Large variation in use of patient-reported outcome measures: A survey of 188 foot and ankle surgeons.

BACKGROUND: There is an increasing interest in the use of patient reported outcome measures (PROMs). However, there is a large variety of PROMs and a lack of consensus regarding preference for their use. Aim of this study is to determine how often PROMS are used for foot and ankle disorders, for what purpose PROMs are used, and what the preferences of the foot and ankle surgeons are, when choosing a PROM to use. METHODS: Members of the Ankleplatform Study Group-Science of Variation Collaborative were invited to participate in this survey by email. The online survey consisted of six questions on the use and preferences regarding foot and ankle PROMs. RESULTS: 188 participants completed the questionnaire. Of the respondents 17% reported not to use PROMs, 72% stated to use PROMS for research, 39% routinely for patient care and 34% for registration or quality assessment. The respondents were familiar with 30 different outcome measures, of which 20 were PROMs. One of the excluded outcome measures, the AOFAS Hindfoot scale was most commonly reported as preferred outcome measure. FAOS and MOXFQ were the preferred PROMs, reported by 9.7% of the surgeons. Subsequently followed by the FFI (4.3%), the FAAM (3.7%) and the VAS-FA (3.7%). CONCLUSIONS: A large majority of the foot and ankle surgeons uses PROMs. The AOFAS hindfoot scale is mentioned as the most preferred outcome measure, while in fact this is not a PROM. Of the twenty different PROMs mentioned in this study, most reported were the FAOS and MOXFQ both supported by only 9.7% of the surgeons. For proper comparison between patients in clinical practice and research, consensus is needed on which easy-to-use PROM with adequate clinimetric properties should be used. Therefore more evidence in the field of clinimetrics of foot and ankle outcome measures is needed.

Comparison between the Harris- and Oxford Hip Score to evaluate outcomes one-year after total hip arthroplasty.

Harris Hip Score (HHS) is a surgeon administered measurement for assessing hip function before and after total hip arthroplasties (THA). Patient reported outcome measurements (PROMs) such as the Oxford Hip Score (OHS) are increasingly used. HHS was compaired to the OHS assessing whether the HHS can be replaced by the OHS for clinical evaluation of THAs. All 155 patients (167 THAs) were asked to complete an OHS before and one-year after surgery. The surgeon independently scored the HHS at the same time points. We examined and compared the clinimetric properties of both instruments. Internal consistency reliability of the OHS was notably higher than that of the HHS at all occasions. HHS had a higher effect size (4.1) than the OHS (2.1). Ceiling effect at follow up was 55.6% (HHS) and 36.4% (OHS). Spearman's rank correlation between HHS and OHS was 0.57 at baseline and 0.65 and after one year. The correlation between the change scores was 0.50. The Oxford Hip Score is of good use in quality assessment after THA.

Euthanasia: mercy, morals and medicine.

The case of Sue Rodriguez has made it painfully clear that it is the ethical responsibility of every nurse to become involved in the debate on euthanasia. If advocacy is the essence of nursing,as has been suggested, then that advocacy must extend to clients such as Rodriguez. It is our responsibility to help our clients reach decisions that are truly their own, to help them determine the unique meaning that health, illness, suffering and dying have for them as individuals. It is also our responsibility to assist our clients to exercise their freedom of self-determination. To participate fully in this debate it is essential that we examine our own beliefs, determine how they concur or conflict with our role as client advocates, and how they apply to this issue.