Background
Methods
Study population
Patient-reported outcome measures
Statistical analysis
Results
Study population
% | ||
---|---|---|
Age years, mean (range) | 57.5 (22.2–91.2) | |
Female | 322 | 56.8 |
Marital statusa | ||
Divorced/separated | 77 | 13.6 |
Cohabitant/married | 379 | 66.8 |
Single | 47 | 8.3 |
Widowed | 46 | 8.1 |
Education | ||
Under 10 yrs | 157 | 27.7 |
10–12 yrs | 206 | 36.3 |
University | 181 | 31.9 |
Body mass index (kg/m2), median range | 27.4 (14.4–61.0) | |
Current smoker | 136 | 25.2 |
Diabetes | 34 | 6.0 |
Fracture classification, Weber | ||
A | 15 | 2.6 |
B | 383 | 67.5 |
C | 156 | 27.5 |
Fracture, clinical features | ||
Uni-malleolar | 294 | 52.5 |
Bimalleolar | 128 | 22.9 |
Trimalleolar | 138 | 24.6 |
Physical status (ASA classification) | ||
Completely healthy fit | 197 | 34.7 |
Mild systemic disease | 340 | 60.0 |
Severe systemic disease, not incapacitating | 30 | 5.3 |
Postoperative length of stay in days, median (range) | ||
Surgery duration in minutes, median (range) | 76.0 (7–352) | |
Waiting time for surgery in days, median (range) | 5.0 (0–68) |
Statistical analysis
Instrument/item | % miss | Mean (SD) | Frequencies % | Cronbach’s alpha (scale)/item scale correlation | Test-retest ICC (scores), weighted kappa (items) | ||||
---|---|---|---|---|---|---|---|---|---|
0 | 1 | 2 | 3 | 4 | |||||
Lower Extremity Functional Scale LEFSb | 4.2 | 67.20 (15.09) | 0.96 | 0.91 | |||||
LEFS adjustedc | 2.8 | 83.89 (19.01) | – | 0.91 | |||||
1 Usual work, housework, school | 2.6 | 3.51 (0.89) | 1.8 | 2.5 | 8.2 | 17.5 | 70.0 | 0.81 | 0.77 |
2 Hobbies, recreational, sports | 4.9 | 3.22 (1.02) | 2.8 | 5.4 | 10.2 | 29.8 | 51.8 | 0.78 | 0.76 |
3 Getting in and out of bath | 5.8 | 3.54 (0.97) | 3.4 | 3.2 | 5.1 | 12.4 | 75.9 | 0.72 | 0.76 |
4 Walking between rooms | 2.8 | 3.91 (0.40) | 0.2 | 0.5 | 0.9 | 5.3 | 93.1 | 0.56 | 0.70 |
5 Putting on socks or shoes | 3.0 | 3.65 (0.72) | 0.9 | 1.5 | 4.9 | 17.3 | 75.4 | 0.70 | 0.71 |
6 Squatting | 3.0 | 3.03 (1.30) | 7.8 | 9.1 | 8.0 | 21.7 | 53.3 | 0.73 | 0.74 |
7 Lifting things up from floor | 2.1 | 3.82 (0.57) | 0.9 | 0.5 | 2.2 | 8.0 | 88.4 | 0.61 | 0.79 |
8 Light activities in the home | 2.5 | 3.82 (0.54) | 0.2 | 0.9 | 3.1 | 8.5 | 87.3 | 0.69 | 0.78 |
9 Heavy activities in the home | 2.5 | 3.27 (1.05) | 2.7 | 6.5 | 9.4 | 23.2 | 58.1 | 0.85 | 0.85 |
10 Getting in/out of car | 2.5 | 3.72 (0.64) | 0.2 | 1.6 | 4.4 | 14.2 | 79.7 | 0.67 | 0.68 |
