Outcome Scores


Foot and Ankle Outcome Score [32]

Foot and Ankle Ability Measure [26]

Symptoms

Foot and Ankle Ability Measure (FAAM)

Do you have swelling in your foot/ankle?

Standing

Do you feel grinding, hear clicking, or any other type of noise when your foot/ankle moves?

Walking on even ground

Walking on even ground without shoes

Does your foot/ankle catch or hang up when moving?

Walking up hills

Can you straighten your foot/ankle fully?

Walking down hills

Can you bend your foot/ankle fully?

Going up stairs

How severe is your foot/ankle stiffness after first wakening in the morning?

Going down stairs

Walking on uneven ground

How severe is your foot/ankle stiffness after sitting, lying, or resting later in the day?

Stepping up and down curbs

Squatting

Pain

Coming up on your toes

How often do you experience foot/ankle pain?

Walking initially

Twisting/pivoting on your foot/ankle

Walking 5 min or less

Straightening foot/ankle fully

Walking approximately 10 min

Bending foot/ankle fully

Walking 15 min or greater

Walking on flat surface

Home responsibilities

Going up or down stairs

Activities of daily living

At night while in bed

Personal care

Sitting or lying

Light to moderate work (standing, walking)

Standing upright

Heavy work (push/pulling, climbing, carrying)

Function, daily living

Recreational activities

Descending stairs

FAAM sports scale

Ascending stairs

Running

Rising from sitting

Jumping

Standing

Landing

Bending to floor/pick up an object

Starting and stopping quickly

Walking on flat surface

Cutting/lateral movements

Getting in/out of car

Low impact activities

Going shopping

Ability to perform activity with your normal technique

Putting on socks/stockings

Ability to participate in your desired sport as long as you would like

Rising from bed

Taking off socks/stockings

Hannover questionnaire [42]

Lying in bed (turning over, maintaining foot/ankle position)

Symptoms severity scale

How severe is your pain in the evening?

Getting in/out of bath

How often did you have pain within the past 2 weeks?

Sitting

Do you feel any pain during the day?

Getting on/off toilet

How often do you feel pain during the day?

Heavy domestic duties (moving heavy boxes, scrubbing floors, etc.)

How long does your pain last during the day?

Do you have swelling around your ankle and/or foot in the evening?

Light domestic duties (cooking, dusting, etc.)

Function, sports and recreational activities

How often did you have swelling around your ankle and/or foot during the past 2 weeks in the evening?

Squatting

Running

How often do you have swelling of your ankle and/or foot during the day?

Jumping

Twisting/pivoting on your injured foot/ankle

Do you feel any stiffness in your foot or ankle?

Kneeling

Does the stiffness bother you?

Quality of life

Questionnaire functional status

How often are you aware of your foot/ankle problem?

Do you have difficulties to climb stairs?

Have you modified your lifestyle to avoid potentially damaging activities to your foot/ankle?

Do you have difficulties driving a car (brake, clutch, gas pedal)?

How much are you troubled with lack of confidence in your foot/ankle?

Do you have difficulties to walk on uneven or slippery ground?

In general, how much difficulty do you have with your foot/ankle?

Are you able to walk fast or do jogging?

Are you able to jump (small ditch or puddle)?

AOFAS ankle-hindfoot score [16]

You have difficulties with single leg stance?

Pain

How long does it take for your leg to get fatigued?

Function

Do you feel your operated leg is more weak than the uninjured one?

Activity limitations, support requirement

Maximum walking distance

How you would describe your gait?

Walking surfaces

Do you have problems wearing conventional shoes?

Gait abnormality

Ogilvie-Harris score [30]

Sagittal motion (flexion plus extension)

Pain

Hindfoot motion (inversion plus eversion)

Swelling

Ankle-hindfoot stability (anteroposterior, varus-valgus)

Stiffness

Alignment

Limping

Activity




Table 11.2
Overview of several radiographic (Van Dijk, modified Takakura, modified Kellgren-Lawrence) and MRI (MOCART) scoring systems for the ankle joint














































































































Van Dijk scale [49]

Magnetic resonance observation of cartilage repair tissue [24]

(0) Normal joint or subchondral sclerosis

(I) Osteophytes without joint space narrowing

Degree of defect repair and filling of the defect

(II) Joint space narrowing with or without osteophytes

Complete (on a level with adjacent cartilage)

(III) (Sub)total disappearance or deformation of the joint space

Hypertrophy (over the level of the adjacent cartilage)

Incomplete (under the level of the adjacent cartilage; underfilling)

Modified Takakura scale [40]

  > 50 % of the adjacent cartilage

(1) No joint space narrowing but early sclerosis and osteophyte formation

  < 50 % of the adjacent cartilage

 Subchondral bone exposed (complete delamination or dislocation and/or loose body)

