankle injury. It is a self-administered region specific sports foot and ankle score that contains four subscales assessing the levels of symptoms, pain, daily living and sports.

Results
The Spearman correlation coefficients between SAFAS and the Foot and Ankle Ability Measure (FAAM) ranged from 0.78 to 0.88. Content validity is established by key informant interviews, expert opinions and a high satisfaction rate of 75%. Cronbach's alpha indicated good internal consistency of each subscale ranging from 0.77 to 0.92.

Conclusion
SAFAS has shown good evidence for being a valid instrudent for assessing sports-related ankle injuries in high-performing athletes.
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NewsBot · Apr 4, 2013

Development process and psychometric testing of foot health assessment instrument
Minna Stolt et al
Journal of Clinical Nursing; Early View

Aims and objectives
To describe the development process of the foot health assessment instrument for the assessment of foot health in older people and to evaluate the psychometric properties of the foot health assessment instrument.

Background
In clinical nursing, assessment of foot health and recognition of foot problems in older people is fundamental for maintain older persons' independent functional ability. However, valid and reliable nurse-administered foot health assessment instruments are lacking.

Design
A cross-sectional methodological design.

Methods
The foot health assessment instrument was developed in 2008–2011 based on a literature review and expertise in podiatry and nursing. Content validity was evaluated in four expert panels. Inter-rater reliability between nurses' and researcher (MS) assessments was evaluated in the pilot test and in the empirical testing of the instrument with a sample of visiting home nurses. Inter-rater reliability was calculated with Cohen's kappa, internal consistency reliability was examined with Cronbach's alpha coefficients and item analysis, and construct validity was evaluated by principal component analysis with Varimax rotation and confirmatory factor analysis.

Results
Content validity was guaranteed by the expert analyses. Inter-rater reliability improved after pilot test. The Cronbach's alpha coefficient for the total foot health assessment instrument was satisfactory. Item-to-total correlations varied between but most of them were acceptable. Principal component analysis and confirmatory factor analysis supported the four component structure of the foot health assessment instrument.

Conclusions
The 23-item foot health assessment instrument showed preliminary acceptable psychometric properties. However, further modifications and testing are needed to strengthen the psychometric properties of the foot health assessment instrument.

Relevance to clinical practice
The existence of a foot health assessment instrument and its application would considerably improve the assessment of foot health in daily nursing practice. The foot health assessment instrument developed in this study is short and easy to administer.
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NewsBot · Jun 13, 2013

Validation of PROMIS® Physical Function Computerized Adaptive Tests for Orthopaedic Foot and Ankle Outcome Research
Man Hung PhD, MSTAT, MED, Judith F. Baumhauer MD, MPH, L. Daniel Latt MD, PhD, Charles L. Saltzman MD, Nelson F. SooHoo MD, Kenneth J. Hunt MD
Clinical Orthopaedics and Related Research® June 2013

Background
In 2012, the American Orthopaedic Foot & Ankle Society® established a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network’s initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting.

Questions/purposes
We determined whether the CAT from the NIH Patient Reported Outcome Measurement Information System® (PROMIS®) Physical Function (PF) item bank provides efficient, reliable, valid, precise, and adequately covered point estimates of patients’ physical function.

Methods
After informed consent, 288 patients with a mean age of 51 years (range, 18–81 years) undergoing surgery for common foot and ankle problems completed a web-based questionnaire. Efficiency was determined by time for test administration. Reliability was assessed with person and item reliability estimates. Validity evaluation included content validity from expert review and construct validity measured against the PROMIS® Pain CAT and patient responses based on tradeoff perceptions. Precision was assessed by standard error of measurement (SEM) across patients’ physical function levels. Instrument coverage was based on a person-item map.

Results
Average time of test administration was 47 seconds. Reliability was 0.96 for person and 0.99 for item. Construct validity against the Pain CAT had an r value of −0.657 (p < 0.001). Precision had an SEM of less than 3.3 (equivalent to a Cronbach’s alpha of ≥ 0.90) across a broad range of function. Concerning coverage, the ceiling effect was 0.32% and there was no floor effect.

