Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

Mikko M Uimonen; Ville T Ponkilainen; Alar Toom; Mikko Miettinen; Arja H Häkkinen; Henrik Sandelin; Antti O Latvala; Timo Sirola; Mika Sampo; Risto P Roine; Jan Lindahl; Outi Ilves; Anna Sandbacka; Jussi P Repo

doi:10.1016/j.fas.2020.02.003

Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

Foot Ankle Surg. 2021 Jan;27(1):52-59. doi: 10.1016/j.fas.2020.02.003. Epub 2020 Feb 12.

Authors

Affiliations

¹ Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland. Electronic address: mikko.uimonen@ksshp.fi.
² Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
³ Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁴ Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine, Central Finland Healthcare District, Jyväskylä, Finland.
⁵ Division of Orthopedic and Trauma Surgery, Department of Surgery, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
⁶ Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁷ Group Administration, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland; Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
⁸ Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
⁹ Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland. Electronic address: mrjussirepo@gmail.com.

PMID: 32111516
DOI: 10.1016/j.fas.2020.02.003

Abstract

Background: Patient-reported outcomes (PROs) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments.

Methods: Altogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester-Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed.

Results: Based on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument.

Conclusions: The ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies.

Keywords: Ankle; Clinimetrics; Foot; Patient-reported outcome; Psychometrics; Validation; ePRO.

Publication types

Multicenter Study
Validation Study

MeSH terms

Ankle Joint / surgery*
Electronic Health Records / standards*
Female
Humans
Male
Middle Aged
Patient Reported Outcome Measures*
Reproducibility of Results
Surveys and Questionnaires
Visual Analog Scale