SLR - March 2012 - Adam Caton

A Systematic Review of Patient-Reported Outcome Measures Used to Assess Achilles Tendon Rupture Management: What’s Being Used and Should We Be Using It? 

Reference: Kearney RS, Achten J, Lamb SE, Plant C, Costa ML (2011 Nov 16). A systematic review of patient-reported outcome measures used to assess Achilles tendon rupture management: What’s being used and should we be using it? British Journal Sports Medicine. PMID: 22089078

Scientific Literature Review

Reviewed by: Adam Caton, DPM
Residency Program: Southern Arizona VA Healthcare System

Podiatric Relevance:
Achilles tendon ruptures are commonly treated by podiatric foot and ankle surgeons. Currently, there is no universally accepted outcome measure regarding the optimal management for patients following this injury. This article is a systematic review of recommendations for the most suitable patient-reported outcome measure for the assessment of patients following an Achilles tendon rupture.

Methods:
A literature search was performed on medical journal databases (MEDLINE, EMBASE and AMED) up to September 2010 regarding patient-reported outcomes after Achilles tendon rupture management. Exclusion criteria included: (1) Not interventional study design, (2) Not acute rupture, (3) Not adult, (4) Not multi-item, (5) Not patient reported.

Results:
50 articles containing 21 different multi-item patient outcomes were included to assess what is currently being used. Only disease specific or region specific multi-item patient outcomes which cited independent validation data were included. These outcome measures were the AOFAS, Olerud and Molander Ankle Score (OMAS), Leppilahti score and the Achilles tendon Total Rupture Score (ATRS). The systematic review showed that AOFAS hind-foot score is the most widely reported outcome measure for evaluating Achilles tendon rupture management with no evidence supporting the many facets of validity in this patient population. The OMAS and Leppilahti score also lacked a methodologically robust approach as the scores were based on expert opinion alone. ATRS is a newly reported outcome measure with no data to support the aspects of validity outside of the initial development centre. The ATRS outcome measure is the only patient-reported outcome measure that has been developed and evaluated using appropriate methodologies, as opposed to an expert opinion alone. It is currently the only evidence-based outcome measure for use in Achilles tendon rupture management.

Conclusions:
The authors performed a systematic review of the literature comparing current methodological approaches to patient-reported outcome measures used to assess Achilles tendon rupture management. To further the development of clinical practice and research, it is necessary to develop practical and appropriate patient-reported outcome measures that are universally accepted. This approach will eventually allow comparisons and meta-analysis of high quality randomized controlled trials. The authors report that the best available current evidence suggests that the ATRS is the most appropriate outcome measure for evaluating the management of acute Achilles tendon ruptures.

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