CORR Insights®: Do Patient Sociodemographic Factors Impact the PROMIS Scores Meeting the Patient-Acceptable Symptom State at the Initial Point of Care in Orthopaedic Foot and Ankle Patients?

In the current study, Bernstein and colleagues [2] look beyond patientreported outcomemeasure (PROM) scores to determine how acceptable the functional limitations these scores reflect are to patients with foot and ankle injuries, and to what degree the level of acceptable symptoms may vary with patient demographics. Using the Patient-Acceptable Symptom State score, the authors found a strong association between income level and both the severity of functional limitations on presentation and the degree to which patients find these limitations acceptable [2]. Bernstein and colleagues created six brackets based on median income: # USD 24,999, USD 25,000USD34,999, USD 35,000-USD 49,999, USD 50,000-USD74,999, USD 75,000USD 99,000, and$USD 100,000 [2]. It is perhaps not surprising that patients in lower income brackets might seek care only when they have more severe limitations, given that they may have fewer resources and less access to health care. It is a novel finding, however, that patients in lower income brackets find more severe functional limitations to be acceptable while patients in higher income brackets have a much higher threshold for an acceptable level of function. Previous studies [1, 3, 4] have noted that patients with more functional limitations had higher expectations for improvement following foot and ankle surgery; lower functional status is also associated with a higher likelihood of clinical improvement following surgery of the foot and ankle.