Conclusions
The PROMIS® PF CAT appears to be an excellent method for measuring outcomes for patients with foot and ankle surgery. Further validation of the PROMIS® item banks may ultimately provide a valid and reliable tool for measuring patient-reported outcomes after injuries and treatment.
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NewsBot · Aug 23, 2013

Use of Patient-Reported Outcome Measures in Foot and Ankle Research
Kenneth J. Hunt; Daniel Hurwit
The Journal of Bone & Joint Surgery, Volume 95, Issue 16 August 21, 2013

Background:
In the orthopaedic literature, there is a wide range of clinical outcome measurement tools that have been used in evaluating foot and ankle procedures, disorders, and outcomes, with no broadly accepted consensus as to which tools are preferred. The purpose of this study was to determine the frequency and distribution of the various outcome instruments used in the foot and ankle literature, and to identify trends for use of these instruments over time.

Methods:
We conducted a systematic review of all original clinical articles reporting on foot and/or ankle topics in six orthopaedic journals over a ten-year period (2002 to 2011). All clinical patient-reported outcome rating instruments used in these articles were recorded, as were study date, study design, clinical topic, and level of evidence.

Results:
A total of 878 clinical foot and ankle articles that used at least one patient-reported outcome measure were identified among 16,513 total articles published during the ten-year period. There were 139 unique clinical outcome scales used, and the five most popular scales (as a percentage of foot/ankle outcome articles) were the American Orthopaedic Foot & Ankle Society (AOFAS) scales (55.9%), visual analog scale (VAS) for pain (22.9%), Short Form-36 (SF-36) Health Survey (13.7%), Foot Function Index (FFI) (5.5%), and American Academy of Orthopaedic Surgeons (AAOS) outcomes instruments (3.3%). The majority of articles described Level-IV studies (70.1%); only 9.4% reported Level-I studies.

Conclusions:
A considerable variety of outcome measurement tools are used in the foot and ankle clinical literature, with a small proportion used consistently. The AOFAS scales continue to be used at a high rate relative to other scales that have been validated. Data from the present study underscore the need for a paradigm shift toward the use of consistent, valid, and reliable outcome measures for studies of foot and ankle procedures and disorders. It is not clear which existing validated outcome instruments will emerge as widely used and clinically meaningful.

Clinical Relevance:
These data support the need for a paradigm shift toward the consistent use of valid and reliable outcome measures for foot and ankle clinical research.
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NewsBot · Sep 12, 2013

Psychometric properties of the foot and ankle outcome score in a community-based study of adults with and without osteoarthritis.
Golightly YM, Devellis RF, Nelson AE, Hannan MT, Lohmander LS, Renner JB, Jordan JM.
Arthritis Care Res (Hoboken). 2013 Sep 10

Objective. Foot and ankle problems are common in adults, and large observational studies are needed to advance our understanding of the etiology and impact of these conditions. Valid and reliable measures of foot and ankle symptoms and physical function are necessary for this research. This study examined psychometric properties of the Foot and Ankle Outcome Score (FAOS) subscales (pain, other symptoms, activities of daily living [ADL], sport and recreational function [Sport/Recreation], and foot and ankle related quality of life [QOL]) in a large, community-based sample of African American and Caucasian men and women 50+ years old.

Methods. Johnston County Osteoarthritis Project participants (N=1670) completed the 42-item FAOS (mean age 69 years, 68% women, 31% African American, mean body mass index [BMI] 31.5 kg/m2 ). Internal consistency, test-retest reliability, convergent validity, and structural validity of each subscale were examined for the sample and for subgroups according to race, gender, age, BMI, presence of knee or hip osteoarthritis, and presence of knee, hip or low back symptoms.

Results. For the sample and each subgroup, Cronbach's alphas were 0.95-0.97 (pain), 0.97-0.98 (ADL), 0.94-0.96 (Sport/Recreation), 0.89-0.92(QOL), and 0.72-0.82 (symptoms). Correlation coefficients were 0.24 -0.52 for pain and symptoms subscales with foot and ankle symptoms and 0.30-0.55 for ADL and Sport/Recreation subscales with Western Ontario and McMaster Universities Osteoarthritis Index function subscale. Intraclass correlation coefficients for test-retest reliability were 0.63-0.81. Items loaded on a single factor for each subscale except symptoms (2 factors).

Conclusions. The FAOS exhibited sufficient reliability and validity in this large cohort study
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NewsBot · Nov 2, 2013

Inter and intra-rater repeatability of the scoring of foot pain drawings
Benjamin D Chatterton, Sara Muller, Martin J Thomas, Hylton B Menz, Keith Rome and Edward Roddy
Journal of Foot and Ankle Research 2013, 6:44 doi:10.1186/1757-1146-6-44

Background
Foot pain drawings (manikins) are commonly used to describe foot pain location in self-report health surveys. Respondents shade the manikin where they experience pain. The manikin is then scored via a transparent overlay that divides the drawings into areas. In large population based studies they are often scored by multiple raters. A difference in how different raters score manikins (inter-rater repeatability), or in how an individual rater scores manikins over time (intra-rater repeatability) can therefore affect data quality. This study aimed to assess inter- and intra-rater repeatability of scoring of the foot manikin.