11 Walking 2 blocks | 3.0 | 3.69 (0.82) | 2.4 | 1.5 | 4.4 | 8.2 | 83.6 | 0.74 | 0.80 |
12 Walking a mile | 3.4 | 3.42 (1.07) | 4.2 | 3.8 | 7.9 | 13.7 | 70.3 | 0.82 | 0.84 |
13 Going up or down ten stairs | 3.2 | 3.65 (0.78) | 1.1 | 2.4 | 4.9 | 13.9 | 77.7 | 0.75 | 0.73 |
14 Standing 1 h | 2.8 | 3.11 (1.21) | 6.0 | 7.8 | 8.6 | 24.0 | 53.6 | 0.84 | 0.85 |
15 Sitting 1 h | 3.4 | 3.77 (0.65) | 0.5 | 1.8 | 3.1 | 9.5 | 84.8 | 0.51 | 0.57 |
16 Running on even ground | 5.1 | 2.74 (1.46) | 13.6 | 10.3 | 9.9 | 20.7 | 45.5 | 0.85 | 0.87 |
17 Running on uneven ground | 4.4 | 2.46 (1.47) | 16.3 | 12.8 | 13.0 | 24.4 | 33.5 | 0.83 | 0.85 |
18 Sharp turns when running fast | 4.9 | 2.53 (1.52) | 17.1 | 12.5 | 9.3 | 22.0 | 39.1 | 0.84 | 0.82 |
19 Hopping | 4.6 | 2.43 (1.53) | 18.2 | 13.2 | 12.2 | 19.9 | 36.5 | 0.83 | 0.83 |
20 Rolling over in bed | 2.7 | 3.82 (0.54) | 0.4 | 1.1 | 1.6 | 10.0 | 86.7 | 0.56 | 0.65 |
Olerud-Molander Ankle Score OMAS | 17.3 | 74.12 (24.91) | 0.82 | 0.92 | |||||
OMAS adjustedc | 1.6 | 75.62 (24.07) | – | 0.91 | |||||
1 Pain when walking | 4.9 | 3.01 (1.21) | 7.3 | 4.8 | 13.8 | 27.6 | 46.6 | 0.67 | 0.76 |
2 Stiffness (2 pt. scale) | 2.7 | 1.81 (1.99) | 54.7 | 45.3 | 0.55 | 0.77 | |||
3 Swelling (3 pt. scale) | 3.5 | 2.83 (1.53) | 17.1 | 24.2 | 58.7 | 0.51 | 0.80 | ||
4 Use of stairs (2 pt. scale) | 1.2 | 3.25 (1.03) | 1.4 | 35.8 | 63.8 | 0.73 | 0.81 | ||
5 Running (2 pt. scale) | 2.5 | 2.66 (1.89) | 33.6 | 66.4 | 0.66 | 0.81 | |||
6 Jumping (2 pt. scale) | 6.2 | 2.60 (1.91) | 34.9 | 65.1 | 0.65 | 0.80 | |||
7 Squatting (2 pt. scale) | 4.6 | 2.68 (1.88) | 33.0 | 67.0 | 0.61 | 0.68 | |||
8 Assistive devices (3 pt. scale) | 3.2 | 3.72 (0.91) | 4.4 | 5.3 | 90.3 | 0.37 | 0.90 | ||
0
|
1.33
|
2.67
|
4
| ||||||
9 Work and daily activities (4 pt. scale) | 2.5 | 3.27 (1.14) | 6.4 | 5.1 | 25.8 | 62.8 | 0.66 | 0.77 | |
Self-Reported Foot & Ankle Score SEFAS | 8.5 | 20.78 (9.16) | 0.93 | 0.93 | |||||
SEFAS adjustedc | 1.6 | 81.40 (19.17) | – | 0.93 | |||||
1 Usual pain level | 1.6 | 2.76 (1.51) | 2.9 | 14.9 | 19.1 | 29.3 | 33.8 | 0.82 | 0.83 |
2 Walking time before pain too much | 3.7 | 3.58 (0.83) | 0.4 | 5.0 | 5.1 | 14.7 | 74.8 | 0.69 | 0.76 |
3 Work not done as carefully as usual | 2.5 | 3.27 (0.96) | 2.2 | 3.8 | 12.0 | 28.5 | 53.5 | 0.69 | 0.78 |
4 Use of special innersoles and shoes | 1.9 | 3.54 (1.06) | 4.7 | 4.2 | 2.7 | 8.8 | 79.6 | 0.35 | 0.69 |
5 Usual work, housework, hobbies | 2.1 | 3.29 (0.99) | 1.1 | 6.9 | 11.0 | 23.5 | 57.5 | 0.87 | 0.85 |
