Preoperative Patient-Reported Outcome Measures Relationship With Postoperative Outcomes in Flexible Adult-Acquired Flatfoot Deformity

Abstract

Background: Previous studies have demonstrated that procedure-specific thresholds using preoperative patient-reported outcome scores may be used to predict postoperative outcomes. The primary purpose of this study was to determine if preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) thresholds could be used to predict which patients would clinically improve at 2 years postoperatively following reconstruction of their flexible adult-acquired flatfoot deformity (AAFD). Methods: PROMIS physical function, pain interference, and depression scores were prospectively collected preoperatively and at a minimum of 2 years postoperatively for 75 feet with flexible AAFD. Minimal clinically important differences (MCIDs) were calculated to establish significant postoperative improvement. Receiver operating characteristic curves and area under the curve analyses were employed to determine whether preoperative PROMIS scores could be used to predict postoperative outcomes. Results: The PROMIS physical function receiver operating characteristic curve analysis (area under the curve = 0.913, P < .001) found that a preoperative PROMIS physical function score greater than 45.7 resulted in a 14.3% probability of achieving the MCID, whereas a preoperative score of less than 40.8 had a 97.7% probability of achieving the MCID. A preoperative PROMIS pain interference score (area under the curve = 0.799, P < .001) less than 54.1 had only a 23.1% probability of achieving the MCID at 2 years postoperatively. Conclusions: Preoperative PROMIS physical function and pain interference scores could be used to predict postoperative improvement in patients with flexible AAFD. These results may help surgeons counsel patients regarding the anticipated benefit of surgery. Level of Evidence: Level III, retrospective comparative series.

Preoperative PROMIS Physical Function Scores Predict Postoperative Outcomes Following Total Ankle Replacement

“…Because the MCIDs from the bootstrapped analysis were all within 0.1 of the estimates from the original sample, the MCIDs from the original sample were used in the analysis because this method has been used in previous studies. 5,18,19,25 Logistic regression models controlling for age, gender, and body mass index (BMI) were then used to evaluate the predictive value of preoperative PROMIS scores in determining meaningful improvement after surgery based on the MCID. The area under the curve (AUC) was calculated in order to ascertain the ability of a PROMIS scale to differentiate between those patients who had meaningful improvement and met the MCID postoperatively and those who did not.…”

Return to Physical Activity Following Flatfoot Reconstruction

“…The improvements in Physical Function and Pain Interference were substantially greater than the reported minimal clinically important differences for PCFD of 3.2 points and 3.7 points on the PROMIS PF and PI subscales, respectively. 4…”

Relationship Between Preoperative PROMIS Scores and Postoperative Outcomes in Hallux Rigidus Patients Undergoing Cheilectomy

“…Prior studies using similar methodology have suggested that preoperative PROMIS scores are associated with out comes in surgical foot and ankle patients in general, and further research has been done to identify diseasespecific thresholds to determine if preoperative PROMIS scores have clinical utility in associating with outcomes after spe cific procedures such as bunionectomy, flatfoot reconstruc tion, and TAR. 1,3,4,8,13 Ho et al 8 found that preoperative PROMIS physical function (AUC = 0.83), pain interfer ence (AUC = 0.73), and depression (AUC = 0.74) scores were associated with postoperative outcomes in a sample of 61 surgical foot and ankle patients. Patients in their cohort that had a physical function score <29.7 had an 83% prob ability of achieving the MCID, and patients with a score >42 had a 94% probability of failing to achieve the MCID.…”

“…For pathologies such as progressive collapsing foot deformity, ankle arthritis, and hallux valgus, preoperative PROMIS scores may be a useful adjunct to clinical examination to give clinicians and patients an idea of how much they can improve after surgery. 3,4,13 However, for hallux rigidus, preoperative outcome scores cannot be used to give patients a prognosis on how much they will improve after a cheilectomy.…”

“…12,17,19 Numerous studies have found that preoperative patient reported outcome measures are associated with which patients will meet the minimal clinically important differ ence (MCID) in orthopaedics. 4,8,13,22 One patientreported outcome measure, the PatientReported Outcomes Measurement Information System (PROMIS), has been recently used for this purpose and is a validated patient reported outcome measure that uses computerized adaptive testing (CAT) based on item response theory. Preoperative PROMIS scores have been validated to predict postopera tive success in foot and ankle patients.…”