Abstract
The lower extremity functional scale (LEFS) is a patient-reported outcome measure for lower extremity disorders. Aim of this study was to assess the longitudinal validity including responsiveness and test-retest reliability of the revised 15-item version, and to define the minimal important change (MIC) of the modified LEFS in a generic sample of orthopedic foot and ankle patients who underwent surgery. Responsiveness, effect size, and standardized response mean were measured by determining the score change between the baseline and 6 months administration of the LEFS from 156 patients. There was no significant difference between preoperative (median 78, interquartile range [IQR] 64.2-90.3) and postoperative (median 75.0, IQR 61.7-95.0) scores. Both effect size and standardized response mean were low (0.06 and 0.06, respectively). Test-retest reliability of the LEFS was satisfactory. Intraclass correlation coefficient was 0.85 (95% confidence interval 0.81-0.88). MIC value could not be estimated due to the lack of significant score change. The modified LEFS presented with relatively low longitudinal validity in a cohort of generic orthopedic foot and ankle patients. The findings of this study indicate that the modified LEFS might not be the optimal instrument in assessing the clinical change over time for these patients.
Highlights
In recent years, use of patient-reported outcome measures (PROMs) has become more frequent in orthopedic surgery [1]
The effect size and the standardized response mean values indicated no actual change in the Lower extremity functional scale (LEFS) scores in the preoperative and 6 months postoperative scores
The finding suggests that the modified LEFS was unable to detect change in the clinical status after operative treatment of foot and ankle pathologies
Summary
Use of patient-reported outcome measures (PROMs) has become more frequent in orthopedic surgery [1]. The modified version of the LEFS lacks investigation on its longitudinal validity and minimal important change (MIC) for foot and ankle patients. Two measurements of HRQL conducted over a short time with no real change in the clinical status should produce similar outcome scores for the score to be reproducible. This is referred to as test-retest reliability [18]. The current study aimed to assess the longitudinal validity of responsiveness and repeatability, and to define the MIC for the modified Finnish version of LEFS in orthopedic foot and ankle patients who undergo surgery
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