CHAPTER SYNOPSIS:
This chapter discusses different tools used to assess the function of patients with ankle arthritis. Some of these tools are disease and location specific; most, however, are not. Few have been validated, whereas most are being used regardless of validation status. It is left to the discretion of the surgeon to determine which of these tools, if any, are most helpful in the evaluation of the arthritic ankle patient.
IMPORTANT POINTS:
The Ankle Osteoarthritis Scale (AOS) is the only assessment tool currently available that is both disease and location specific. While the Short Form (SF)-36, the SF-12, and the visual analog scale have been shown to be valid and reliable, the AOS is the only anatomically specific assessment tool that has been validated.
CLINICAL PEARLS
There is a lack of patient assessment tools that are validated and anatomically specific to the ankle. Of the available options, the SF-36, the SF-12, the visual analog scale, and the AOS are the only validated patient assessment tools. Although widely used, the American Orthopaedic Foot and Ankle Society scales have not been validated to date.
HISTORY/INTRODUCTION/SCOPE OF THE PROBLEM
Ankle osteoarthritis is much less common than hip or knee osteoarthritis, just as the surgical procedures used to treat ankle arthritis are far less frequently performed than the procedures for the hip or knee. The relative distribution of arthritis among the hip, knee, and ankle has been reported at 19%, 41%, and 4.4%, respectively. According to the 2005 National Hospital Discharge Survey, approximately 235,000 total hip replacements and 534,000 total knee replacements were performed in the United States. Far fewer ankle arthrodeses and ankle replacements are performed annually in the United States. These differences in procedure volumes reflect the relative immaturity of the ankle arthritis field, including tools used to assess the patient with ankle osteoarthritis.
In this chapter, the currently available functional assessment tools for patients with ankle osteoarthritis are reviewed. Both validated tools and those that have not been statistically shown to be valid are discussed.
ASSESSMENT TOOLS
Visual Analog Scale
The visual analog scale (VAS) is an assessment tool, which can be used quantify the amount of pain a patient is experiencing. In patients with ankle osteoarthritis, monitoring changes in the level of chronic pain over time can be of use in determining the success of the course of treatment.
Patients are given paper copies of the VAS ( Fig. 4-1 ) and instructed to make a mark on the line that corresponds to the severity of their pain. The left end of the line represents “No Pain,” and the right end of the line represents “Worst Pain.” To interpret the patient’s result on the VAS, the scale line must be of a specified, known length, which is usually 100 mm. The distance between the patient’s mark and the left end starting point of the line is then recorded for comparison with future assessments. A study by Singer and Thode suggested that with a 100-mm line, the minimum clinically significant difference for efficacy of a treatment was between 7 and 11 mm.
The VAS has been shown to be a valid tool in the assessment of patients’ levels of pain. Therefore, it is useful in the assessment of patients with ankle osteoarthritis. Unfortunately, this assessment tool is not ankle pain specific and may be affected by pain occurring in other parts of the body. Furthermore, this tool does not provide a rating of a patient’s functional status.
Short Form-36
The SF-36 (Short Form-36) is a questionnaire consisting of 36 questions originally developed for the Medical Outcomes Study. It can be used to assess various aspects of a patient’s health. It includes questions related to eight health concepts: a patient’s physical, mental, and general health, social functioning, bodily pain, limitations from physical and emotional problems, and energy or fatigue; there is also one question related to changes in the patient’s health.
