Are current foot- and ankle outcome measures appropriate for the evaluation of treatment for osteoarthritis of the ankle?: Evaluation of ceiling effects in foot- and ankle outcome measures. Validity and responsiveness of the ankle function score after acute ankle injury. Preoperative PROMIS Scores Predict Postoperative Success in Foot and Ankle Patients Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle. Psychometric Comparison of the PROMIS Physical Function CAT With the FAAM and FFI for Measuring Patient-Reported Outcomes Evaluation of the Dutch version of the Foot and Ankle Outcome Score (FAOS): responsiveness and Minimally Important Change Assessing the performance of the EQ-VAS in the NHS PROMs programme Clinical value of regular passive ROM exercise by a physical therapist after total knee arthroplasty Reliability and Validity of 6 Measures of Pain, Function, and Disability for Ankle Arthroplasty and Arthrodesis A systematic review of outcome tools used to measure lower leg conditions. How do doctors refer to patient-reported outcome measures (PROMS) in oncology consultations? Validation of the Foot and Ankle Outcome Score in Adult Acquired Flatfoot Deformity INFANT GROWTH AND HUMAN MILK REQUIREMENTS: A Fresh Approach Patient-Reported Outcomes Measurement Information System (PROMIS) instruments among individuals with symptomatic knee osteoarthritis: a cross-sectional study of floor/ceiling effects and construct validity No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation Validation of the Turkish version of the foot and ankle outcome score Gait assessment during the initial fitting of customized selective laser sintering ankle foot orthoses in subjects with drop foot
BACKGROUND Many PROMs used for evaluation of ankle  osteoarthritis  are not vali date d for this purpose . We hypothesize that frequently used PROMs have an early ceiling or floor effect . METHODS We prospect ively collected data from patients with ankle osteoarthritis between 2011 and 2013 . At baseline visit patients completed the Foot and Ankle Outcome Score , the Ankle Osteoarthritis Score , the American Orthopaedic Foot and Ankle Society scale , a visual analogue scale for pain and quality of life . Outcomes were analyzed for floor or ceiling effects . RESULTS 197 patients were included in the study . A floor effect was present for the AOFAS and VAS for pain in all groups . Floor and ceiling effect are absent for the FAOS outcome measure for all groups . CONCLUSIONS Physicians should be aware of floor or ceiling effects when evaluating treatment using patient reported outcome measures . The FAOS outcome measure lacks early ceiling or floor effects The purpose of this study was to examine prognostic validity , concurrent validity and responsiveness of ankle function score ( AFS ) for patients with acute ankle injury . In a prospect i ve cohort study , AFS was compared with Olerud and Mol and er ankle score ( OMAS ) , patient-specific complaints ( PSC ) , and global perceived effect . Sensitivity and specificity were calculated to estimate prognostic validity ; correlation was calculated for concurrent validity . Effect Size , St and ardized Response Mean , and Responsiveness Ratio were calculated to estimate responsiveness . The sensitivity of AFS was 76 % and the specificity was 57 % . Correlation between AFS and OMAS at baseline , end of treatment and difference was 0.82 , 0.70 and 0.79 , respectively . Outcomes for responsiveness of AFS were comparable to outcomes for OMAS and PSC . This study found limited evidence for the AFS as a prognostic and evaluative instrument . The AFS is a simple instrument based on basic functional outcomes ( pain , stability , weight bearing , swelling and gait ) and may be used in addition to subjective clinical judgment as a prognostic and evaluative tool for recovery after acute ankle injury Background : The use of patient-reported outcomes continues to exp and beyond the scope of clinical research to involve st and ard of care assessment s across orthopedic practice s. It is currently unclear how to interpret and apply this information in the daily care of patients in a foot and ankle clinic . We prospect ively examined the relationship between preoperative patient-reported outcomes ( PROMIS Physical Function , Pain Interference and Depression scores ) , determined minimal clinical important differences for these values , and assessed if these preoperative values were predictors of improvement after operative intervention . Methods : Prospect i ve collection of all consecutive patient visits to a multisurgeon tertiary foot and ankle clinic was obtained between February 2015 and April 2016 . This consisted of 16 023 unique visits across 7996 patients , with 3611 new patients . Patients undergoing elective operative intervention were identified by ICD-9 and CPT code .  