Background The aim of this study was to evaluate the use of patient reported experience measures (PREMs) in humeral shaft fractures managed with or without surgery against patient reported outcome measures (PROMs). Methods Adult patients treated for a humeral shaft fracture between June 2015 and August 2017 were included in non-surgery and surgery (early and late surgery) groups. The PREM questionnaire was based on patient and clinician feedback obtained during focus groups and was posted to patients. PROMs included the short form-12 (SF-12) and visual analogue scale (VAS) for pain, stiffness, function and satisfaction. Results Eighty-one patients responded, 54 patients were treated in a brace and 27 with surgery (13 early, 14 late). There was moderate positive correlation between PREM and VAS satisfaction and function and moderate negative correlation with VAS pain and stiffness. There was also moderate positive correlation between PREM and SF-12 mental and weak positive correlation with SF-12 physical. The late surgery group had poorer PREMs (expectations, p = 0.002 and friends & family test, p = 0.0001) and PROMs (VAS satisfaction, p = 0.005) compared to the early surgery group. Conclusions PREMs can be used in conjunction with PROMs to improve the patient's quality of care and as a means of identifying, at an early stage, those patients not doing well and to offer surgery.

Category: Midfoot/Forefoot Introduction/Purpose: First metatarsal phalangeal joint (MTPJ) arthrodesis is a well established procedure in the treatment of end-stage arthritis. Patient reported outcome measures (PROMs) are an important part of the modern healthcare system. The aim of surgery is to improve pain, function and health related quality of life (HRQoL). The Manchester-Oxford Foot Questionnaire (region-specific) and the Euro-QOL 5 dimension (generic) are both PROMs, known to be sensitive to change following foot/ ankle surgery at 6-months post-procedure (Maher & Kilmartin, J of Foot & Ankle Res, 5: 17, 2012). However we don’t know if baseline scores and the presence of comorbidities influence the change in these PROMs. This is important to understand so that we can identify which patients to offer MTPJ arthrodesis surgery to. Methods: Aims 1. To identify the change in two patient-reported outcome measures (PROMs) following MTPJ arthrodesis: The Manchester-Oxford Foot Questionnaire (MOxFQ) and the Euro-QOL 5 dimension tool. Do baseline scores make a difference to the change? 2. To describe the impact of co-morbidities on the change in both PROMs. Data was collected prospectively from patients who had undergone a first MTPJ arthrodesis. Patients with complete pre- and post-PROMs data were included in the analysis. PROMs data was collected on average 5.2 months post-operatively. Surgery notes were crosschecked with radiographic findings. A comparative analysis was done between pre and post-operative data using SPSS (version 20). The MOxFQ generates a total score, as well as 3 sub-domain scores for pain, walking/ standing and social interaction. The EQ5D generates a total score and a health today score (visual analogue scale: VAS from 0-100). Results: 90 patients were identified, 52 had complete data. Mean (SD) age 56.9(17.8) years, 78% female. Comorbidities: diabetes 2%, hypertension 21%, rheumatoid arthritis (RA) 43%, current smokers 10%, average (SD) weekly units of alcohol 5.2 (9.1). Most cases were unilateral (94%) and fixed with two screws (87%). 37% had other foot procedures carried out concurrently.Table 1 shows the change in MoxFQ total, domain scores and the EQ5D total score, health today (VAS). The correlation between baseline EQ5D total and the change for this outcome was r=0.6 (p<0.001). The correlation between baseline MOxFQ total and the change for this outcome was r=0.5 (p<0.001). The only comorbidity to have an influence on PROMs was RA- the presence of RA significantly reduced change in EQ5D total (p<0.05). Conclusion: Following MTPJ arthrodesis, statistically and clinically significant changes were observed in EQ5D total score, MOxFQ total scores (and all sub-domains). The EQ5D VAS did not change. Baseline scores in both PROMs were correlated with the change scores following surgery- suggesting that we may be able to identify a baseline score which could predict the outcome in PROMs and target who we offer surgery to as a consequence. Comorbidities had little influence on the change in both PROMs following surgery, other than the presence of RA dampening the change in EQ5D total score. Again this is useful to inform pre- operative discussions. [Table: see text]