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
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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2021, Foot and Ankle SurgeryCitation Excerpt :When evaluating internal consistency, CA level >0.7 and < 0.9 has been recommended. Too high levels of CA might indicate that all items are identical [29]. Though, Confirmatory Factor Analysis for SEFAS has previously shown a good fit [7].
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2020, Foot and Ankle SurgeryCitation Excerpt :The inferences from this study should not lead to the conclusion that the FAOS should not be used for measuring bunion patients’ outcomes, and reassuring findings, such as absence of ceiling or floor effects among the FAOS subscales, were confirmed. Moreover, the responsiveness and internal consistency of the FAOS have been previously reported to be adequate [39] and not dissimilar to those reported of the MOXFQ and SEFAS [3,4,6]. Every PRO has limitations, and this study’s careful measurement and reporting of the limitations of the FAOS should encourage strengthening this instrument.