PROMIS physical function , pain interference , and depression scores were assessed at initial and follow-up visits . Minimum clinical ly important differences ( MCIDs ) were calculated using a distribution-based method . Receiver operating characteristic ( ROC ) curves were calculated to determine whether preoperative PROMIS scores were predictive of achieving MCID . Cutoff values for PROMIS scores that would predict achieving MCID and not achieving MCID with 95 % specificity were determined . Prognostic pre- and posttest probabilities based off these cutoffs were calculated . Patients with a minimum of 7-month follow-up ( mean 9.9 ) who completed all PROMIS domains were included , result ing in 61 patients . Results : ROC curves demonstrated that preoperative physical function scores were predictive of postoperative improvement in physical function ( area under the curve [ AUC ] 0.83 ) . Similarly , preoperative pain interference scores were predictive of postoperative pain improvement ( AUC 0.73 ) and preoperative depression scores were also predictive of postoperative depression improvement ( AUC 0.74 ) . Patients with preoperative physical function T score below 29.7 had an 83 % probability of achieving a clinical ly meaningful improvement in function as defined by MCID . Patients with preoperative physical function T score above 42 had a 94 % probability of failing to achieve MCID . Patients with preoperative pain above 67.2 had a 66 % probability of achieving MCID , whereas patients with preoperative pain below 55 had a 95 % probability of failing to achieve MCID . Patients with preoperative depression below 41.5 had a 90 % probability of failing to achieve MCID . Conclusion : Patient-reported outcomes ( PROMIS ) scores obtained preoperatively predicted improvement in foot and ankle surgery . Threshold levels in physical function , pain interference , and depression can be shared with patients as they decide whether surgery is a good option and helps place a numerical value on patient expectations . Physical function scores below 29.7 were likely to improve with surgery , whereas those patients with scores above 42 were unlikely to make gains in function . Patients with pain scores less than 55 were similarly unlikely to improve , whereas those with scores above 67 had clinical ly significant pain reduction postoperatively . Reported prognostic cutoff values help to provide guidance to both the surgeon and the patient and can aid in shared decision making for treatment . Level of Evidence : Level II , prognostic study The foot and ankle outcome score ( FAOS ) has been evaluated for many conditions of the foot and ankle . We evaluated its construct validity in 136 patients with osteoarthritis of the ankle , its content validity in 37 patients and its responsiveness in 39 . Data were collected prospect ively from the registry of patients at our institution . All FAOS subscales were rated relevant by patients . The Pain , Activities of Daily Living , and Quality of Life subscales showed good correlation with the Physical Component score of the Short-Form-12v2 . All subscales except Symptoms were responsive to change after surgery . We concluded that the FAOS is a weak instrument for evaluating osteoarthritis of the ankle . However , some of the FAOS subscales have relative strengths that allow for its limited use while we continue to seek other satisfactory outcome instruments Background : Selecting optimal patient-reported outcome ( PRO ) instruments is critical to improving the quality of health care . The purpose of this study was to compare the reliability , responsiveness , and efficiency of three PRO measures : the Foot and Ankle Ability Measure – Activity of Daily Living subscale ( FAAM_ADL ) , the Foot Function Index 5-point verbal rating scale ( FFI-5pt ) , and the PROMIS Physical Function computerized adaptive test ( PF CAT ) . Methods : Data were aggregated from 10 clinical sites in the AOFAS ’s National Orthopaedic Foot and Ankle Research ( OFAR ) Network from 311 patients who underwent elective surgery for a disorder of the foot or ankle . Patients were administered the FAAM_ADL , FFI-5pt , and PF CAT at their preoperative visit and at 6 months after surgery . Reliabilities were evaluated using a Rasch model . Responsiveness was calculated using paired sample s t test and efficiency was recorded as number of seconds to complete the instrument . Results : Similar reliabilities were found for the three instruments . Item reliabilities