New Ankle Foot Questionnaire for Health Outcomes Assessment

22 June 2009

A new health outcomes questionnaire has been developed by the University of Oxford's Department of Public Health for assisting with the assessment of the extent children’s lives are affected by foot and ankle problems. The Oxford Ankle Foot Questionnaire was developed to assess reported health status for children with foot and ankle problems aged from 5 to 16 years.

This new patient-reported questionnaire uniquely takes the perceptions of both the child and their parent or carer into account. Usual clinical assessment methods do not systematically capture the patient perspective and may not accurately reflect how children function in their typical environments.

Patient Reported Outcome Measures (PROMs) have been shown to be useful for studies of the wellbeing of patients. Joint specific (foot and ankle) PROMs have been developed to tackle this requirement for adults but these instruments have not been shown to be valid when used to assess children.

The scores from the 15-item questionnaire can be used to measure the effect of foot and ankle problems on three domains of children’s lives: physical, school and play, and emotional well being. The Physical domain assesses general activity limitations such as standing and walking; the School & Play domain assesses participation restrictions in specific environmental contexts; the Emotional domain assesses to what extent a child is bothered about their foot or ankle problem because of appearance or the way people treat them. A single item assesses whether children can wear the type of shoes they prefer. The items were based on issues that children with foot or ankle problems identified as important in focus groups.

The domain scales have been shown to be responsive to change and can be used to evaluate interventions and indicate recovery in clinical trials, benchmarking studies and clinical audit. The questionnaire can be used with child patients affected by foot and ankle problems originating from common conditions such as flat feet, congenital deformities such as clubfoot, clinical syndromes, trauma or neuromuscular conditions. The questionnaire provides complementary information to clinical assessments.

The author of the questionnaire, Dr Christopher Morris of Oxford’s Department of Public Health said: “Foot and ankle problems are extremely common among children, and there is frequently little evidence to support the widespread use of orthotic, physiotherapy, surgery and pharmaceutical interventions. The Oxford Ankle Foot Questionnaire will help us to understand how children’s lives are affected by these conditions, and to evaluate the effectiveness of interventions in order to support evidence based clinical decision-making, and to assess the performance of health services.”

Development of the Oxford Ankle Foot Questionnaire was funded by the MRC through a Research Training Fellowship in Health Services Research awarded to Dr Morris, and involved collaboration between the University of Oxford Departments of Public Health and Orthopaedic Surgery, and the clinical services at the Nuffield Orthopaedic Centre and Oxford Trauma Unit, John Radcliffe Hospital.

The Oxford Health Services Research Unit also includes authors of the industry-standard Parkinsons’ disease health outcomes questionnaire, PDQ-39, the mostly widely used outcomes measure for that condition. The group has developed a number of condition-specific questionnaires for motor neurone disease and endometriosis as well as joint-specific scores for adult elbow, shoulder, and foot and ankle conditions.

The utility of PROMs is gaining increasing importance worldwide. In the UK, the Department of Health is implementing the routine collection of PROMs data for specific interventions and chronic conditions. The Oxford Hip and Knees scores have been selected as the mandatory questionnaires for assessing the efficacy of hip and knee replacements. Initially aimed at 120,000 patients a year that receive hip and knee replacement, the results will be used to assess the improvement in the quality of life for hip and knee patients receiving treatment throughout the NHS.

The Oxford Health Outcomes questionnaires are available from Isis Innovation.

For more information:

E: healthoutcomes@isis.ox.ac.uk
T: +44 (0) 1865 280857
W: www.isis-innovation.com/licensing/healthoutcomes

Press Enquiries:

Renate Krelle
Isis Innovation
E: renate.krelle@isis.ox.ac.uk
T: +44 (0) 1865 280850