6 Limping | 1.6 | 3.02 (1.23) | 6.8 | 4.5 | 22.7 | 11.0 | 55.0 | 0.75 | 0.77 |
7 Staircase | 2.3 | 3.55 (0.80) | 0.9 | 2.0 | 8.3 | 18.5 | 70.3 | 0.71 | 0.80 |
8 Problem in bed | 1.6 | 3.21 (1.10) | 2.5 | 4.7 | 22.7 | 10.1 | 60.1 | 0.72 | 0.70 |
9 Usual free time activities | 1.8 | 3.11 (1.09) | 2.7 | 9.2 | 10.6 | 29.7 | 47.7 | 0.86 | 0.88 |
10 Swelling | 2.1 | 3.00 (1.20) | 7.1 | 6.9 | 9.4 | 32.4 | 44.3 | 0.57 | 0.90 |
11 Getting up from a chair | 1.8 | 3.60 (0.72) | 0.2 | 1.8 | 7.0 | 19.6 | 71.4 | 0.77 | 0.77 |
12 Sudden strong pain | 1.8 | 3.15 (1.02) | 1.3 | 3.4 | 27.7 | 14.2 | 53.2 | 0.68 | 0.77 |
Instrument | χ2 |
df
| CFIa | TLIb | RMSEAc |
---|---|---|---|---|---|
LEFS unidimensional | 843.4 | 171 | 0.99 | 0.99 | 0.091 |
LEFS bidimensionald | 604.4 | 169 | 1.00 | 1.00 | 0.073 |
SEFAS | 165.9 | 54 | 0.99 | 0.99 | 0.063 |
OMAS | 122.8 | 27 | 0.99 | 0.98 | 0.087 |
Instrument |
n
| Test mean (SD) | Retest mean (SD) | SEMb | SDCcindividual | SDCcgroup |
---|---|---|---|---|---|---|
LEFS (0–80)c | 179 | 68.54 (15.03) | 69.03 (15.14) | 4.50 | 12.49 | 0.93 |
LEFS adjusted | 181 | 85.48 (18.39) | 86.19 (18.41) | 5.61 | 15.55 | 1.16 |
SEFAS (12–60)b | 172 | 19.70 (8.99) | 19.49 (9.23) | 2.39 | 6.62 | 0.50 |
SEFAS adjusted | 182 | 83.85 (18.52) | 84.11 (19.01) | 5.09 | 14.10 | 0.93 |
OMAS | 140 | 78.04 (24.44) | 79.64 (24.29) | 6.87 | 19.04 | 0.92 |
OMAS adjusted | 176 | 77.66 (24.38) | 78.85 (23.90) | 7.41 | 20.55 | 1.55 |
Instrument | LEFS | LEFS Adjustedb | OMAS | OMAS Adjusted | SEFAS | SEFAS Adjusted |
---|---|---|---|---|---|---|
OMAS | 0.86 | 0.86 | ||||
OMAS Adjusted | 0.86 | 0.86 | ||||
SEFAS | −0.84 | −0.84 | − 0.89 | −0.89 | ||
SEFAS Adjusted | −0.84 | −0.84 | − 0.88 | −0.88 | ||
SF-36 physical function | 0.85 | 0.86 | 0.76 | 0.77 | −0.74 | −0.73 |
EQ-5D index | 0.73 | 0.73 | 0.79 | 0.79 | −0.80 | −0.79 |
Mobility | −0.65 | −0.64 | − 0.66 | −0.67 | 0.66 | 0.66 |
Self-care | −0.35 | −0.36 | − 0.32 | −0.33 | 0.34 | 0.34 |
Usual activities | −0.60 | −0.61 | − 0.59 | −0.60 | 0.62 | 0.62 |
Pain/discomfort | −0.64 | −0.64 | − 0.73 | −0.73 | 0.76 | 0.75 |
Anxiety/depression | −0.30 | −0.31 | − 0.30 | −0.31 | 0.31 | 0.30 |
ASA classification | −0.26 | −0.26 | − 0.19 | −0.21 | 0.21 | 0.20 |
Body Mass Index | −0.15 | −0.16 | − 0.21 | −0.19 | 0.14 | 0.15 |
Duration of operation | −0.24 | −0.23 | − 0.25 | −0.26 | 0.24 | 0.22 |
Uni-, bi-, tri-malleolar | −0.23 | −0.22 | − 0.21 | −0.23 | 0.21 | 0.19 |