for FAAM_ADL , FFI-5pt , and PF CAT were all .99 . Pearson reliabilities for FAAM_ADL , FFI-5pt , and PF CAT were .95 , .93 , and .96 , respectively . On average , patients completed the FAAM_ADL in 179 seconds , the FFI-5pt in 194 seconds , and the PF CAT in 44 seconds , ( P < .001 ) . The PF CAT and FAAM_ADL showed significant improvement ( P = .01 and P = .001 , respectively ) in patients ’ physical function after treatment ; the FFI-5pt did not show improvement . Conclusions : Overall , the PF CAT performed best in terms of reliability , responsiveness , and efficiency in this broad sample of foot and ankle patients . It can be a potential replacement for the conventional PRO measures , but further validation is needed in conjunction with the PROMIS Pain instruments . Level of Evidence : Level I , prospect i ve comparative outcome study Purpose The aim of this study was to evaluate the responsiveness of the Foot and Ankle Outcome Score ( FAOS ) and provide data on the Minimally Important Change ( MIC ) in patients 1 year after hindfoot and ankle surgery . Methods Prospect i ve pre-operative and 1 year post-operative FAOS scores were collected from 145 patients . A patient ’s global assessment and a longitudinal derived Function Change Score were used as external anchors . To assess responsiveness , effect sizes ( ES ) and St and ardized Response Means ( SRM ) were calculated and hypotheses on their magnitudes were formulated . Additional ROC curve analysis was performed , and the Area Under the Curve ( AUC ) was calculated as a measure of responsiveness . MIC values were estimated using two different methods : ( 1 ) the mean change method and ( 2 ) the optimal cut-off point of the ROC curve . Results Responsiveness was supported by confirmation of 84 % of the hypothesized ES and SRM and almost all AUCs exceeding 0.70 . MIC values ranged from 7 ( symptoms ) to 38 ( sport ) points . They varied between calculation methods and were negatively associated with baseline values . A considerable amount of MIC values did not exceed the smallest detectable change limit , indicating that the FAOS is more suitable at group level than for longitudinally following individual patients . Conclusions The FAOS demonstrated good responsiveness in patients 1 year after hindfoot and ankle surgery . Due to their wide variation , MIC estimates derived in this study should be interpreted with caution . However , these estimates can be of value to facilitate sample size calculation in future studies .Level of evidence Diagnostic study , Level Objectives The study aims to increase knowledge about the performance of the EuroQol-visual analogue scales ( EQ-VAS ) in the UK NHS patient-reported outcome measures ( PROMs ) programme , which covers groin hernia , hip and knee replacement and varicose vein surgery , and make suggestions for improved collection , coding and analysis of data . Methods Four hundred scanned images of matched before- and -after EQ-VAS PROMs responses were selected at r and om . These were classified according to the different ways in which they were completed . Patient-level PROMs programme data linked to Hospital Episode Statistics for all patients from April 2009 to February 2011 were used to analyse the relationship between the EQ-VAS and the EQ-5D profile , index-weighted profile and condition-specific instruments . The linked PROMs and HES data comprise 331,951 anonymised patient records . Results A large majority ( 95 % ) of EQ-VAS responses were completed in an unambiguous way , but only a minority ( 45 % ) conformed strictly to the instructions given , posing challenges for data coding . The EQ-VAS data have a predictable and consistent relationship with the EQ-5D profile , although the correlations between the EQ-VAS and other measures of patient-reported health , both before and after surgery and in the change between them , are weak . Conclusions EQ-VAS data might be improved by providing better guidance on collection and coding . It is argued that the observed differences in results from EQ-VAS and other measures of health reflect the fact that it measures a broader underlying construct of health , arguably providing a means of summarising overall health that is closer to the patient ’s perspective Regular passive ROM exercise ( PROME ) by a physical therapist is often incorporated in rehabilitation protocol s after total knee arthroplasty ( TKA ) . This r and omized , controlled trial examined whether or not the incorporation of PROME to a postoperative rehabilitation protocol would offer a better clinical outcome after TKA . Fifty consecutive patients who underwent bilateral TKAs staged 2 weeks apart received