Abstract
Background
There is a clear call for improved patient-centered outcomes. The Foot and Ankle Outcome Score (FAOS) is a region-specific patient-reported measure that has been validated for a number of foot and ankle diagnoses, but not hallux rigidus.
Questions/Purposes
The aim of this study was to validate the FAOS in patients with hallux rigidus.
Methods
From 2007 to 2013, 211 patients with hallux rigidus (HR) were included in the study. For the construct validity portion of the study, 125 patients completed a Short-Form 12 (SF-12) and FAOS survey. Forty additional HR patients were prospectively given questionnaires to assess the relevance of each FAOS question as it pertained to their HR. Reliability was assessed in 36 HR patients via administration of a second FAOS an average 1 month following the first. In 55 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness.
Results
All FAOS subscales demonstrated moderate correlation coefficients with the physical functioning, role physical, bodily pain, and physical health component scores of the SF-12, with all subscales demonstrating poor correlation with the SF-12 mental health-related domains. Content validity was high for all FAOS scores, with the exception of the daily activities subscale. All subscales achieved acceptable test–retest reliability with correlation coefficients of ≥0.72. Furthermore, all subscales were rated as responsive to change in postoperative patients (p < 0.001).
Conclusion
This study demonstrates the acceptable construct and content validity, reliability, and responsiveness of the FAOS for hallux rigidus. Due to its broad applicability and proven validation across multiple foot and ankle pathologies, the FAOS represents a patient-centered outcome measure that can be reliably used for the assessment of patients with hallux rigidus.
Similar content being viewed by others
References
Baumhauer JF, Nawoczenski DA, DiGiovanni BF, et al. Reliability and validity of the American Orthopaedic Foot and Ankle Society clinical rating scale: a pilot study for the hallux and lesser toes. Foot Ankle Int. 2006; 27(12): 1014-1019.
Bekkers JE, de Windt TS, Raijmakers NJ, et al. Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthr Cartil. 2009; 17(11): 1434-1439.
Button G, Pinney S. A meta-analysis of outcome rating scales in foot and ankle surgery: is there a valid, reliable, and responsive system? Foot Ankle Int. 2004; 25(8): 521-525.
Canseco K, Long J, Smedberg T, et al. Multisegmental foot and ankle motion analysis after hallux valgus surgery. Foot Ankle Int. 2012; 33(2): 141-147.
Chen L, Lyman S, Do H, et al. Validation of foot and ankle outcome score for hallux valgus. Foot Ankle Int. 2012; 33(12): 1145-1155.
Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003; 85-A(11): 2072-2088.
Dawson J, Boller I, Doll H, et al. Responsiveness of the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery. J Bone Joint Surg (Br). 2012; 94(2): 215-221.
Deland JT, Williams BR. Surgical management of hallux rigidus. J Am Acad Orthop Surg. 2012; 20(6): 347-358.
Gould N, Schneider W, Ashikaga T. Epidemiological survey of foot problems in the continental United States: 1978–1979. Foot Ankle. 1980; 1(1): 8-10.
Hunt KJ, Hurwit D. Use of patient-reported outcome measures in foot and ankle research. J Bone Joint Surg Am. 2013; 95(16): e118(1–9).
Mani SB, Brown HC, Nair P, et al. Validation of the foot and ankle outcome score in adult acquired flatfoot deformity. Foot Ankle Int. 2013; 34(8): 1140-1146.
Mani SB, Do H, Vulcano E, et al. Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle. Bone Joint J. 2015; 97-B(5): 662-667.
Marsh JL, Rattay RE, Dulaney T. Results of ankle arthrodesis for treatment of supramalleolar nonunion and ankle arthrosis. Foot Ankle Int. 1997; 18(3): 138-143.
Martin DP, Engelberg R, Agel J, et al. Comparison of the Musculoskeletal Function Assessment questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile health-status measures. J Bone Joint Surg Am. 1997; 79(9): 1323-1335.
Myerson MS, Badekas A, Schon LC. Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int. 2004; 25(7): 445-450.
Patel AA, Donegan D, Albert T. The 36-item short form. J Am Acad Orthop Surg. 2007; 15(2): 126-134.
Pinsker E, Daniels TR. AOFAS position statement regarding the future of the AOFAS clinical rating systems. Foot Ankle Int. 2011; 32(9): 841-842.
Roos EM, Brandsson S, Karlsson J. Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int. 2001; 22(10): 788-794.
Roos EM, Roos HP, Lohmander LS, et al. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998; 28(2): 88-96.
SooHoo NF, Shuler M, Fleming LL. American Orthopaedic Foot and Ankle Society. Evaluation of the validity of the AOFAS clinical rating systems by correlation to the SF-36. Foot Ankle Int. 2003; 24(1): 50-55.
Tarlov AR, Ware JE Jr, Greenfield S, et al. The medical outcomes study. An application of methods for monitoring the results of medical care. JAMA. 1989; 262(7): 925-930.
Terwee CB, Bot SD, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007; 60(1): 34-42.
Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3): 220-233.
Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Ca 1992; 30(6): 473-83.
Disclosures
Conflict of Interest
MaCalus V. Hogan, MD; Sriniwasan B. Mani, BS; Jeremy Y. Chan, MD; Huong Do, MA; Jonathan T. Deland, MD; Scott J. Ellis, MD have declared that they have no conflict of interest.
Human/Animal Rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed Consent
Informed consent was obtained from all patients for being included in the study.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
Author information
Authors and Affiliations
Corresponding author
Additional information
Level of Evidence: Level II, prospective comparative study.
Work performed at Hospital for Special Surgery, New York, NY.
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(PDF 1224 kb)
Rights and permissions
About this article
Cite this article
Hogan, M.V., Mani, S.B., Chan, J.Y. et al. Validation of the Foot and Ankle Outcome Score for Hallux Rigidus. HSS Jrnl 12, 44–50 (2016). https://doi.org/10.1007/s11420-015-9466-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11420-015-9466-4