PROMIS Depression Scores Improved by Surgical Intervention of Acute, but Not Chronic, Foot and Ankle Conditions
Authors: Zona Nathaniel , Hunt Kenneth 
Published: December 2024

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Introduction/Purpose:

PROMIS metrics such as Physical Function and Pain Interference are commonly used to assess outcomes of foot and ankle intervention due to their direct application to daily activity. Preoperative scores for these patient reported outcomes (PROs) can frequently be well below the national population average of PROMIS metrics, and are often sensitive to improvement. However, mental health plays an important role in the improvement of foot and ankle conditions as well. Improvement in PROMIS Depression scores is sparsely reported and seemingly less sensitive to orthopedic surgical intervention. Determining whether baseline depression scores vary across foot and ankle conditions, and to what degree intervention changes these scores, will help providers with a more global assessment of preoperative care plans and postoperative progress.

Methods:

All foot and ankle procedures consecutively enrolled into a single institution’s PRO registry were screened for inclusion. Patients that had a completed preoperative PROMIS Depression Computer Adaptive Test score and at least one follow-up measure, corresponding to 3-, 6-, 12-, and/or 24-month postoperative timepoints, were included in the analysis. PROMIS scores utilize a common metric T-score, with the U.S. population mean of 50 ± 10. Patients were stratified by procedure category, which included Achilles repairs, ankle arthritis and degeneration, ankle fracture, excision, hardware removal, midfoot/forefoot arthritis and degeneration, midfoot/forefoot deformity, midfoot/forefoot fracture, and small soft tissue procedures. Differences in a patients’ baseline and longest follow-up PROMIS Depression scores were determined using paired t-tests. A p-value of < 0.05 was considered statistically significant.

Results:

A total of 1381 patients were included in the analysis. The sample’s average age was 51.7 ± 16.2 years and consisted of 855 (62%) female patients. There was an average follow-up time of 360 ± 197 days for postoperative PROMIS Depression scores. Collectively, foot and ankle conditions did not substantially deviate from the national average in PROMIS Depression scores, with a baseline of 48.6 ± 8.34. Statistically significant improvements in depression scores were observed in patients following Achilles repair, ankle fracture, midfoot/forefoot fracture, and small soft tissue procedures (figure 1). Intervention associated with chronic conditions did not observe significant improvements. No improvements in PROMIS Depression exceeded 3 points, and all procedures had an average postoperative score well within one standard deviation of the national average.

Conclusion:

Generally, PROMIS Depression scores are consistently close to the national average before and after surgical intervention across foot and ankle conditions. Improvements don’t reach values considered to be the minimal clinically important difference of other PROMIS metrics such as Physical Function and Pain Interference. However, the surgical intervention of acute injuries significantly improved patient depression scores, suggesting PROMIS Depression is a valuable metric for certain surgical cohorts. It may be less valuable for assessing mental health outcomes for chronic conditions, where no significant improvement was observed.