Methods
A random sample was generated of 50 respondents to a large population based survey of adults aged 50 years and older who experienced foot pain and completed a foot manikin. Manikins were initially scored by any one of six administrative staff (Rating 1). These manikins were re-scored by a second rater (Rating 2). The second rater then re-scored the manikins one week later (Rating 3). The following scores were compared: Rating 1 versus Rating 2 (inter-rater repeatability), and Rating 2 versus Rating 3 (intra-rater repeatability). A novel set of clinically relevant foot pain regions made up of one or more individual areas on the foot manikin were developed, and assessed for inter- and intra-rater repeatability.

Results
Scoring agreement of 100% (all 50 manikins) was seen in 69% (40 out of 58) of individual areas for inter-rater scoring (range 94 to 100%), and 81% (47 out of 58) of areas for intra-rater scoring (range 96 to 100%). All areas had a kappa value of >=0.70 for inter- and intra-rater scoring. Scoring agreement of 100% was seen in 50% (10 out of 20) of pain regions for inter-rater scoring (range 96 to 100%), and 95% (19 out of 20) of regions for intra-rater scoring (range 98 to 100%). All regions had a kappa value of >0.70 for inter- and intra-rater scoring.

Conclusions
Individual and multiple raters can reliably score the foot pain manikin. In addition, our proposed regions may be used to reliably classify different patterns of foot pain using the foot manikin.
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NewsBot · Nov 25, 2013

Evaluation of the Rearfoot Component (Module 3) of the ACFAS Scoring Scale
Naohiro Shibuya, Ryan T. Kitterman, Daniel C. Jupiter
Journal of Foot and Ankle Surgery; Article in Press

The American College of Foot and Ankle Surgeons (ACFAS) scoring scale modules 3 and 4 have not been validated or tested against other validated instruments widely used in medical and surgical research and practice. The purpose of the present study was to evaluate the rearfoot component (module 3) of the ACFAS scoring system by assessing its correlation against well-established instruments. A modified ACFAS scale (mACFAS), Medical Outcomes Study 36-item short form (SF-36), version 2 (SF-36v2), and the short form of the International Physical Activity Questionnaire (IPAQ) were administered to subjects enrolled in our ongoing longitudinal cohort flatfoot study. Eighty-six patients were evaluated. The mACFAS correlated moderately to highly with the SF-36v2 physical component score and moderately with the mental component score and IPAQ. When divided into higher arched, lower arched, and rectus foot groups, the mACFAS correlated more strongly with the SF-36v2 and correlated with the IPAQ in the lower arched population. The results of the present study are promising for the rearfoot component of the ACFAS scoring scale, especially in the evaluation of the lower arched foot type. Future research should evaluate the disease- and symptom-specific validity, responsiveness, and reproducibility of the mACFAS.
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NewsBot · Jan 1, 2014

A systematic review of outcome tools used to measure lower leg conditions.
Shultz S, Olszewski A, Ramsey O, Schmitz M, Wyatt V, Cook C.
Int J Sports Phys Ther. 2013 Dec;8(6):838-48

BACKGROUND CONTEXT:
A variety of self-report and physical performance-based outcome measures are commonly used to assess progress and recovery in the lower leg, ankle, and foot. A requisite attribute of any outcome measure is its ability to detect change in a condition, a construct known as "responsiveness". There is a lack of consistency in how responsiveness is defined in all outcome measures.
PURPOSE:
The purpose of this study was to review the currently used recovery outcome measures for lower leg, ankle and foot conditions in order to determine and report recommended responsiveness values.
METHODS:
A systematic literature search that included electronic searches of PubMed, CINAHL and SportDiscus as well extensive cross-referencing was performed in January, 2013. Studies were included if each involved: 1) a prospective, longitudinal study of any design; 2) any condition associated with the lower leg, ankle or foot; 3) a measure of responsiveness; and 4) was an acceptable type of outcome measure (eg. self-report, physical performance, or clinician report). The quality of the included articles was assessed by two independent authors using the responsiveness sub-component of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN).
RESULTS:
Sixteen different studies met the inclusion criteria for this systematic review. The most commonly used outcome measures were the Foot and Ankle Ability Measure and the Lower Extremity Functional Scale. Responsiveness was calculated in a variety of methods including effect size, standardized response mean, minimal clinically important difference/importance, minimal detectable change, and minimal important change.
CONCLUSION:
Based on the findings of this systematic review there is a lack of consistency for reporting responsiveness among recovery measures used in the lower leg, ankle or foot studies. It is possible that the variability of conditions that involve the lower leg, ankle and foot contribute to the discrepancies found in reporting responsiveness values. Further research must be conducted in order to standardize reporting measures for
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NewsBot · Feb 26, 2014

