Patient-reported outcome measures in hallux valgus surgery. A review of literature

doi:10.1016/j.fas.2014.11.004

Foot and Ankle Surgery

Volume 21, Issue 1, March 2015, Pages 11-15

https://doi.org/10.1016/j.fas.2014.11.004 Get rights and content

Highlights

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There is no consensus on outcome measurement of hallux valgus treatment.
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The VAS is the best pain score assessing outcome of hallux valgus treatment.
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The SF36 is the best QoL outcome instrument assessing hallux valgus treatment.
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The MOXFQ is the best disease-specific score assessing hallux valgus treatment.
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The SEFAS could be a good alternative.
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Future research must lead to general consensus on outcome measurement.

Abstract

Background

Up to a third of patients may be dissatisfied with the outcome of hallux valgus surgery. This stresses the importance of uniform and relevant outcome measures. The purpose of the current systematic review is to identify and rate available patient-reported outcome measures (PROMs) in hallux valgus surgery.

Methods

We performed a systematic literature search for outcome measures directed at hallux valgus. We searched electronic databases for relevant content according to the PRISMA standard. Eligible articles were used to give an overview of available PROMs, with qualitative evaluation of their properties.

Results

Twenty-eight eligible studies were included. Most adapted general health assessment tools, in studies on hallux valgus surgery, were the EQ5D and the SF-36 score. The visual analogue scale (VAS) was most cited as pain score. Three disease-specific outcome scores were identified: the Manchester-Oxford foot questionnaire (MOXFQ), the foot and ankle outcome score (FAOS) and the self-reported foot and ankle score (SEFAS). The MOXFQ showed the best psychometric properties.

Conclusions

The MOXFQ scores best on positively rated qualities based on our criteria. The SEFAS may be a good alternative, however it contains less items which are regarded as important by patients with foot/ankle complaints. A relative drawback of the MOXFQ consists of the copyright licence. The VAS is the best pain score and the SF36 the best general health assessment tool. Availability in native languages and future research should lead to uniformity in application of these tools.

Introduction

Hallux valgus has a prevalence of 23% in adults and this increases with age [1]. Although numerous articles have been published on hallux valgus surgery, there is no consensus on the optimal surgical technique or timing of surgery. Up to a third of treated patients may be dissatisfied with the outcome of surgery [2]. This is definitely not always reflected in outcome parameters in literature, due to a lack of uniform and relevant outcome measures in hallux valgus surgery [3], [4], [5].

Patients typically want a painless greater toe when wearing conventional shoes, and it is surprising that these expectations are only partly revealed by physician-based clinical outcome scores [6]. Current outcome measures tend not to use validated patient-reported outcome measures (PROMs), but rather physician-based outcome measurements [3], [4], [5]. Traditionally, these measurement tools have been developed for research purposes, not for quantifying patient-based outcome [7]. Standardized PROMs reflect the patients’ rather than the clinicians’ perspective and can provide useful information on patient satisfaction. Moreover, they are independent of the surgical team [6], [8].

PROMs are classified into three general categories: general quality of life (QoL), pain scale and disease-specific outcome measures [9]. For various highly prevalent orthopaedic conditions, such as knee and hip osteo-arthritis, validated QoL, pain and disease specific PROMS are widely used for both research and clinical evaluation. Current literature shows the majority of scores in foot and ankle pathology have questionable validity, reliability, applicability and responsiveness [5], [7], [10]. The high incidence of hallux valgus surgery, the various treatment options, and the uncertainty regarding the optimal indication and timing of surgery warrant the need for consensus on outcome measurement. The purpose of current systematic review is to identify and rate available PROMs on hallux valgus surgery.

Section snippets

Methods

The electronic databases Medline, Pubmed, Embase and Cochrane were searched systematically to identify relevant publications. Our systematic searches used the keywords “hallux valgus” OR “foot” OR “ankle”, “PROM” OR “questionnaire” OR “instrument” OR “outcome measure”, “validity” OR “reliability” OR “responsiveness”. Our search strategy was conducted applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standard [11], [12]. All references in the databases were

Results

Initial search strategies yielded a total of 496 hits. Application of the search objective, inclusion/exclusion criteria and analysis of the bibliographies eventually resulted in 28 eligible manuscripts. These were included in this study and underwent quality assessment [Fig. 1].

Table 1 demonstrates the psychometric properties and quality of the included PROMs according to a checklist described in previous studies [14], [16].

Discussion

Both the MOXFQ and SEFAS show good psychometric properties when used for the assessment of hallux valgus treatment. For the SEFAS, data on the minimal clinically important difference and interpretability are currently lacking. As a result, the MOXFQ scores best on positively rated qualities based on our criteria. This score has been specifically designed for patients with hallux valgus. The SEFAS, however, may still be a good alternative as it particularly uses fewer items. Both PROMs have

Conflict of interest statement

There are no known conflicts of interest.

