Patient-reported outcome measures for the evaluation of foot and ankle function—recommendations from the research committee of the AGA

Abstract

The standardized collection of treatment results is increasingly utilized in modern medicine. The primary focus is on the subjective clinical outcome and patient satisfaction, which has gained importance not only in the academic world but also in current healthcare policy. There are numerous questionnaires (scores or patient-reported outcome measures, PROMs) that are both joint-specific and in some cases pathology-specific and can be used in patients undergoing orthopedic treatment. Accordingly, a variety of questionnaires are available in the field of foot and ankle surgery, yet these are often very heterogeneous and rarely pathology-specific. Considering the diversity of PROMs in the current literature, it is of great interest to evaluate the scientific quality while unifying research communication by using well-established questionnaires selected according to academic quality criteria. The overall goal is to obtain valid, reliable and representative data to get an accurate characterization of the actual treatment results. Aside from qualitative criteria, compact and easy to understand questionnaires are required to generate high response rates among patients. Lastly, the results obtained should always be assessed in light of the clinical relevance they may have. Thus, the utilization of the minimal clinically important difference (MCID) of the respective PROM, which represents the smallest value that is perceived as clinical change by the patient, is recommended. Considering all these criteria, the research committee of the AGA recommends the following PROMs: the foot and ankle outcome score (FAOS) to assess general pain symptoms and function, and the EQ 5D questionnaire for assessment of the quality of life. Although no pathology-specific recommendation can be made due to a lack of data, the FAOS has been validated for numerous foot and ankle pathologies and is available in the German language.