Validity, reliability, and responsiveness of the Self-reported Foot and Ankle Score (SEFAS) in forefoot, hindfoot, and ankle disorders.
Cöster MC1, Bremander A, Rosengren BE, Magnusson H, Carlsson A, Karlsson MK.
Acta Orthop. 2014 Feb 25.

Background and purpose - The self-reported foot and ankle score (SEFAS) is a questionnaire designed to evaluate disorders of the foot and ankle, but it is only validated for arthritis in the ankle. We validated SEFAS in patients with forefoot, midfoot, hindfoot, and ankle disorders.

Patients and methods - 118 patients with forefoot disorders and 106 patients with hindfoot or ankle disorders completed the SEFAS, the foot and ankle outcome score (FAOS), SF-36, and EQ-5D before surgery. We evaluated construct validity for SEFAS versus FAOS, SF-36, and EQ-5D; floor and ceiling effects; test-retest reliability (ICC); internal consistency; and agreement. Responsiveness was evaluated by effect size (ES) and standardized response mean (SRM) 6 months after surgery. The analyses were done separately in patients with forefoot disorders and hindfoot/ankle disorders.

Results - Comparing SEFAS to the other scores, convergent validity (when correlating foot-specific questions) and divergent validity (when correlating foot-specific and general questions) were confirmed. SEFAS had no floor and ceiling effects. In patients with forefoot disorders, ICC was 0.92 (CI: 0.85-0.96), Cronbach's α was 0.84, ES was 1.29, and SRM was 1.27. In patients with hindfoot or ankle disorders, ICC was 0.93 (CI: 0.88-0.96), Cronbach's α was 0.86, ES was 1.05, and SRM was 0.99.

Interpretation - SEFAS has acceptable validity, reliability, and responsiveness in patients with various forefoot, hindfoot, and ankle disorders. SEFAS is therefore an appropriate patient- reported outcome measure (PROM) for these patients, even in national registries.
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NewsBot · Mar 28, 2014

Psychometric Comparison of the PROMIS Physical Function CAT With the FAAM and FFI for Measuring Patient-Reported Outcomes
Man Hung et al
Foot & Ankle International March 27, 2014

Background: Selecting optimal patient-reported outcome (PRO) instruments is critical to improving the quality of health care. The purpose of this study was to compare the reliability, responsiveness, and efficiency of three PRO measures: the Foot and Ankle Ability Measure–Activity of Daily Living subscale (FAAM_ADL), the Foot Function Index 5-point verbal rating scale (FFI-5pt), and the PROMIS Physical Function computerized adaptive test (PF CAT).
Methods: Data were aggregated from 10 clinical sites in the AOFAS’s National Orthopaedic Foot and Ankle Research (OFAR) Network from 311 patients who underwent elective surgery for a disorder of the foot or ankle. Patients were administered the FAAM_ADL, FFI-5pt, and PF CAT at their preoperative visit and at 6 months after surgery. Reliabilities were evaluated using a Rasch model. Responsiveness was calculated using paired samples t test and efficiency was recorded as number of seconds to complete the instrument.
Results: Similar reliabilities were found for the three instruments. Item reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were all .99. Pearson reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were .95, .93, and .96, respectively. On average, patients completed the FAAM_ADL in 179 seconds, the FFI-5pt in 194 seconds, and the PF CAT in 44 seconds, (P < .001). The PF CAT and FAAM_ADL showed significant improvement (P = .01 and P = .001, respectively) in patients’ physical function after treatment; the FFI-5pt did not show improvement.
Conclusions: Overall, the PF CAT performed best in terms of reliability, responsiveness, and efficiency in this broad sample of foot and ankle patients. It can be a potential replacement for the conventional PRO measures, but further validation is needed in conjunction with the PROMIS Pain instruments.
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NewsBot · Apr 22, 2014

Translation and validation of the German version of the foot and ankle outcome score.
van Bergen CJ, Sierevelt IN, Hoogervorst P, Waizy H, van Dijk CN, Becher C.
Arch Orthop Trauma Surg. 2014 Apr 19.

