5/8/2014 Co-Investigators Comparison of the PROMIS Physical OFAR (Orthopaedic Foot & Ankle Outcomes Research Network) Function CAT with the FFI and FAAM Ian Alexander, MD , Cleveland Clinic, Cleveland, OH Judith Baumhauer, MD , University of Rochester, NY for Foot and Ankle Disorders James Brodsky, MD , Baylor/UT Southwestern, Dallas, TX Christopher Chiodo, M.D. , Brigham and Women’s Hospital, Boston, MA Timothy Daniels, MD , University of Toronto, Canada W. Hodges Davis, MD , Orthocarolina, Charlotte, NC Kenneth J. Hunt, M.D. Jon Deland, MD , Hospital for Special Surgery, New York, NY Scott Ellis, MD , Hospital for Special Surgery, New York, NY Stanford University Man Hung, PhD , University of Utah, Salt Lake City, UT Department of Orthopaedic Surgery Susan N. Ishikawa, MD , Campbell Clinic, Memphis, TN L. Daniel Latt, MD PhD , University of Arizona, Tucson, AZ Phinit Phisitkul, MD , University of Iowa, Iowa City, IA Nelson Fong SooHoo, MD , UCLA, Los Angeles, CA Arthur Yang, MS Stanford University, Redwood City, CA Charles L. Saltzman, MD , University of Utah, Salt Lake City, UT Background Disclosures Patient Reported Outcomes • No disclosures pertinent to this work • Project funded by AOFAS/OEF “ Measuring, reporting and comparing outcomes are perhaps the most important steps toward improving outcomes and reducing costs ” Porter ME, NEJM Dec, 2010 1
5/8/2014 Background Background Patient Reported Outcomes Patient Reported Outcomes Assess Effectiveness Patient Patient Quality initiatives Reported Clinician Reported Clinician Observed Observed Value-based Radio- Radio- Reimbursement graphic graphic Outcomes Outcomes Background Background Patient Reported Outcomes Outcomes in Foot and Ankle • Wide range of clinical outcome measures used in the evaluation of foot and ankle procedures and disorders • No broadly accepted consensus • 10 year review of Foot/Ankle Outcome Metrics AAOS LE SF-12 FFI Top 5 – 139 unique scales Olerud SMFA 0.6 AOFAS scale 0.4 – 55 used more than once PROMIS CATs FAOS 0.2 FAAM 0 SF-36 – 28 used 5 times or more EQ-5D Tegner VAS VISA Hunt & Hurwit, 2013 JBJS Martin et al, 2007 J Orth Sports PT 2
5/8/2014 Background Objectives Outcomes in Foot and Ankle The aim of this study was to examine and compare PF CAT to FAAM and FFI 1. Psychometric Properties • Physical Function CAT – Validity – Reliability – Valid and reliable for lower extremity patients – Equal or Superior to SF-36 PF – Responsiveness – Responsiveness not yet determined 2. Efficiency (i.e., time for completion) 1 Hung et al., 2013 FAI 2 Hung et al., 2014 FAI Methods Methods Data Collection OFAR Network • PRO Data collected through OFAR Network – OFAR created in 2012 by AOFAS – Facilitate collection of PRO measures – Using PROMIS CATs 10 Pilot Sites 3
5/8/2014 Methods Methods Data Collection Data Collection • Each of 10 sites: • Each of 10 sites: – Enrolled patients undergoing surgery for: – Enrolled patients undergoing surgery for: – PRO measures collected: Ankle/Hindfoot Forefoot • Ankle Arthritis • Bunions Legacy Instruments Computer Adaptive Test • Ankle Instability • Hammer toe(s) • Foot and Ankle Ability • Physical Function CAT • Flatfoot Deformity • Hallux rigidus Measure (FAAM) • Foot Function Index (FFI) Methods Results Total Enrollment Data Collection 311 total patients enrolled at 10 sites • Each of 10 sites: – Enrolled patients undergoing surgery for: – PRO measures collected: Legacy Instruments Computer Adaptive Test • Foot and Ankle Ability • Physical Function CAT Measure (FAAM) • Foot Function Index (FFI) – Pre-operative survey – 6 month follow-up survey 4
5/8/2014 Results Results Total Enrollment Psychometric Properties 311 total patients enrolled at 10 sites • Construct validity : 80 – Rasch model 60 – High for all instruments # Patients 40 • Convergent validity 20 – Pearson correlation 0 PF CAT FAAM FFI Ankle Ankle Hallux Hammertoe Hallux Flatfoot PF CAT 1.000 0.785 0.792 Instability Arthritis Valgus Rigidus FAAM 1.000 0.685 FFI 1.000 56% completed 6 month follow-up surveys Results Results Psychometric Properties Psychometric Properties • Reliability : High for all instruments • Responsiveness : 55 Physical Function CAT Person Item Pre-op Post-op Reliability Reliability Average Function 50 * * * PF CAT 0.96 0.99 45 * * 40 FAAM 0.95 0.99 35 FFI 0.93 0.99 30 Ankle Ankle Hallux Hammertoe Hallux Flatfoot Instability Arthritis Valgus Rigidus 5
5/8/2014 Results Results Psychometric Properties Psychometric Properties • Responsiveness : • Responsiveness : FAAM Pre-op 100 Foot Function Index Pre-op Post-op Post-op 100 * * 80 * 80 * 60 * 60 40 40 20 20 Ankle Ankle Hallux Hammertoe Hallux Flatfoot Ankle Ankle Hallux Hammertoe Hallux Flatfoot Instability Arthritis Valgus Rigidus Instability Arthritis Valgus Rigidus Results Results Efficiency Efficiency Item count (# of questions) Time to Complete Instrument PF CAT PF CAT 4.3 0:44 FAAM FAAM 28.0 3:16 FFI FFI 23.0 2:59 0.0 10.0 20.0 30.0 0:00 1:12 2:24 3:36 6
5/8/2014 Summary Conclusions • PROMIS Physical Function CAT • PROMIS Physical Function CAT – Valid, reliable tool for foot/ankle disorders – Increasingly recognized outcomes tool – Responsive to change at 6 months – May augment legacy scales – More efficient than FFI and FAAM – Allow orthopaedic subspecialties to “speak the same language” for outcomes assessment • fewest items and least time to completion • FFI – Less sensitive to change at 6 months compared to FAAM and PF CAT Conclusions Thank You OFAR Network • Our Ultimate Goals: AOFAS/OEF – Enhance our ability to assess patient outcomes – Improve quality and generalizability of outcomes research – Direct the conversation on quality assessment and appropriate allocation of health care resources 7
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