PROME for one knee and not for the other . The pain level ( 7D and 14D ) , patient ’s preference ( before discharge , 6 M ) , maximum flexion ( 7D , 14D , 3 M , 6 M ) and American Knee Society and WOMAC scores ( 6 M ) were determined in the knees with and without PROME and compared . There were no significant differences in the maximum flexion , pain level , patient ’s preference , AKS scores and WOMAC scores . This study demonstrates that the incorporation of PROME does not offer additional clinical benefits to the patients after TKA . Our findings may suggest that encouraging patients to perform active ROM exercise would be a better option and that a physiotherapy session by a physical therapist can focus on more functional rehabilitation , such as preparing to return to daily activities Background : Patient-reported outcome measures are increasingly used evaluating clinical care . Many measures used to assess operative hindfoot interventions vary in content , and some have not been psychometrically vali date d in this population . The purpose of this study was to compare measurement properties of  6 lower-extremity patient-reported outcome measures  , and to evaluate their reliability and validity in light of patients ’ preferences . Methods : Cross-sectional survey of 42 preoperative and 100 postoperative patients completed 6 lower-extremity outcome measures  on 2 occasions : Foot Function Index ( FFI ) , Ankle Osteoarthritis Scale ( AOS ) , patient-reported items of the  American  Orthopaedic Foot & Ankle Society Question naire ( AOFAS ) , Lower Extremity Functional Scale ( LEFS ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the Short Musculoskeletal Function Assessment ( SMFA ) , as well as measures of preference , and symptoms . Results : Internal consistency was good to excellent for all scales and subscales ( α = .84-.97 ; ICC [ 2,1 ] = .81-.96 ) . Correlations between scales ranged from .50 ( WOMACStiffness and FFIActivity Limitations ) to .92 ( LEFS and SMFAOverall , WOMACPain and AOSOverall , FFIOverall and AOFASOverall ) . Higher correlations occurred within instruments ( r = .97 AOSPain and AOSOverall ) and between similar subscales from different instruments ( r = .91 WOMACPain and AOSPain ) . Construct validity showed moderate to high correlations to global ratings of Pain , Stiffness , and difficulty performing Daily Activities . The highest correlations ( r > .75 ) occurred between Pain and AOSOverall ( r = .84 ) , stiffness and WOMACStiffness ( r = .81 ) , and Daily Activities and AOSDisability ( r = .87 ) . Patients rated instruments by preference . FFI , WOMAC , LEFS , and SMFA rated favorably for length . FFI , WOMAC , LEFS , and AOFAS rated high for underst and ability . FFI was rated by postoperative patients as most likely to capture change due to surgery . SMFA rated the best overall . Conclusions : Direct comparison of instruments revealed similarity between scales in construct validity and reliability . Patient preferences supported the use of these scales . Foot-specific instruments offered no clear advantage over lower-extremity instruments . Level of Evidence : Level II , prospect i ve comparative study BACKGROUND CONTEXT A variety of self-report and physical performance-based outcome measures are commonly used to assess progress and recovery in the lower leg , ankle , and foot . A requisite attribute of any outcome measure is its ability to detect change in a condition , a construct known as " responsiveness " . There is a lack of consistency in how responsiveness is defined in all outcome measures . PURPOSE The purpose of this study was to review the currently used recovery outcome measures for lower leg , ankle and foot conditions in order to determine and report recommended responsiveness values . METHODS A systematic literature search that included electronic search es of PubMed , CINAHL and SportD iscus as well extensive cross-referencing was performed in January , 2013 . Studies were included if each involved : 1 ) a prospect i ve , longitudinal study of any design ; 2 ) any condition associated with the lower leg , ankle or foot ; 3 ) a measure of responsiveness ; and 4 ) was an acceptable type of outcome measure ( eg . self-report , physical performance , or clinician report ) . The quality of the included articles was assessed by two independent authors using the responsiveness sub-component of the Consensus-based St and ards for the selection of health Measurement Instruments ( COSMIN ) . RESULTS Sixteen different studies met the inclusion criteria for this systematic review . The most commonly used outcome measures were the Foot and Ankle Ability Measure and the Lower