Patients with most severe flatfoot deformity report most gains from corrective surgery
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SAN DIEGO — Preoperative patient-reported outcomes measure information system, known as PROMIS, scores are predictive of 2-year postoperative improvement in patients with flexible adult-acquired foot deformity, data presented showed.
The purpose of the study, which was conducted at Hospital for Special Surgery (HSS) and presented at the American Academy of Orthopaedic Surgeons Annual Meeting, here, was to determine if preoperative PROMIS physical function (PF) and pain interference (PI) thresholds could be used to predict which patients would clinically improve at 2 years following reconstruction of flexible adult-acquired foot deformity (AAFD), according to the study abstract.
“Once the foot starts collapsing, it never uncollapses, and the worry is that over time the ligaments will continue to stretch, the foot will flatten, and the pain will increase,” Scott J. Ellis, MD, a foot and ankle surgeon at HSS and senior author of the study, said in the press release.
Ellis, Matthew Conti, MD, who is a chief resident at HSS and first author on the paper, and colleagues identified 71 adults (75 feet) who underwent surgery for progressive collapsing foot deformity between February 2016 and April 2018. Patients all had PROMIS data available. The average follow-up time was about 27 months.
Researchers prospectively collected PROMIS PF and PI scores preoperatively and at 2-year minimum postoperatively. They calculated minimal clinically important differences (MCIDs) to determine what represented significant postoperative improvement using the distribution-based method in which the MCID for a particular subscale was determined as one-half of the standard deviation of the change in score from preoperatively to 2 years postoperatively, according to the abstract. They determined 95% sensitivity and specificity thresholds for patients who achieved the MCID from receiver operating characteristic (ROC) curves, which had statistically significant areas under the curve (AUCs).
At 2 years postoperatively, researchers found significant improvements in the PROMIS PF (mean improvement 6.8) and PI (mean improvement 9.3) domains, according to the abstract.
Furthermore, the PROMIS PF ROC analysis demonstrated high accuracy and a statistically significant AUC, according to the abstract.
In the press release, researchers said patients with the lowest preoperative PROMIS PF scores, which indicate the most severe impairment, were most likely to experience clinically meaningful improvements 2 years after the procedure. Furthermore, patients with a PROMIS-PF score of 45.7 had about a 14% chance of improvement, while patients with a score below 40.9 had nearly a 98% chance of clinical gains.
This new information gives surgeons a more objective way of informing patients of their chances of a successful operation, Ellis noted in the press release. “When a patient walks in the door, you can get an idea of where they stand on that scale, and we know based on our study where patients need to land to achieve clinically meaningful improvements from the surgery,” Ellis said in the release. “It could be a real-time decision with the patient and something they could follow over time to allow them to see the trajectory of their recovery and where they are heading.”
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Conti M, et al. Paper 232. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31-Sept. 3, 2021; San Diego.
Conti MS, et al. Foot Ankle Int. 2020;doi.org/10.1177/1071100720963077.
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