Underutilization of Patient Reported Outcomes Data in the Recent Foot and Ankle Literature

CATEGORY: Other INTRODUCTION/PURPOSE: The importance of collecting outcomes information was promoted by Ernest Codman in the early 1900's. He stated the importance of 'Following every patient treated long enough to determine whether or not the treatment has been successful, then inquire-if so or if not- WHY?', ' He stressed the importance of evaluating outcomes for each patient as an individual and not from groups of patients. Since that time numerous outcomes measures have been validated and are in current use. The purpose of this study was to review all publications in Foot and Ankle International from 2019-2020 which included outcomes data. Then to determine if these principles (use of individual versus group data and WHY treatment was successful or not) were followed. METHODS: All articles published in Foot and Ankle International during 2019-2020 were reviewed. Articles which included patient outcomes data were selected for further review. This review then included assessment of outcomes measure(s) used, organization of outcomes data, utilization of this data by the study, analysis of individual versus group data, and any assessment of WHY the outcomes scores had improved or not. RESULTS: Eighty-five publications were selected. Eleven different outcomes measurement tools were used. All were reportedy validated tools except for the AOFAS scoring system. Every study reported outcomes data as group means (some with standard deviations, some with range of scores). These studies then compared group means (of different treatment groups or preop vs post op). No specific individual patient outcomes data was provided. There was no specific assessment of WHY scores improved or not. There was also no analysis of individual questions from these outcomes tools (e.g. can you put on your own shoes?–if patient answered 'no' there was no further explanation of why this response was selected). When the range of scores were provided it was common to have scores on the low end of the scale before and after treatment with overall conclusion of improvement based on group means but no assessment of why individual patients improved or not. CONCLUSION: Outcomes measures are generally considered to be part of the 'standard of care'. They may be considered important by third party payers, used in evaluation treatment options, and are usually necessary for publication. However trhis data is being underutilized. It is commonly reported as group means +/- range or standard deviations with provides little information about the individuals in a group or groups. Even with methodologies to minimize Type I or II errors evaluation of group means can obscure significant progress, lack of progress, or decline by individual patients. Methods to more effectively utilize outcomes measures are needed.