Extremity Functional Scale . Responsiveness was calculated in a variety of methods including effect size , st and ardized response mean , minimal clinical ly important difference/ importance , minimal detectable change , and minimal important change . CONCLUSION Based on the findings of this systematic review there is a lack of consistency for reporting responsiveness among recovery measures used in the lower leg , ankle or foot studies . It is possible that the variability of conditions that involve the lower leg , ankle and foot contribute to the discrepancies found in reporting responsiveness values . Further research must be conducted in order to st and ardize reporting measures for responsiveness . LEVEL OF EVIDENCE 2a Purpose We conducted a secondary qualitative analysis of consultations between oncologists and their patients to explore how  patient-reported outcome measures ( PROMs ) data were referred to in the process of ( 1 ) eliciting and exploring patients ’ concerns ; ( 2 ) making decisions about supportive treatment and ( 3 ) making decisions about chemotherapy and other systemic treatments . Methods We purposively sample d audio recordings of 18 consultations from the intervention arm and 4 from the attention control arm of a previous UK r and omised controlled trial of the feedback of PROMs data to doctors ( Velikova et al. in J Clin Oncol 22(4):714–724 [ 1 ] ) . We used a combination of content and conversation analysis to examine how opportunities for discussion of health-related quality of life issues are opened up or closed down within the consultation and explore why this may or may not lead to changes in patient management . Findings Explicit reference to the PROMs data provided an opportunity for the patient to clarify and further elaborate on the side effects of chemotherapy . High scores on the PROMs data were not explored further if the patient indicated they were not a problem or were not related to the cancer or chemotherapy . Symptomatic treatment was more often offered for problems like nausea , constipation , pain and depression but much less so for fatigue . Doctors discussed fatigue by providing a cause for the fatigue ( e.g. the chemotherapy ) , presenting this as ‘ something to be expected ’ , minimising its impact or moving on to another topic . Chemotherapy regimens were not changed on the basis of the PROMs data alone , but PROMs data were sometimes used to legitimise changes . Conclusions Explicit mention of PROMs data in the consultation may strengthen opportunities for patients to elaborate on their problems , but doctors may not always know how to do this . Our findings have informed the development of a training package to enable doctors to optimise their use of PROMs data within the consultation Introduction : The American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Score has been under recent scrutiny . The Foot and Ankle Outcome Score ( FAOS ) is an alternative subjective survey , assessing outcomes in 5 subscales . It is vali date d for lateral ankle instability and hallux valgus patients . The aim of our study was to vali date the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity ( AAFD ) . Methods : Patients from the authors ’ institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study . In all , 126 patients who completed the FAOS and the Short-Form 12 ( SF-12 ) on the same visit were included in the construct validity component . Correlation was deemed moderate if the Spearman ’s correlation coefficient was .4 to .7 . Content validity was assessed in 63 patients by a question naire that asked patients to rate the relevance of each FAOS question , with a score of 2 or greater considered acceptable . Reliability was measured using intraclass correlation coefficients ( ICCs ) in 41 patients who completed a second FAOS survey . In 49 patients , preoperative and postoperative FAOS scores were compared to determine responsiveness . Results : All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains . Mental health related domains showed poor correlation . Content validity was high for the Quality of Life ( QoL ; mean 2.26 ) and Sports/Recreation subscales ( mean 2.12 ) . All subscales exhibited very good test – retest reliability , with ICCs of .7 and above . Symptoms , QoL , pain , and daily activities ( ADLs ) were responsive to change in postoperative patients ( P < .05 ) . Conclusion : This study has vali date d the FAOS for AAFD with acceptable construct and content validity , reliability , and responsiveness . Given its previous validation for patients with ankle instability and hallux valgus , the additional findings in this study support its use