TY - JOUR
T1 - The completely patient-reported version of the American Orthopaedic Foot and Ankle Society (AOFAS) score
T2 - A valid and reliable measurement for ankle osteoarthritis
AU - Paget, Liam D. A.
AU - Sierevelt, Inger N.
AU - Tol, Johannes L.
AU - Kerkhoffs, Gino M. M. J.
AU - Reurink, Gustaaf
N1 - Funding Information: This is a substudy of the Platelet-Rich plasma Injections in the Management of Ankle oa (PRIMA) trial, a randomized, double-blind, placebo-controlled, multicentre prospective study, designed to determine the efficacy of platelet-rich plasma injections in the management of ankle OA [ 12 , 13 ]. The PRIMA trial is approved by the Medical Ethics Review Committee Amsterdam Medical Center, the Netherlands (ABR 2018–042, approved 23 July 2018) and is registered in the Netherlands trial register (NTR7261). This substudy was sponsored by the Marti-Keuning Eckhardt Foundation, a nonprofit patient organization. Funding Information: Although the PR-AOFAS score was expected to be similar in construct, it cannot replace the AOFAS score due to the systematic difference between the outcome measures and low level of agreement. There may be several explanations for this poor agreement. Firstly, the lower correlation could be explained by the fact that both instruments are measuring something else. The insufficient construct validity when compared to other PROMs may be a possible explanation. However, also disability weights assigned by patients have been found to be higher than the weights based on the judgement of the physician in osteoarthritis and other musculoskeletal conditions [35]. This is further supported by the fact that the PR-AOFAS score has a higher correlation with the other PROMs as they all measure the patient's perspective. One study also found that the AOFAS had a similar responsiveness to other PROMs once the objective items were removed [2]. Secondly, the correlation of identical patient-reported items also differed. Answering the same patient-reported items could therefore have been affected by the presence of a physician or by being in a hospital or clinical setting. Finally, the ceiling effect in the alignment subscale of both the PR-AOFAS and the AOFAS scores and the floor effect in the pain subscale of the AOFAS score may result in restricted variation with a subsequent lower correlation. Publisher Copyright: © 2023 The Authors
PY - 2023/10
Y1 - 2023/10
N2 - Background: The American Orthopaedic Foot and Ankle score (AOFAS) is an outcome measure for ankle and hindfoot conditions, which requires scoring from both the patients and the physician. A completely patient-reported version has been developed and used before, but its measurements properties are unknown. Our goal was to determine the measurement properties and the minimally important change (MIC) of a completely patient-reported AOFAS (PR-AOFAS) in patients with ankle osteoarthritis. Additionally, the MIC of both the PR-AOFAS and the AOFAS was estimated, which had not previously been done. Materials and methods: The PR-AOFAS of 112 patients was evaluated for reliability, construct validity (using the AOFAS, Foot and Ankle Outcome Score, Ankle Osteoarthritis Score, Visual Analogue Scale, and Short Form-36), and responsiveness. The MIC was estimated using the optimal cut-off point of the receiver operating characteristic curve. This was a substudy of a randomized clinical trial on the efficacy of platelet-rich plasma injections for ankle osteoarthritis (OA). Results: The PR-AOFAS had sufficient construct validity, internal consistency, test–retest reliability, and responsiveness. The smallest detectable change at group level was 2.34. The MIC was 6.5 points (95% confidence interval: 0.6–14.4). Conclusions: The measurement properties of the Dutch PR-AOFAS were sufficient in patients with ankle osteoarthritis who are willing to participate in a trial on injection therapy. The minimally important change of the PR-AOFAS is smaller than its smallest detectable change, making it more suitable for use in groups of patients, such as a research setting. Level of clinical evidence: 1.
AB - Background: The American Orthopaedic Foot and Ankle score (AOFAS) is an outcome measure for ankle and hindfoot conditions, which requires scoring from both the patients and the physician. A completely patient-reported version has been developed and used before, but its measurements properties are unknown. Our goal was to determine the measurement properties and the minimally important change (MIC) of a completely patient-reported AOFAS (PR-AOFAS) in patients with ankle osteoarthritis. Additionally, the MIC of both the PR-AOFAS and the AOFAS was estimated, which had not previously been done. Materials and methods: The PR-AOFAS of 112 patients was evaluated for reliability, construct validity (using the AOFAS, Foot and Ankle Outcome Score, Ankle Osteoarthritis Score, Visual Analogue Scale, and Short Form-36), and responsiveness. The MIC was estimated using the optimal cut-off point of the receiver operating characteristic curve. This was a substudy of a randomized clinical trial on the efficacy of platelet-rich plasma injections for ankle osteoarthritis (OA). Results: The PR-AOFAS had sufficient construct validity, internal consistency, test–retest reliability, and responsiveness. The smallest detectable change at group level was 2.34. The MIC was 6.5 points (95% confidence interval: 0.6–14.4). Conclusions: The measurement properties of the Dutch PR-AOFAS were sufficient in patients with ankle osteoarthritis who are willing to participate in a trial on injection therapy. The minimally important change of the PR-AOFAS is smaller than its smallest detectable change, making it more suitable for use in groups of patients, such as a research setting. Level of clinical evidence: 1.
KW - Ankle
KW - Ankle osteoarthritis
KW - Clinimetrics
KW - Orthopaedic surgery
KW - Sports medicine
UR - http://www.scopus.com/inward/record.url?scp=85168378513&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jisako.2023.07.003
DO - https://doi.org/10.1016/j.jisako.2023.07.003
M3 - Article
C2 - 37467932
SN - 2059-7754
VL - 8
SP - 345
EP - 351
JO - Journal of ISAKOS
JF - Journal of ISAKOS
IS - 5
ER -