(2) Narrowing of the joint space medially

(3a) Obliteration of the joint space limited to the facet of medial malleolus with subchondral bone contact

Integration to border zone

Complete (complete integration with adjacent cartilage)

(3b) Obliteration of the joint space advanced to the roof of the talar dome with subchondral bone contact

Incomplete (incomplete integration with adjacent cartilage)

Modified Kellgren-Lawrence scale [15]

 Demarcating border visible (split-like)

(0) No radiographic findings of osteoarthritis

 Defect visible

(1) Minute osteophytes of doubtful clinical significance

   < 50 % of the length of the repair tissue

(2) Definite osteophytes with unimpaired joint space

   > 50 % of the length of the repair tissue

(3) Definite osteophytes with moderate joint space narrowing

Surface of the repair tissue

Surface intact (lamina splendens intact)

(4) Definite osteophytes with severe joint space narrowing and subchondral sclerosis

Surface damaged (fibrillations, fissures, and ulcerations)

  < 50 % of repair tissue depth

  > 50 % of repair tissue depth or total degeneration

Structure of the repair tissue

Homogenous

Inhomogeneous or cleft formation

Signal intensity of the repair tissue

Dual T2-FSE

 Isointense

 Moderately hyperintense

 Markedly hyperintense

3D-GE-FS

 Isointense

 Moderately hypointense

 Markedly hypointense

Subchondral lamina

Intact

Not intact

Subchondral bone

Intact

Non-intact (edema, granulation tissue, cysts, sclerosis)

Adhesions

No

Yes

Effusion

No

Yes




11.2 Clinical and Functional Outcome Measures



11.2.1 The American Orthopaedic Foot & Ankle Society: Ankle-Hindfoot Score


The American Orthopaedic Foot & Ankle Society (AOFAS) has developed four rating systems, in which the clinical status of the ankle and foot is reported [16]. In the original publication, the AOFAS ankle-hindfoot score was described to be used for ankle replacement, ankle arthrodesis, ankle instability operations, subtalar arthrodesis, subtalar instability operations, talonavicular arthrodesis, calcaneocuboid arthrodesis, calcaneal osteotomy, calcaneus fracture, talus fracture, and ankle fractures [16]. This scale incorporates both subjective and objective factors with a maximal score of 100, indicating no symptoms or impairments. The scale includes nine items that can be divided into three subscales (pain, function, and alignment). Pain consists of one item with a maximal score of 40, indicating no pain. Function consists of seven items with a maximal score of 50, indicating full function. Alignment consists of one item with a maximal score of 10, indicating good alignment.

The AOFAS ankle-hindfoot score, as a complete score, has been shown to be valid [22, 37, 51]. The score has shown good responsiveness over time in two studies, with reported effect sizes of 1.69 [22] and 1.12 [38]. The subjective portion of the scale has been shown to be valid and reliable [12]. The objective portion of the scale has not been evaluated for reliability. This is one of the main criticisms of the AOFAS score. The second major concern of the AOFAS score is the weighting and calculations of the items; for example, high scores are obtained relatively easily (i.e., ceiling effect). Furthermore, the subscale pain is heavily weighted (40 points), and there is a 20-point difference between rating pain as severe (almost always present) and moderate (daily). To establish reliability, validity, and responsiveness, the scale has been evaluated related to a wide spectrum of diagnoses, such as general ankle-hindfoot complaints [37], pending ankle or foot surgery [12], surgically treated calcaneal fractures [51], and end-stage ankle arthritis [22]. However, there is no study that has evaluated the psychometric properties in patients with talar OCD.


11.2.2 The Foot and Ankle Outcome Score


The Foot and Ankle Outcome Score (FAOS) [32] is a patient-reported score, which evaluates symptoms and functional limitations related to the foot and ankle (www.​koos.​nu). It includes five different subscales: pain (nine items), other symptoms (stiffness, swelling, and range of motion; seven items), activities of daily living (17 items), sports and recreational activities (five items), and foot-and-ankle-related quality of life (four items). The items are scored on a 0–4-point scale and then normalized, resulting in a subscale score of 0–100. A score of 100 equals no symptoms or difficulty with activities. The FAOS is based on the Knee injury and Osteoarthritis Outcome Score (KOOS) and has been shown to have good validity and reliability in patients with ankle injury [32]. When used as an outcome measure for patients with Achilles tendinopathy, it has been shown to be responsive to changes over time [17, 33]. No study has evaluated the minimal clinically important difference, nor has the reliability or validity been investigated specifically for talar OCD. The FAOS is available in numerous languages (www.​koos.​nu), enabling its use in international multicenter studies.

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May 22, 2017 | Posted by in SPORT MEDICINE | Comments Off on Outcome Scores

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