Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS)

Abstract

Background:

The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure, while the American Orthopedic Foot and Ankle Society Score (AOFAS) is a clinician-based score, both used for evaluation of foot and ankle disorders. The purpose of this study was to compare the psychometric properties of these 2 scoring systems.

Methods:

A total of 95 patients with great toe disorders and 111 patients with ankle or hindfoot disorders completed the 2 scores before and after surgery. We evaluated time to complete the scores in seconds, correlations between scores with Spearman’s correlation coefficient (r_s), floor and ceiling effects by proportion of individuals who reached the minimum or maximum values, test–retest reliability and interobserver reliability by intraclass correlation coefficient (ICC), internal consistency by Cronbach’s coefficient alpha (CA), and responsiveness by effect size (ES). Data are provided as correlation coefficients, means, and standard deviations.

Results:

SEFAS was completed 3 times faster than AOFAS. The scores correlated with an r_s of .49 for great toe disorders and .67 for ankle/hindfoot disorders (both P < .001). None of the scores had any floor or ceiling effect. SEFAS test–retest ICC values measured 1 week apart were .89 for great toe and .92 for ankle/hindfoot disorders, while the corresponding ICC values for AOFAS were .57 and .75. AOFAS interobserver reliability ICC values were .70 for great toe and .81 for ankle/hindfoot disorders. SEFAS CA values were .85 for great toe and .86 for ankle/hindfoot disorders, while the corresponding CA values for AOFAS were .15 and .42. SEFAS ES values were 1.15 for great toe and 1.39 for ankle/hindfoot disorders, while the corresponding ES values for AOFAS were 1.05 and 1.73.

Conclusion:

As SEFAS showed similar or better outcome in our tests and was completed 3 times faster than AOFAS, we recommend SEFAS for evaluation of patients with foot and ankle disorders.

Level of Evidence:

Level II, prospective comparative study.

Keywords

ankle AOFAS comparison foot hindfoot reliability responsiveness SEFAS score validity

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References

Baertschi

Swanenburg

Brunner

Kool

. Interrater reliability of clinical tests to evaluate scapulothoracic motion. BMC Musculoskelet Disord. 2013;14:315.

Baumhauer

Nawoczenski

DiGiovanni

Wilding

. Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes. Foot Ankle Int. 2006;27:1014-1019.

Becker

. Synthesizing standardized mean change measures. Br J Math Stat Psychol. 1988;41:257-278.

Button

Pinney

. A meta-analysis of outcome rating scales in foot and ankle surgery: is there a valid, reliable, and responsive system? Foot Ankle Int. 2004;25:521-525.

Cohen

. Statistical Power Analysis for the Behavioral Sciences. New York, NY: Academic Press; 1978.

Coster

Bremander

Rosengren

. Validity, reliability, and responsiveness of the Self-reported Foot and Ankle Score (SEFAS) in forefoot, hindfoot, and ankle disorders. Acta Orthop. 2014;85:187-194.

Coster

Karlsson

Nilsson

Carlsson

. Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS). Acta Orthop. 2012;83:197-203.

Dahlberg

. Statistical Methods for Medical and Biological Students. 2nd ed. London, UK: George Allen and Unwin; 1940.

Dawson

Boller

Doll

. Responsiveness of the Manchester-Oxford Foot Questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery. J Bone Joint Surg Br. 2012;94:215-221.

10.

Dawson

Doll

Coffey

Jenkinson

. Responsiveness and minimally important change for the Manchester-Oxford Foot Questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus. Osteoarthritis Cartilage. 2007;15:918-931.

11.

Farrugia

Goldstein

Petrisor

. Measuring foot and ankle injury outcomes: common scales and checklists. Injury. 2011;42:276-280.

12.

Guyton

. Theoretical limitations of the AOFAS scoring systems: an analysis using Monte Carlo modeling. Foot Ankle Int. 2001;22:779-787.

13.

Hosman

Mason

Hobbs

Rothwell

. A New Zealand national joint registry review of 202 total ankle replacements followed for up to 6 years. Acta Orthop. 2007;78:584-591.

14.

Hunt

Hurwit

. Use of patient-reported outcome measures in foot and ankle research. J Bone Joint Surg Am. 2013;95:e118(111-119).

15.

Juul

Langberg

Enoch

Sogaard

. The intra- and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain. BMC Musculoskelet Disord. 2013;14:339.

16.

Kitaoka

Alexander

Adelaar

. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349-353.

17.

Lau

Mahomed

Schon

. Results of an Internet survey determining the most frequently used ankle scores by AOFAS members. Foot Ankle Int. 2005;26:479-482.

18.

Madeley

Wing

Topliss

. Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int. 2012;33:57-63.

19.

Malviya

Makwana

Laing

. Correlation of the AOFAS scores with a generic health QUALY score in foot and ankle surgery. Foot Ankle Int. 2007;28:494-498.

20.

Martin

Irrgang

Lalonde

Conti

. Current concepts review: foot and ankle outcome instruments. Foot Ankle Int. 2006;27:383-390.

21.

Mayich

. Life without the AOFAS score: a critical problem in a time of scarcity. Foot Ankle Int. 2012;33:689-691.

22.

Mokkink

Terwee

Knol

. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Method. 2010;10:22.

23.

Mokkink

Terwee

Knol

. Protocol of the COSMIN study: consensus-based standards for the selection of health measurement instruments. BMC Med Res Method. 2006;6:2.

24.

Mokkink

Terwee

Patrick

. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19:539-549.

25.

Mokkink

Terwee

Patrick

. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737-745.

26.

Naal

Impellizzeri

Rippstein

. Which are the most frequently used outcome instruments in studies on total ankle arthroplasty? Clin Orthop Relat Res. 2010;468:815-826.

27.

Pena

Agel

Coetzee

. Comparison of the MFA to the AOFAS outcome tool in a population undergoing total ankle replacement. Foot Ankle Int. 2011;28:788-793.

28.

SooHoo

Shuler

Fleming

. Evaluation of the validity of the AOFAS Clinical Rating Systems by correlation to the SF-36. Foot Ankle Int. 2003;24:50-55.

29.

SooHoo

Vyas

Samimi

. Responsiveness of the foot function index, AOFAS clinical rating systems, and SF-36 after foot and ankle surgery. Foot Ankle Int. 2006;27:930-934.

30.

Streiner

Norman

. Health Measurement Scales: A Practical Guide to Their Development and Use. New York, NY: Oxford University Press; 2008.

31.

Suk

. Musculoskeletal Outcomes Measures and Instruments. Davos, Switzerland: AO Foundation; 2009.

32.

Terwee

Bot

de Boer

. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34-42.

33.

Terwee

Mokkink

Knol

. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2011;21:651-657.

34.

Thomas

Roddy

Zhang

. The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain. 2011;152:2870-2880.

35.

Wamper

Sierevelt

Poolman

Bhandari

Haverkamp

. The Harris hip score: do ceiling effects limit its usefulness in orthopedics? Acta Orthop. 2010;81:703-707.

36.

Ware

Jr Sherbourne

. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-448.