PURPOSE:
Outcome assessment is critical in evaluating the efficacy of orthopaedic procedures. The Foot and Ankle Outcome Score (FAOS) is a 42-item questionnaire divided into five subscales, which has been validated in several languages. Germany has no validated outcome score for general foot and ankle pathology. The aim of this study was to develop a German version of the FAOS and to investigate its psychometric properties.
MATERIALS AND METHODS:
Forward and backward translation was executed according to official guidelines. The final version of the FAOS was investigated in 150 patients with various foot and ankle disorders. All patients completed the FAOS, Short Form-36, numeric rating scales for pain and disability, and the Hannover questionnaire. The FAOS was re-administered after 1 week. Test-retest reliability, internal consistency, minimal detectable change, construct validity, and floor and ceiling effects were analyzed.
RESULTS:
Test-retest reliability and internal consistency of each subscale were excellent (intraclass correlation coefficient, 0.88-0.95; Cronbach's α, 0.94-0.98). The minimal detectable changes of each subscale were 17.1-20.8 at the individual level and 2.0-2.4 at group level. There were moderate to strong correlations between FAOS subscales and physical outcomes and low to moderate correlations between FAOS subscales and mental outcomes. Floor and ceiling effects were not present.
CONCLUSION:
The German version of the FAOS is a reliable and valid instrument for use in foot and ankle patients.
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NewsBot · May 8, 2014

Validation of the Dutch language version of the Foot and Ankle Outcome Score
I. N. Sierevelt, L. Beimers, C. J. A. van Bergen, D. Haverkamp, C. B. Terwee, G. M. M. J. Kerkhoffs
Knee Surgery, Sports Traumatology, Arthroscopy; May 2014

Purpose
The aim of this study was to develop a Dutch language version of the Foot and Ankle Outcome Score (FAOS-DLV) and evaluate its measurement properties according to the definitions of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).
Methods
After a standard forward–backward translation procedure, the Dutch version of the FAOS was evaluated for reliability and validity in 110 patients with various hind foot and ankle complaints. Reliability was evaluated by calculation of intraclass correlation coefficients (ICC), Cronbach’s alpha for internal consistency, and the smallest detectable change (SDC). Construct validity of the FAOS was assessed by calculation of Spearman’s correlation coefficients with similar and dissimilar domains of the SF-36 health survey, American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale, and visual analogue scales for pain and disability. Dimensionality was tested with confirmatory factor analysis.
Results
Reliability of the FAOS-DLV was good. The ICC of the subscales ranged from 0.83 to 0.88. The minimal value of Cronbach’s alpha was 0.76. The SDC at individual level ranged from 18 to 21 and at group level between 2.1 and 2.5. Construct validity was supported by confirmation of 85 % of the hypothesized correlations. Unidimensionality of the FAOS-DLV domains was moderate.
Conclusion
The Dutch version of the FAOS seems to have acceptable measurement properties. The questionnaire can be used for functional assessment of patients with varying hindfoot and ankle symptoms. It is, however, more suitable for clinical evaluation at group level than for monitoring a specific patient.
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NewsBot · Jul 12, 2014

Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS)
Maria C. Cöster et al
Foot & Ankle International July 11, 2014

Background: The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure, while the American Orthopedic Foot and Ankle Society Score (AOFAS) is a clinician-based score, both used for evaluation of foot and ankle disorders. The purpose of this study was to compare the psychometric properties of these 2 scoring systems.
Methods: A total of 95 patients with great toe disorders and 111 patients with ankle or hindfoot disorders completed the 2 scores before and after surgery. We evaluated time to complete the scores in seconds, correlations between scores with Spearman’s correlation coefficient (rs), floor and ceiling effects by proportion of individuals who reached the minimum or maximum values, test–retest reliability and interobserver reliability by intraclass correlation coefficient (ICC), internal consistency by Cronbach’s coefficient alpha (CA), and responsiveness by effect size (ES). Data are provided as correlation coefficients, means, and standard deviations.
Results: SEFAS was completed 3 times faster than AOFAS. The scores correlated with an rs of .49 for great toe disorders and .67 for ankle/hindfoot disorders (both P < .001). None of the scores had any floor or ceiling effect. SEFAS test–retest ICC values measured 1 week apart were .89 for great toe and .92 for ankle/hindfoot disorders, while the corresponding ICC values for AOFAS were .57 and .75. AOFAS interobserver reliability ICC values were .70 for great toe and .81 for ankle/hindfoot disorders. SEFAS CA values were .85 for great toe and .86 for ankle/hindfoot disorders, while the corresponding CA values for AOFAS were .15 and .42. SEFAS ES values were 1.15 for great toe and 1.39 for ankle/hindfoot disorders, while the corresponding ES values for AOFAS were 1.05 and 1.73.
Conclusion: As SEFAS showed similar or better outcome in our tests and was completed 3 times faster than AOFAS, we recommend SEFAS for evaluation of patients with foot and ankle disorders.
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NewsBot · Oct 9, 2014