as an alternative to less reliable outcome surveys . Level of Evidence : Level II , prospect i ve comparative study Abstract The relationship between growth and the breast-milk plus complementary food intake of a group of British babies has been studied prospect ively up to 8 months . From the data the human milk needs of  solely breast-fed children to grow along the 5th , 50th , and 95th Gentile of the NCHS st and ard have been predicted using multiple regression analysis . The values obtained are substantially lower than previous estimates and they may form a more practical guideline for the evaluation of lactational adequacy within a community . Individual variation is important . It is futile to identify a single age when breast-feeding becomes inadequate as the sole source of food Background The psychometric properties of Patient Reported Outcomes Measurement Information System ( PROMIS ) instruments have been explored in a number of general and clinical sample s. No study , however , has evaluated the psychometric function of these measures in individuals with symptomatic knee osteoarthritis ( KOA ) . The aim of this project was to evaluate the construct ( structural ) validity and floor/ceiling effects of four PROMIS measures in this population . Methods We conducted a secondary analysis of baseline data from a r and omized trial comparing Tai Chi and physical therapy . Participants completed four PROMIS static short-form instruments ( i.e. , Anxiety , Depression , Physical Function , and Pain Interference ) as well as six well-vali date d ( legacy ) measures that assess pain , function , and psychological health . We calculated descriptive statistics and percentages of participants scoring the minimum ( floor ) and maximum ( ceiling ) possible scores for PROMIS and legacy measures . We also estimated the association between PROMIS scores and scores on legacy measures using Spearman ’s rank correlations coefficients . Results Data from 204 participants were analyzed . Mean age of the sample was 60 years ; 70 % were female .  The PROMIS Anxiety and Depression had floor effects with 17 and 24 % of participants scoring the minimum , respectively . PROMIS Anxiety and Depression scores had strongest associations with general mental health , including stress ( Perceived Stress Scale , r ≥ 0.65 ) and depression ( Beck Depression Index-II , r = 0.70 ) . PROMIS Pain Interference scores correlated most strongly with measures of whole body pain ( Short-Form 36 Bodily Pain , r = −0.73 ) and physical health ( Short-Form 36 Physical-Component Summary , r = −0.73 ) ; their correlations were lower with other legacy measures , including with the WOMAC knee-specific pain ( r = 0.47 ) . PROMIS Physical Function scores had stronger associations with scores on the Short-Form 36 Physical Function ( r = 0.79 ) than with scores on other legacy measures . Conclusion The four PROMIS static-short forms performed well among individuals with symptomatic knee osteoarthritis as evidence d in correlations with legacy measures . PROMIS Anxiety and Depression target general mental health ( e.g. , stress , depression ) , and PROMIS Pain Interference and Physical Function static-short forms target whole-body outcomes among participants with symptomatic knee osteoarthritis . Floor effects in the PROMIS Anxiety and Depression scores should be considered if needing to distinguish among patients with very low levels of these outcomes .Trial registration Clinical trials.gov NCT01258985 . Registered 10 December Purpose and hypothesisPatient-specific instrumentation ( PSI ) uses 3D preoperative imaging to produce individualized cutting blocks specific to patients ’ anatomy and according to the preoperative plan with the aim to reduce the number of mechanical leg alignment ( MLA ) outliers , to improve implant positioning and to decrease surgery time . The primary purpose of this study was to investigate the efficacy of a specific PSI in comparison with st and ard instrumentation ( SI ) in reducing the number of MLA outliers . It was hypothesized that the number of MLA outliers would be significantly lower in the PSI group . Methods A multicenter r and omized controlled trial was implemented . There were 59 patients in the PSI group and 66 in the SI group . The absolute number of outliers outside the ± 3 ° target neutral MLA was compared between the groups with a Chi-square test . As secondary outcomes , the Knee Society Score ( KSS ) and the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) were compared between the groups preoperatively and at 90-day follow-up . Results There were 15 ( 26.3 % ) MLA outliers in the PSI group and 8 ( 12.3 % ) in the SI