Defining the patient acceptable symptom state (PASS) for PROMIS after Hallux Rigidus correction surgery.

Abstract

It is unclear which patient reported outcome metric correlates best with clinical improvement. The patient acceptable symptom state (PASS) incorporates the patient's subjective outcome experience into the outcome measurement. This study aims to establish PASS thresholds using Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients undergoing hallux rigidus (HR) correction. A retrospective review of prospectively collected data identified 144 patients who were treated surgically for HR between February 2019 and March 2021, had preoperative and 2-year postoperative PROMIS scores, and had responses to two distinct PASS anchor questions. PASS thresholds were determined using the maximum Youden Index. Differences in demographic and surgical characteristics between patients who met or did not meet the PASS thresholds were compared using independent samples T-tests and Pearson Chi-Square tests. Overall, 70 % of patients met the PASS thresholds. Patients with better baseline PROMIS scores were more likely to meet the postoperative PASS thresholds for every PROMIS domain (p < 0.05). Patients who did not undergo first metatarsophalangeal (MTP) fusion were more likely to reach the PASS threshold for the Physical Function domain (p = 0.045). For the Pain Intensity domain, younger patients were more likely to meet the thresholds (p = 0.005). Patient sex, BMI, and use of either cheilectomy or Akin/Moberg osteotomy during surgery did not impact a patient's likelihood of meeting the PASS thresholds. After surgical intervention for HR, it may not be necessary for patients to reach normal physical function or pain levels in order to reach an acceptable postoperative symptom state. Level of Evidence: Level III, Retrospective Review.