Session V - Knee / Foot & Ankle


Fri., 10/14/11 Knee, Foot & Ankle, Paper #64, 4:38 pm OTA-2011

TEFTOM – A Promising General Trauma Outcome Measure? Results of a Validation Study of Pan–American Ankle Trauma Patients

Michael Suk, MD, JD, MPH1; Monica Daigl Cattaneo, MS2; Richard E. Buckley, MD3;
Cleber A.J. Paccola, MD4; Dean G. Lorich, MD5; David L. Helfet, MD6;
Beate Hanson, MD, MPH2;
1University of Florida, Jacksonville, Florida, USA;
2AO Foundation, Clinical Investigation and Documentation, Dübendorf, Switzerland;
3Foothills Medical Centre, Calgary, Alberta, Canada;
4Ribeirao Preto Medical School, Sao Paolo, Brazil;
5New York Presbyterian Hospital, New York, New York, USA;
6Hospital for Special Surgery, New York, New York, USA

Purpose: Orthopaedic outcomes research lacks an instrument specifically designed for trauma populations to assess the role of a patient’s expectations prior to surgical intervention and actual outcomes. To assess this, a 10-question, patient self-rating outcome instrument, the Trauma Expectation Factor Trauma Outcome Measure (TEFTOM) has been developed. TEFTOM is composed of 2 parts: (1) TEF, administered preoperatively, assesses patient expectations for their outcome at 1-year after surgery; and (2) TOM, administered postoperatively, to assess the degree to which the surgical outcome fulfills their expectations. The TEFTOM instrument was tested to demonstrate its content, construct and criterion validity as well as its reliability and sensitivity to change.

Methods: 201 patients with ankle or pilon fractures were recruited at 5 international centers in Canada, the United States, and Brazil and followed for a period of 12 months. TEF was administered preoperatively, following consultation with the orthopaedic surgeon to collect data regarding the patient’s 1-year expectation of outcome. TOM was tested postoperatively. To confirm validity, TOM results were compared against the American Academy of Orthopaedic Surgeons Foot and Ankle Scale (AAOS), the Foot and Ankle Outcome Score (FAOS), and the Short Form–36 (SF-36) health survey.

Results: TEF showed good internal consistency (Cronbach alpha = 0.69) and reproducibility. The agreement between scores yielded on the first and second testing occasions was always higher than 0.67 over a 6-month testing period. TOM showed good criterion validity when validated against the AAOS, with correlation coefficients ranging from 0.70 to 0.77 over a 1-year testing period. Internal consistency proved to be excellent, with Cronbach alpha ranging from 0.75 to 0.85. There was sound agreement between TOM scores yielded on the first and second testing occasions. The correlation was higher than 0.92, suggesting the excellent reproducibility of TOM. TOM also proved to be responsive to changes in patient condition over time.

Conclusion: The TEFTOM instrument is a short and sound trauma patient outcome questionnaire that is easy to score and interpret. It proved to be valid, reliable, and responsive to change in assessing the condition of ankle and pilon fracture patients after surgery and is a first of its kind musculoskeletal trauma instrument that associates a patient’s preoperative expectation with actual outcomes in ankle and tibial pilon fracture surgery.


Alphabetical Disclosure Listing (628K PDF)

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.