Defining the Patient Acceptable Symptom State (PASS) for PROMIS After Hallux Valgus Correction Surgery

Abstract

Background. The patient acceptable symptom state (PASS) is defined as the symptom threshold beyond which a patient is satisfied with the outcome of their surgery. PASS thresholds have been utilized throughout the orthopedics literature but have not yet been identified for hallux valgus (HV) deformity. This study aimed to establish PASS thresholds for using Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients undergoing HV deformity correction. Methods. A retrospective review of 286 patients who underwent HV deformity correction was performed using data from an institutional outcome registry. PASS thresholds were determined using 2-year postoperative PROMIS scores and patient Likert scale responses to 2 validated anchor questions: the Satisfied Scale and the Delighted-Terrible Scale. The impact of patient demographics and surgical factors on the likelihood of meeting PASS thresholds were compared using independent t tests and Pearson’s chi-square tests. Results. The PASS threshold values for patients undergoing surgical management of HV ranged from 41.6 to 65.1 depending on the PROMIS domain and anchor question. For both anchor questions, the PASS thresholds for PROMIS physical function (PF) and pain intensity (PIntens) were found to be 50.3 and 41.5, respectively. Seventy-one percent (203/286) of patients met the PASS threshold for PF and 72.4% (207/286) of patients met the PASS threshold for PIntens. The PASS thresholds for the other 4 PROMIS domains varied by anchor question. Higher preoperative PROMIS scores and lower body mass index were associated with an increased likelihood of meeting the PASS thresholds. Patients who underwent first metatarsophalangeal fusion were less likely to reach the PASS threshold for the PROMIS PF domain. Conclusions. Foot and ankle surgeons may be able to use these results to guide treatment plans. Furthermore, the results may be helpful in counseling and educating patients on the likelihood of obtaining a satisfactory result following HV correction surgery.

Level of Evidence: Level III, Retrospective review