group . The number of outliers was not independent from the group ( X2(1 ) = 3.8 , p = 0.04 ; Relative risk = 1.5 ) . Preoperatively , there were no significant differences between the groups when comparing their KSS and KOOS sub-scores . At 90 days postoperatively , the patients in the SI group showed better KOOS- Quality of Life ( KOSS-QOL ) in comparison with the PSI group ( p < 0.0001 ) . Conclusion The use of PSI did not significantly reduce the number of MLA outliers in comparison with SI . There were no differences when comparing the achieved mean MLA of both groups . Level of evidence Level I , prospect i ve r and omized controlled trial The objective is to develop a Turkish version of the foot and ankle outcome score ( FAOS ) and to investigate its validity and reliability . The Turkish version of FAOS was developed after the translation and back-translation . The translated version was pretested on 20 patients with rheumatoid arthritis . Then , the Turkish FAOS was administered to 55 patients having foot and ankle problems . They were also evaluated by using the four subscales of the Turkish version of AIMS 2 , and the Turkish version of SF-36 question naire to test validity . Fifty patients filled out the FAOS for second time to determine test – retest reliability . Construct validity was investigated with use of Spearman ’s rank correlation coefficient . Test – retest reliability was assessed with use of the intraclass correlation coefficient ( ICC ) and Cronbach ’s alpha score . The psychometric properties of the Turkish FAOS were generally similar to the original FAOS . The r and om ICC for the five subscales ranged from 0.70 to 0.96 . The Cronbach ’s alpha coefficient ranged from 0.79 to 0.97 . Construct validity of the FAOS was good . The Turkish FAOS correlated with the SF-36 and AIMS 2 scales . The Turkish version of FAOS was valid and reliable instrument to assess the foot and ankle related problems . However , to assess its responsiveness further studies are needed Background : Recently , additive fabrication has been proposed as a feasible engineering method for manufacturing of customized ankle foot orthoses ( AFOs ) . Consequently , studies on safety , comfort and effectiveness are now carried out to assess the performance of such devices . Objective : Evaluate the clinical performance of customized ( selective laser sintering ) SLS-AFOs on eight subjects with unilateral drop foot gait and compare to clinical ly accepted ( polypropylene ) PP-AFOs . Study Design : Active control trial . Methods : For each subject two customized AFOs were fabricated : one SLS-AFO manufactured following an additive fabrication framework and one thermoplastic PP-AFO manufactured according to the traditional h and craft method .  Clinical performance of both AFOs was evaluated during gait analysis . Results : A significant beneficial effect of both custom-moulded PP-AFO and customized SLS-AFO in terms of spatial temporal gait parameters and ankle kinematic parameters compared to barefoot gait of adults with drop foot gait are observed . No statistically significant difference between the effect of PP-AFO and of SLS-AFO was found in terms of spatial temporal gait parameters and ankle kinematic parameters . Conclusion : AFOs manufactured through the SLS technique show performances that are at least equivalent to the h and crafted PP-AFOs commonly prescribed in current clinical practice . Clinical relevance Manufacturing personalized AFOs with selective laser sintering ( SLS ) in an automated production process results in decreased production time and guarantees the consistency of shape and functional characteristics over different production time points compared to the traditional manufacturing process . Moreover , it reduces the dependency of the appliance on the experience and craftsmanship of the orthopaedic technician
More evidence was available for the measurement properties of the FAOS and the FAAM , but overall evidence supporting all measurement properties is not yet sufficient .
Purpose In the foot and ankle literature , a wide range of patient-reported outcome measures ( PROMs ) is used , however , consensus as to which PROMs are preferred is lacking .
Selection of a PROM is among other reasons , often based on measurement properties without considering the method ological quality of the studies that evaluate these measurement properties .
The aim of current study was first to identify the most frequently used foot and ankle-specific PROMs in recent orthopaedic foot and ankle literature , and second to conduct a systematic review to synthesize and critically appraise the measurement properties of these PROMS .