Investigating patient reported outcomes and experience for first metatarsal scarf+/- akin osteotomy for hallux-valgus

K. Ahmad, A. Pillai, K. Somasundaram, A. Fox, N. Kurdy

Introduction: Patient reported outcome and experience measures have been a fundamental part of the NHS. We used PROMS2.0, a semi-automated web-based system, which allows collection and analysis of outcome data, to assess the patient reported outcome/experience measures for scarf+/- akin osteotomy for hallux valgus.

Methods: Prospective PROMs/PREMs data was collected. Scores used to asses outcomes included EQ-5D VAS, EQ-5D Health Index, and MOxFQ, collected pre-operatively and post-operatively (Post-op follow-up 6-12months) Patient Personal Experience (PPE-15) was collected postoperatively.

Results: 40 patients (35Female/5Male) (19Left +21Right). Average age- 60.7 years (Range 29-88). No bilateral procedures.
Pre-op average MOXFQ scores for pain, walking and social interaction: 51.6 (range 5-100), 51.4 (range 0-96) and 48.8 (range 0-100) respectively. Post-operatively improved to 24.4 (range 0-100), 22.9 (range 0-86) and 23.1 (range 0-88). Corresponding P values for all < 0.00001 and statistically significant. 32/40 (80%) patients showed improvement in all three domains. Of 8 who worsened- 6 worse with pain, 4 with walking and 5 with social-interaction. EQ5D improved; pre-op index average- 0.70 and pre-op VAS score average- 79.3. Post-op index average- 0.80. VAS score average- 82.9. Index improvements were significant, P-value < 0.0023 (significant). EQ5D improvements in line with those found in hip/knee replacements. No differences between 6/12m follow-up. Patients stratified according to age-groups for analysis, 11 patients under 54 years old, 15 between 55-64, and 14 over 65. Greatest improvement in over 65s for MOxFQ and under 55s for EQ5D. 27/35 women improved in all MOxFQ domains, whilst 5/5 men did. P-value for age and sex both < 0.05 therefore significant. Age/sex EQ5D showed results of no statistical significance. 65 patients filled post-op PPE questionnaire. Average overall satisfaction of 72.9%.

Conclusion: The procedure is very effective with high PROMs/PREMs. Older sub-group have best outcomes and highest satisfaction.