AOFAS Position Statement on the Future Use of AOFAS Clinical Rating Scale

Abstract

Category: Other Introduction/Purpose: Measuring patient outcomes is a critical piece toward advancing medical care. A previous study reviewing the commonly obtained outcomes measures used in orthopaedic foot and ankle surgery (Hunt 2013) demonstrated the AOFAS clinical rating scale was the most commonly reported measure over the past 10 years (2002-2011). Since that time, the American Orthopaedic Foot and Ankle Society published a position statement recommending against the continued use of this rating scale. The purpose of this study is to determine the impact of this position statement on the continued use of this invalidated instrument. Methods: We systematically reviewed all foot and ankle articles published in six major orthopaedic journals between 2012 and 2017. Any clinical study utilizing outcome measures was included. All outcome measures, level of evidence, type of study, study date and topic were recorded. The current utilization of the AOFAS was compared to the prior published percentages (outcome measure/total number of clinical articles) to determine the impact of use over time. Results: A total of 660 foot and ankle articles using clinical outcome measures were identified from a total of 14,164 articles published from the six journals between 2012-2017. Of the 108 outcome measures used, the 6 most common were the AOFAS (57.42%), Pain VAS (38.33%), SF-36 (18.18%), FAOS (8.79%), SF-12 (6.67%) and FFI (6.67%). Compared with Hunt et al. 2013, there is a consistently high usage of the AOFAS clinical rating scale during the past 5 years. A unique finding was more clinical studies were using two or more measures (59.09%) than a single outcome measure (40.91%). The majority of the studies represented level IV evidence (55.91%) with only 7% Level I (Hunt et al. 70% and 9.4% respectively). Conclusion: There continues to be a wide variety of outcome measures used in foot and ankle clinical studies. There are more higher evidence (Level II and III) studies completed in the past 6 years than prior years. The purpose of the AOFAS position statement was to discourage the use of the AOFAS clinical rating scales. Although this did not occur, there was a shift from the isolated use of one to multiple different outcome measures. As researchers become more comfortable with other validated outcome measures, hopefully the use of the AOFAS clinical rating scale will decline.