To administer the SF-36, a patient must be provided with a paper copy of the 36-question survey ( Table 4-1 ). Once completed, the survey can be interpreted using standard scoring guidelines ( Table 4-2 ). Each answer must first be recoded to a point value between 0 and 100, according to the table. Then the questions that apply to each health concept can be averaged and compared with the means, as determined in the original Medical Outcomes Study.
| 1. In general, would you say your health is: | |||
| Excellent Very Good Good Fair Poor | |||
| □ □ □ □ □ | |||
| 2. Compared to one year ago, how would you rate your health in general now? | |||
| □ Much better now than one year ago | |||
| □ Somewhat better now than one year ago | |||
| □ About the same as one year ago | |||
| □ Somewhat worse now than one year ago | |||
| □ Much worse now than one year ago | |||
| 3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? | |||
| Yes, limited a lot | Yes, limited a little | No, not limited at all | |
| a. Vigorous activities, such as running, lifting heavy objects, or participating in strenuous sports | □ | □ | □ |
| b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf | □ | □ | □ |
| c. Lifting or carrying groceries | □ | □ | □ |
| d. Climbing several flights of stairs | □ | □ | □ |
| e. Climbing one flight of stairs | □ | □ | □ |
| f. Bending, kneeling, or stooping | □ | □ | □ |
| g. Walking more than a mile | □ | □ | □ |
| h. Walking several hundred yards | □ | □ | □ |
| i. Walking one hundred yards | □ | □ | □ |
| j. Bathing or dressing yourself | □ | □ | □ |
| Step 1: Recording Items | |||
|---|---|---|---|
| Item Numbers | Change Original Response Category From | To Recoded Value of | |
| 3a, 3b, 3c, 3d, 3e, 3f, 3g, 3h, 3i, 3j |
|
|
|
| 2, 4a, 4b, 4c, 4d, 5a, 5b, 5c, 9b, 9c, 9f, 9g, 9i, 10, 11a, 11c |
|
|
|
| 7 |
|
|
|
| 1, 6, 8, 9a, 9d, 9e, 9h, 11b, 11d |
|
|
|
The SF-36 has been shown to be a valid and reliable tool in evaluating the physical and mental health of the general population as well as across diverse patient groups. The SF-36 is a useful tool when assessing the functional status of patients with ankle osteoarthritis, but, again, it is not specific to the ankle. Furthermore, this questionnaire can be labor intensive when compiling the data for interpretation.
Short Form-12
The SF-12 (Short Form-12) is a shorter 12-question version of the SF-36, which can also be used to assess the same eight health concepts as the SF-36, but it does not include the question relating to change in the patient’s health. All of the questions on the SF-12 are included on the SF-36.
To administer the SF-12, a patient must be provided with a paper copy of the 12-question survey ( Table 4-3 ). The patient’s survey can then be interpreted using the standard scoring guidelines ( Table 4-4 ). Similar to the way the SF-36 is scored, each answer must first be recoded to a point value between 0 and 100, according to the table. Then the questions that apply to each health concept can be averaged and compared with the mean scores.
| 1. In general, would you say your health is: | |||||
| Excellent Very Good Good Fair Poor | |||||
| □ □ □ □ □ | |||||
| 2. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? | |||||
| Yes, limited a lot | Yes, limited a little | No, not limited at all | |||
| a. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf | □ | □ | □ | ||
| b. Climbing several flights of stairs | □ | □ | □ | ||
| 3. During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health? | |||||
| All of the time | Most of the time | Some of the time | A little of the time | None of the time | |
| a. Accomplished less than you would like | □ | □ | □ | □ | □ |
| b. Were limited in the kind of work or other activities | □ | □ | □ | □ | □ |
| 4. During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? | |||||
| All of the time | Most of the time | Some of the time | A little of the time | None of the time | |
| a. Accomplished less than you would like | □ | □ | □ | □ | □ |
| b. Did work or other activities less carefully than usual | □ | □ | □ | □ | □ |
Related posts:
Distraction Arthroplasty for the Treatment of Ankle Arthritis
The Challenging Total Ankle Arthroplasty: Management of Associated Foot Pathology
Conversion of a Failed Total Ankle Replacement to an Ankle Fusion: Indications and Technique
Diagnosis and Classification of Bone Defects: The Effect on Total Ankle Arthroplasty
Tendon Transfers for Acquired Posterior Tibial Tendon Deficiency
Midfoot Arthritis: Nonoperative Treatment and Arthrodesis
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