Validity and responsiveness of a self-administered foot evaluation questionnaire in rheumatoid arthritis.
Yano K1, Ikari K, Ochi K, Ishida O, Sakuma Y, Yoshida S, Koyama T, Koenuma N, Momohara S.
Mod Rheumatol. 2014 Oct 8:1-4

Objectives. A self-administered foot evaluation questionnaire (SAFE-Q) was developed by the Japanese Society for Surgery of the Foot (JSSF). The aim of this study is to evaluate the validity and responsiveness of the SAFE-Q in patients with rheumatoid arthritis (RA).

Methods. In total, 180 patients with RA answered the SAFE-Q. Of 180 patients, 34 answered the SAFE-Q twice, preoperatively and postoperatively, to assess responsiveness. Construct validity was tested by comparing the 5 SAFE-Q subscales and the JSSF standard rating system for the RA foot and ankle scale (JSSF-RA), a Japanese version of the Health Assessment Questionnaire (JHAQ), disease activity score in 28 joints (DAS28), simplified disease activity index (SDAI), and clinical disease activity index (CDAI). Responsiveness was examined by calculating the standardized response mean (SRM) and effect size (ES) 3 months after surgery.

Results. There were moderate correlations between the SAFE-Q and the JSSF-RA and JHAQ. Conversely, a low correlation was observed between the SAFE-Q and DAS28, SDAI, and CDAI. The responsiveness was high, with an SRM of 0.9 and ES of 0.7 for pain subscales.

Conclusion. SAFE-Q is a useful tool for assessing the foot and ankle in RA patients.
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NewsBot · Oct 14, 2014

Evidence of Validity for the Japanese Version of the Foot and Ankle Ability Measure.
Uematsu D, Suzuki H, Sasaki S, Nagano Y, Shinozuka N, Sunagawa N, Fukubayashi T.
J Athl Train. 2014 Oct 13

Context : The Foot and Ankle Ability Measure (FAAM) is a valid, reliable, and self-reported outcome instrument for the foot and ankle region.

Objective : To provide evidence for translation, cross-cultural adaptation, validity, and reliability of the Japanese version of the FAAM (FAAM-J).

Design : Cross-sectional study.

Setting : Collegiate athletic training/sports medicine clinical setting.

Patients or Other Participants : Eighty-three collegiate athletes.

Main Outcome Measure(s) : All participants completed the Activities of Daily Living and Sports subscales of the FAAM-J and the Physical Functioning and Mental Health subscales of the Japanese version of the Short Form-36v2 (SF-36). Also, 19 participants (23%) whose conditions were expected to be stable completed another FAAM-J 2 to 6 days later for test-retest reliability. We analyzed the scores of those subscales for convergent and divergent validity, internal consistency, and test-retest reliability.

Results : The Activities of Daily Living and Sports subscales of the FAAM-J had correlation coefficients of 0.86 and 0.75, respectively, with the Physical Functioning section of the SF-36 for convergent validity. For divergent validity, the correlation coefficients with Mental Health of the SF-36 were 0.29 and 0.27 for each subscale, respectively. Cronbach α for internal consistency was 0.99 for the Activities of Daily Living and 0.98 for the Sports subscale. A 95% confidence interval with a single measure was ±5.1 and ±3.2 points for each subscale. The test-retest reliability measures revealed intraclass correlation coefficient values of 0.87 for the Activities of Daily Living and 0.90 for the Sports subscales with minimal detectable changes of ±4.9 and ±9.9 for the respective subscales.

Conclusions : The FAAM was successfully translated for a Japanese version, and the FAAM-J was adapted cross-culturally. Thus, the FAAM-J can be used as a self-reported outcome measure for Japanese-speaking individuals; however, the scores must be interpreted with caution, especially when applied to different populations and other types of injury than those included in this study.
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Another bl....y outcome measure for the foot

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