Comparison of the Manchester–Oxford Foot Questionnaire (MOXFQ) and the Self-Reported Foot and Ankle Outcome Score (SEFAS) in patients with foot or ankle surgery

https://doi.org/10.1016/j.fas.2018.01.003Get rights and content

Highlights

  • Comparison of psychometric properties of the Manchester–Oxford Foot Questionnaire (MOXFQ) and the Self-Reported Foot and Ankle Outcome Score (SEFAS).

  • The MOXFQ and SEFAS demonstrated good psychometric properties and proofed to be valid and reliable instruments for use in foot and ankle patients.

  • MOXFQ showed better outcomes in responsiveness.

Abstract

Background

Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures. The intention of this study was to compare the psychometric properties of the Manchester–Oxford Foot Questionnaire (MOXFQ) and the Self-Reported Foot and Ankle Outcome Score (SEFAS) in patients with foot or ankle surgery.

Methods

177 patients completed both scores and FAOS, Foot and Ankle Outcome Score (FAOS), Short Form 36 (SF-36) and numeric scales for pain and disability (NRS) before and after surgery. Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity, responsiveness and minimal important change were analyzed.

Results

The MOXFQ and SEFAS demonstrated excellent test-retest reliability with interclass correlation coefficient values >0.9 Cronbach’s alpha (α) values demonstrated strong internal consistency. No floor or ceiling effects were observed for both questionnaires. As hypothesized MOXFQ subscales correlated strongly with corresponding SEFAS, FAOS and SF-36 domains. MOXFQ subscales showed excellent responsiveness between preoperative assessment and postoperative follow-up, whereas SEFAS demonstrated moderate responsiveness.

Conclusions

The MOXFQ and SEFAS demonstrated good psychometric properties and proofed to be valid and reliable instruments for use in foot and ankle patients. MOXFQ showed better outcomes in responsiveness.

Introduction

Patient reported outcome measurements (PROMS) can provide reliable and valid measures of patient’s degree of pain, impairment, disability, and quality of life. They are a critical tool in evaluating the efficacy of orthopedic procedures and are increasingly used in clinical trials to assess outcomes of health care [1]. The Manchester–Oxford Foot Questionnaire (MOXFQ) is a PROM for surgery of the foot and ankle, initially assessed in patients undergoing hallux valgus surgery [2], [3]. Further evaluation provided evidence in support of the reliability and validity using data from a large sample of patients undergoing surgery of a wide range of foot or ankle conditions [4], [5]. The MOXFQ contains three sub-scores for pain, walking/standing and social interaction dimensions as well as a summary index score (MOXFQ-Index). The Self-reported Foot and Ankle Score (SEFAS) is a PROM for surgery of the foot and ankle, initially assessed in patients undergoing total ankle replacement due to osteoarthritis or inflammatory arthritis [6]. It proofed to be a valid score for different forefoot, hindfoot and ankle disorders [7], [8]. The SEFAS is based on the New Zealand total ankle questionnaire [9], and was translated and culturally adapted by Cöster et al. in 2012 [6]. It contains 12 items, with 5 response options. The questionnaire covers different constructs, which are not reported separately in subscales. Pain, limitation of function and other symptoms are the main constructs.

The aim of this study was to compare the psychometric properties of the Manchester–Oxford Foot Questionnaire (MOXFQ) and the Self-Reported Foot and Ankle Outcome Score (SEFAS) in patients with foot or ankle surgery.

Section snippets

Methods

The study was approved by the local research ethics committee (ref 15-252) and performed in accordance with the Declaration of Helsinki. Written informed consent from all participants was obtained.

Results

177 patients, 130 women and 47 men, with a mean age of 57 years (18–92) undergoing surgery of the foot or ankle were consecutively recruited at a single institution and completed the baseline 3–14 days before surgery (t1). On the morning before surgery (t2) 145 patients completed MOXFQ and SEFAS to determine test-retest reliability. 6 months after surgery (t3) 117 patients completed MOXFQ, SEFAS, FAOS, SF-36 and NRS to test responsiveness. 118 patients were undergoing forefoot, 56 patients

Discussion

Patient related outcome measures have become an important tool in clinical practice and clinical trials to assess outcome of health care [1], [19]. Several scores are in use for evaluating the outcome of foot and ankle surgery but none has been accepted as gold standard [7]. The MOXFQ is an increasingly used PROM in foot and ankle surgery which has been extensively tested and translated into German, Italian, Dutch, Turkish, Persian and Spanish [2], [3], [4], [5], [14], [20], [21], [22], [23],

Conclusion

Comparison of the MOXFQ and SEFAS showed that both scores demonstrate good psychometric properties. Our study demonstrated that both questionnaires are valid and reliable instruments for patients with foot and ankle disorders and can be used as a tool for evaluating the efficacy of surgical procedures and in clinical trials to assess outcomes of health care. The MOXFQ proved slight advantage showing higher responsiveness as an extent to which a questionnaire is able to detect changes over time

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Source of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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