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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThere is a tangible need for improved tools to measure patient outcomes after treatment of foot and ankle disorders. One of those is the Patient-Reported Outcomes Measurement Information (PROMIS) physical function computerized adaptive testing (PF CAT), which has been validated for orthopaedic patients, as well as for lower extremity patients. This article discusses a study comparing the psychometric properties and efficiency of the PF CAT with the Foot Function Index and Foot and Ankle Ability Measure.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFoot \u0026amp; Ankle Conditions\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFoot \u0026amp; Ankle Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThere is a tangible need for improved tools to measure patient outcomes after treatment of foot and ankle disorders. Numerous clinical outcome measures are used to evaluate foot and ankle disorders and procedures, but consensus on these measures has not been reached. Evidence of validity, reliability, and responsiveness for foot and ankle disorders has been published only for a few scores designed for foot and ankle patient-reported outcome (PRO) measures. Of these few scores, only the Foot Function Index (FFI) and Foot and Ankle Ability Measure (FAAM) have been used in published studies \u2265 5 times in the last decade [Hunt KJ, Hurwit D. \u003Cem\u003EJ Bone Joint Surg Am.\u003C\/em\u003E 2013; Martin et al. \u003Cem\u003EJ Orthop Sports Phys Ther\u003C\/em\u003E. 2007].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Patient-Reported Outcomes Measurement Information (PROMIS) physical function computerized adaptive testing (PF CAT) has been validated for orthopaedic patients, as well as for lower extremity patients specifically [Hung M et al. \u003Cem\u003EFoot Ankle Int.\u003C\/em\u003E 2013]. However, the responsiveness of the PF CAT has not been determined in foot and ankle patients. This study, presented by Kenneth J. Hunt, MD, Stanford University, Stanford, California, USA, compared the psychometric properties and efficiency of the PF CAT with the FAAM and FFI.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ETen participating US sites enrolled 328 patients undergoing ankle, hindfoot, or forefoot surgery. Preoperative and 6-month PROs were collected through the National Orthopaedic Foot and Ankle Outcomes Research Network using the FAAM, FFI, and PF CAT.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe patients underwent surgery for ankle instability, ankle arthritis, hallux valgus, hammertoe, hallux rigidus, and flatfoot; 56% completed the 6-month surveys. Construct validity, determined using the Rasch model, was high for all 3 instruments. Pearson correlations showed that the PF CAT was highly correlated with the FFI 5-point verbal rating scale (FFI-5pt) (\u003Cem\u003Er\u003C\/em\u003E = 0.685) and the FAAM Activity of Daily Living subscale (FAAM_ADL) (\u003Cem\u003Er\u003C\/em\u003E = 0.792). All 3 measures demonstrated excellent item reliability, suggesting that the order of item difficulty would be comparable across various patient samples. Person reliability was also high, suggesting similar ordering of individuals\u0027 function levels with repeated measures (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12073\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12073\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12073\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EPerson and Item Reliability\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EPaired \u003Cem\u003Et\u003C\/em\u003E tests showed that the PF CAT had a preoperative responsiveness measure of \u22121.6965 and a postoperative responsiveness measure of \u22120.2476, resulting in a change score of 1.44888 (95% CI, 0.47119 to 2.42657; \u003Cem\u003Et\u003C\/em\u003E = 2.930; \u003Cem\u003EP\u003C\/em\u003E = .004; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/18\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Psychometric Properties\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-912028051\u0022 data-figure-caption=\u0022Psychometric Properties\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/18\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/18\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/34\/18\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12072\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EPsychometric Properties\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECAT, computer adaptive testing.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from KJ Hunt, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EFor the FAAM_ADL, the preoperative (1.2693) and postoperative (3.9964) measures resulted in a change score of 2.72717 (95% CI, 2.19813 to 3.25620; \u003Cem\u003Et\u003C\/em\u003E = 10.207; \u003Cem\u003EP\u003C\/em\u003E = .000). Both the PF CAT and FAAM_ADL change scores indicated that patients had significantly improved physical function at 6 months.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe FFI-5pt had a preoperative measure of 0.4866 and a postoperative measure of 0.1828, resulting in a change score of \u22120.30381 (95% CI, \u22120.58721 to \u22120.02040; \u003Cem\u003Et\u003C\/em\u003E = \u22122.120; \u003Cem\u003EP\u003C\/em\u003E = .036), indicating that patients had significantly deteriorated function at 6 months. All 3 instruments were responsive to change, but the FFI-5pt change was in the opposite direction.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThe item counts (number of questions) for the 3 instruments were 4.3 for the PF CAT, 28.0 for the FAAM, and 23.0 for the FFI. Patients completed the PF CAT in 44 seconds, the FAAM_ADL in 179 seconds, and the FFI-5pt in 194 seconds, showing that the PF CAT was significantly more efficient than both other measures (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .000).\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EDr Hunt concluded that the PROMIS PF CAT allows for consistent outcomes assessment across orthopaedic subspecialties, while providing a high degree of precision and efficiency. However, it is important to remember that physical function is not the only domain to measure; mental and social health can also affect disease burden and outcomes, and should be considered during outcomes assessment.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/34\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzorcp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzorcp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzorcp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}