Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study
Abstract Background Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-05-01
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| Series: | Journal of Patient-Reported Outcomes |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41687-020-00203-y |
| _version_ | 1818776658928205824 |
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| author | Jessica M. Kohring Jeffrey R. Houck Irvin Oh Adolf S. Flemister John P. Ketz Judith F. Baumhauer |
| author_facet | Jessica M. Kohring Jeffrey R. Houck Irvin Oh Adolf S. Flemister John P. Ketz Judith F. Baumhauer |
| author_sort | Jessica M. Kohring |
| collection | DOAJ |
| description | Abstract Background Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMIS-Preference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence Level II, prospective single cohort study. |
| first_indexed | 2024-12-18T11:16:26Z |
| format | Article |
| id | doaj.art-6b55df7618604b41997b70a1468f44a2 |
| institution | Directory Open Access Journal |
| issn | 2509-8020 |
| language | English |
| last_indexed | 2024-12-18T11:16:26Z |
| publishDate | 2020-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Patient-Reported Outcomes |
| spelling | doaj.art-6b55df7618604b41997b70a1468f44a22022-12-21T21:09:55ZengSpringerOpenJournal of Patient-Reported Outcomes2509-80202020-05-01411810.1186/s41687-020-00203-yPattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort studyJessica M. Kohring0Jeffrey R. Houck1Irvin Oh2Adolf S. Flemister3John P. Ketz4Judith F. Baumhauer5Department of Orthopaedics, University of RochesterDepartment of Physical Therapy, George Fox UniversityDepartment of Orthopaedics, University of RochesterDepartment of Orthopaedics, University of RochesterDepartment of Orthopaedics, University of RochesterDepartment of Orthopaedics, University of RochesterAbstract Background Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMIS-Preference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence Level II, prospective single cohort study.http://link.springer.com/article/10.1186/s41687-020-00203-yAnkle fusionPatient reported outcomesFunctionPainPROMIS |
| spellingShingle | Jessica M. Kohring Jeffrey R. Houck Irvin Oh Adolf S. Flemister John P. Ketz Judith F. Baumhauer Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study Journal of Patient-Reported Outcomes Ankle fusion Patient reported outcomes Function Pain PROMIS |
| title | Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study |
| title_full | Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study |
| title_fullStr | Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study |
| title_full_unstemmed | Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study |
| title_short | Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study |
| title_sort | pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion a retrospective cohort study |
| topic | Ankle fusion Patient reported outcomes Function Pain PROMIS |
| url | http://link.springer.com/article/10.1186/s41687-020-00203-y |
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