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We aimed to investigate whether foot function and physical performance differ between women with and without bilateral painful hallux valgus (HV).
Forty-four women with bilateral painful HV and forty-three controls were included. The Foot Function Index, American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joints Scale, and Manchester-Oxford Foot Questionnaire were used. The time while walking 10 m-walkway at maximum speed and ascending and descending ten stairs as fast as possible also single-limb stance time were measured.
All self-reported and performance-based measures showed that women with HV had poorer foot function and physical performance than controls (p < 0.05). Women with mild HV had better self-reported foot function than those with moderate HV or severe HV (p < 0.05), but physical performance did not differ (p > 0.05).
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Postoperative outcome measurement typically relies on postoperative radiological results and clinical–functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery.
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An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our centre. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it.
The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p value of 0.218.
The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.
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Determinar si el mostrar una fotografía de la apariencia preoperatoria mejora la satisfacción en los pacientes posoperados de antepié.
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El grado de satisfacción total fue de 78,33% a los tres meses de la intervención. De los pacientes que recibieron la fotografía, 93,6% estaban satisfechos en el control posoperatorio, mientras que en el grupo control fue de 86,2% con una p = 0,218.
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Hallux valgus; An observational study on patient characteristics, surgical treatment and pre-operative HRQoL from the Swedish foot and ankle register (Swefoot)
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Hallux valgus (HV) is a common condition with impact on pain, function and HrQoL. International consensus does not exist on operative treatment of HV and population-level data regarding surgical treatment of HV is lacking. In this study we aimed to present base-line data from surgically treated HV patients reported to the Swedish register for foot and ankle surgery (Swefoot) during the period 2014–2021.
In total, 7543 feet in 6770 patients were analyzed regarding patient characteristics, grading of HV, surgical procedures and pre-operative PROMs Euroqol-5 Dimension-3 L (EQ-5D-3 L) and Self-reported Foot and Ankle Score (SEFAS).
Median age was 55 years (range 15–91) and 87% were women. The surgeon classified 63% of the cases as moderate HV, 15% as mild and 22% as severe. The Chevron osteotomy was the preferred surgical method and was used in 74% of all cases. Out of these, 58% were fixated with a screw. The Offset-V osteotomy was the most performed shaft osteotomy. Proximal osteotomies and lateral releases were less common. The pre-operative mean EQ-5D-3 L index and SEFAS summary score were low and HV patients with overweight and rheumatoid arthritis had significantly lower scores.
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The European Foot and Ankle Society score is a popular tool for monitoring treatment outcomes of foot or ankle conditions. However, few studies have assessed its psychometric properties in patients with hallux valgus. We aimed to validate the European Foot and Ankle Society score in patients with hallux valgus in Singapore. This is a cohort study of 121 patients with operatively managed hallux valgus from a tertiary referral hospital, evaluated preoperatively and at 6 months postoperatively with the primary endpoint of restoring patients to premorbid status. Internal consistency was assessed via Cronbach's alpha. Construct validity was assessed through 7 a priori hypotheses by correlating the European Foot and Ankle Society score with other patient‐reported outcomes measures. Structural validity was assessed via Confirmatory Factor Analysis, whereby a good fit was indicated when Comparative Fit Index >0.95, Tucker‐Lewis Index >0.95, Root Mean Square Error of Approximation <0.06, and Standardized Root Mean Residuals <0.08. Among our subjects, the European Foot and Ankle Society score demonstrated reliability, reflected by a good internal consistency (Cronbach's alpha = 0.773). Six out of the 7 a priori hypotheses were fulfilled, indicating both convergent and divergent construct validity. Structural validity was confirmed with our European Foot and Ankle Society score model which showed good fit for a 1‐factor structure (Confirmatory Factor Analysis = 0.998, Tucker‐Lewis Index = 0.996, Root Mean Square Error of Approximation = 0.025 [90% CI: 0-0.111], Standardized Root Mean Residuals = 0.027). In conclusion, the European Foot and Ankle Society score was validated for monitoring treatment outcomes of patients with hallux valgus in Singapore.

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ReviewPatient-reported outcome measures in hallux valgus surgery. A review of literature

Highlights

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conflict of interest statement

J Clin Epidemiol

J Clin Epidemiol

Clin Ther

Osteoarthritis Cartilage

J Clin Epidemiol

Soc Sci Med

J Arthroplasty

Pain

Pain

Foot (Edinb)

J Clin Epidemiol

J Clin Epidemiol

Prevalence of hallux valgus in the general population: a systematic review and meta-analysis

J Foot Ankle Res

Scarf versus chevron osteotomy in hallux valgus: a randomized controlled trial in 96 patients

Foot Ankle Int

A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus

Qual Life Res

Use of patient-reported outcome measures in foot and ankle research

J Bone Joint Surg Am

A meta-analysis of outcome rating scales in foot and ankle surgery: is there a valid, reliable, and responsive system?

Foot Ankle Int

Surgery for hallux valgus. The expectations of patients and surgeons

Int Orthop

Age and sex differences between patient and physician-derived outcome measures in the foot and ankle

J Bone Joint Surg Am

The problem with measuring patient perceptions of outcome with existing outcome measures in foot and ankle surgery

Foot Ankle Int

Patient-reported outcome measures in spine surgery

J Am Acad Orthop Surg

A survey of self-reported outcome instruments for the foot and ankle

J Orthop Sports Phys Ther

Psychometric properties of vision-related quality of life questionnaires: a systematic review

Ophthalmic Physiol Opt

Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature

Ann Rheum Dis

Methodological considerations in functional assessment

J Rheumatol Suppl

Psychometric evaluation of osteoarthritis questionnaires: a systematic review of the literature

Arthritis Rheum

Psychometric evaluation of self-report questionnaires - the development of a checklist

A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity

Med Care

Overview of adult health measures fielded in Rand's health insurance study

Med Care

Review
Patient-reported outcome measures in hallux valgus surgery. A review of literature