Identifying Foot and Ankle Patients at Risk to Fall Based on Patient Reported Outcomes Assessments

Abstract

Aims: To determine if patient reported outcomes (PROMIS) can identify orthopaedic and specifically foot and ankle patients at risk to fall. Method(s): Prospective patient reported outcomes (PROMIS CAT physical function, pain interference and depression and CMS fall risk assessment questions) and patient demographics were collected for all patients at each clinic visit from an academic orthopaedic multispecialty practice between January 2015 and November 2017. Standardized yes/no validated self-reported fall risk questions include: "Have you fallen in the last year?" and "Do you feel you are at risk of falling?" Histograms, t-tests, confidence intervals and effect size were used to determine the fall risk "YES" patients were different than the "NO" for ALL orthopaedic patients and specifically foot and ankle patients. Logistic Regression was used to determine if age, gender, height, weight, and PROMIS scales predicted self-reported falls risk. Result(s): 94,761 orthopaedic patients comprising 315,273 visits (44% male, mean age 53.7 +/- 17 years) and 13,720 foot/ankle patients comprising 33,480 visits (37% male, mean age 52.7 +/- 16.1 years) had complete data for analysis. Table 1 provides the means/SD/pvalues/ effect sizes for patient self-identifying at risk to fall stratified by PROMIS PF/PI/Dep t-scores. Although all PROMIS scores demonstrated significant impairment between patients at risk designation (yes/no), PROMIS PF had the largest effect size for ALL Ortho and FOOT AND ANKLE patients (0.8 and 0.7 respectively). Patients who are at risk to fall have PROMIS PF t-scores >1.5 lower than the United States normative population while the patients not at risk are less< 1 SD. In the adjusted regression models gender and PROMIS PF had the largest coefficients. Conclusion(s): Falls are a major cost to the healthcare system and threat to patient's quality of life and independence. Screening patients for prevention/treatment strategies has previously been difficult to implement across a health system due to the burdensome "hands on" clinical testing required. This study demonstrates that PROMIS PF t-scores can be linked to self-reported fall risk. This information can potentially be used to fulfill a quality indicator requirement by CMS (falls risk). Most importantly this screening can aid the provider in identifying patients who may benefit from prevention programs.