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      Predicting Treatment Success after Scarf Osteotomy for Hallux Valgus using The American Orthopedic Foot and Ankle Society and Short Form Health Survey Scores

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          ABSTRACT

          Aim

          Various hallux valgus corrective surgeries, including Scarf osteotomy, have demonstrated improvement in patients’ forefoot function and quality of life. However, no threshold values of these measures have been reported to define the success of surgery from the patients’ perspective. This study aims to define treatment success threshold values of The American Orthopedic Foot and Ankle Society (AOFAS)-Health Management Information System (HMIS) and Short Form (36) Health Survey (SF-36) Scores for patients underwent Scarf osteotomy (SO) for hallux valgus.

          Materials and methods

          A retrospective analysis of patients who underwent scarf osteotomy between 2007 and 2013 was conducted. Patients were evaluated for AOFAS-HMIS, SF-36 score, satisfaction, and pain scoreatvarious time points. Treatment success was defined as a significant improvement in pain and satisfaction with surgery. Using receiver operating characteristic (ROC) analysis, threshold score for treatment success was defined as the cut-off value providing the largest sum of sensitivity and specificity.

          Results

          A total of 360 and 345 patients completed assessments at 6-month and 2-year after surgery, with a success rate of 70.0% and 77.4%, respectively. The AOFAS-HMIS and physical component score (PCS) improved significantly atboth postoperative time points as compared to preoperatively. The ROC analyses revealed the excellent predictive value of AOFAS-HMIS for treatment success (AUC = 0.840 and 0.835).

          Conclusion

          The American Orthopedic Foot and Ankle Society-Health Management Information System of 84 and above at 6-month, or 89 and above at 2-year after surgery can be used to define treatment success of OS for hallux valgus. Anincreasingly higher threshold is required to define treatment success with time.

          How to cite this article

          Zhu M, Chen JY, Teo THL, Koo KOT, Rikhraj IS. Predicting Treatment Success after Scarf Osteotomy for Hallux Valgus using The American Orthopedic Foot and Ankle Society and Short Form Health Survey Scores. J Foot Ankle Surg (Asia Pacific) 2018;5(2):59-63.

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          Most cited references28

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          Index for rating diagnostic tests.

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            Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.

            Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.
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              Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus.

              To assess responsiveness and minimally important change (MIC) for the Manchester-Oxford foot questionnaire (MOXFQ) using anchor and distribution-based approaches. Responsiveness and estimates of minimal clinically important difference (MCID) and minimal detectable change are compared with those from the Short-Form 36 (SF-36) and American Orthopaedic Foot & Ankle Society (AOFAS) measures. A prospective observational study of 91 consecutive patients (125 foot operations) undergoing hallux valgus surgery at an orthopaedic hospital. Pre- and 12 month post-surgery, patients completed the MOXFQ and SF-36, and foot surgeons assessed all four AOFAS scores corresponding to four regions of the foot. Transition items were asked about perceived changes compared with before surgery. Mean changes in all domains of each instrument were statistically significant, but foot-specific MOXFQ and AOFAS domains produced much larger effect sizes (>1) than any SF-36 domains, indicating superior responsiveness. Clear associations occurred between transition items and all MOXFQ and AOFAS scores, but with only one (physical function) SF-36 domain. Anchor and distribution-based approaches identified generally comparable measures of MIC, which for the MOXFQ and AOFAS domains were between 1 and 2 standard error of measurement. In metric terms, the MCIDs were 16, 12, and 24 for the MOXFQ Walking/standing, Pain, and Social Interaction domains, respectively. For hallux valgus surgery, the MOXFQ is highly responsive. Performance is comparable to the AOFAS and notably better than the generic SF-36. Study estimates of MIC for the MOXFQ are useful to inform sample-size calculations for future clinical trials.
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                Author and article information

                Contributors
                Role: Resident
                Role: Associate Consultant
                Role: Associate Consultant
                Role: Consultant
                Role: Senior Consultant
                Journal
                JFASAP
                Journal of Foot and Ankle Surgery (Asia Pacific)
                JFASAP
                Jaypee Brothers Medical Publishers
                2348-280X
                2394-7705
                July-December 2018
                : 5
                : 2
                : 59-63
                Affiliations
                [1-5 ] Department of Orthopedic Surgery, Singapore General Hospital, Singapore
                Author notes
                Meng Zhu, Resident, Department of Orthopedic Surgery, Singapore General Hospital, Singapore, e-mail: meng.zhu@ 123456mohh.com.sg
                Article
                10.5005/jp-journals-10040-1091
                4ed690b7-1a17-4c3b-b4bc-012ad66f18c3
                Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.

                Creative Commons Attribution 4.0

                History
                Categories
                ORIGINAL ARTICLE
                Custom metadata
                jfasap-2018-5-59.pdf

                General medicine,Pathology,Surgery,Sports medicine,Anatomy & Physiology,Orthopedics
                Hallux valgus,Patient-reported outcome,Scarf osteotomy,The American Orthopedic Foot and Ankle Society- Health Management Information System,Threshold score,Treatment success

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