Vigilance: An Unmeasured Patient-Centered Outcome for Ankle Reconstruction

CATEGORY: Ankle, Ankle Arthritis INTRODUCTION/PURPOSE: A wide range of patient-reported outcome measures are used to evaluate ankle reconstruction outcomes, but there is little agreement regarding which best captures patients’ perceptions of illness and treatment outcomes. There has been little exploration of what outcomes are important to patients. Qualitative work offers one approach to try to understand patients’ experiences of ankle reconstruction for treatment of end-stage ankle osteoarthritis. METHODS: Individuals were recruited from an existing cohort of persons who had undergone total ankle replacement or ankle fusion. Twenty-five English-speaking individuals who had surgery at least one year prior and were receptive to in-depth interviews were asked to participate following a routine clinic visit. Semi-structured, face-to-face interviews were conducted by a qualitative researcher in a private hospital room. RESULTS: Twenty-five adults (12 women, 13 men) ages 25–82 years were interviewed for 1–2 hours. Participants commonly described a state of having to keep careful watch for potential environmental challenges on a daily basis. ‘Vigilance’ was related to ongoing symptoms (i.e. pain, stiffness) and concerns related to balance, stability, and damage to the fused ankle or implant. Findings indicated that vigilance existed along a continuum with higher levels associated with stress, mental exhaustion, and a negative impact on relationships with friends and family. Vigilance appeared to effect participants’ perception of their surgical outcome, with high levels of vigilance linked to negative perceptions of outcome. The degree to which individuals perceived they needed to be vigilant was influenced by environmental factors like uneven ground or crowds. CONCLUSION: Vigilance, or the constant appraisal of the environment and personal ability, is not captured by current instruments assessing ankle reconstruction outcomes. However, the mental load and worry associated with high ‘vigilance’ was important to patients and played a role in their perception of outcome, distinct from related pain or functional status. As such, reducing high levels of vigilance appears to be an appropriate target for patient-centered treatment outcomes and one that can be managed or remedied. A thorough outcome battery for ankle reconstruction should consider this domain.