title: Symptom Resolution and Patient-Perceived Recovery Following Ankle Arthroplasty and Arthrodesis.
abstract: BACKGROUND
  Patients' perception of outcomes is not always defined by the absence of limitations/symptoms (resolution), but can also be characterized by behavioral adaptation and cognitive coping arising in cases with residual deficits. Patient-reported outcome measures (PROs) are designed to measure levels of function or symptoms, largely missing whether patients are coping with ongoing limitations. This study aimed to broaden the conventional definition of a "satisfactory" outcome following ankle reconstruction by comparing patient-reported outcomes of patients with and without residual symptoms and limitations.
  
  
  METHODS
  The study consisted of a cross-sectional survey of ankle arthroplasty (n = 85) and arthrodesis (n = 15) patients. Outcome measures included the Ankle Osteoarthritis Scale, Short Musculoskeletal Function Assessment, Short Form-12, and EuroQol-5 Dimension. Patients also completed measures of pain (0-10), stiffness (0-10), satisfaction (0-3), and ability to complete activities of daily living (ADL) (0-6). Based on a self-reported question regarding recovery and coping, patients were categorized as "Recovered-Resolved" (better with no symptoms or residual effects), "Recovered, not Resolved" (RNR, better with residual effects), or "Not Recovered" (not better). Recovery groups were compared across measures.
  
  
  RESULTS
  Only 15% of patients were categorized Recovered-Resolved. Most were RNR (69%), leaving 14% Not Resolved. Recovered-Resolved experienced lower rates of pain (1.4 ± 2.3), stiffness (1.1 ± 2.6), and difficulty performing ADLs (0.9 ± 1.2). Overall, outcome measure scores were high (ie, better health) for Recovered-Resolved patients, midrange for RNR patients, and low for Not Recovered patients, thus confirming predefined hypotheses. Recovered-Resolved and RNR patients had similarly high satisfaction summary scores (3.0 ± 0.0 vs 2.6 ± 0.6).
  
  
  CONCLUSIONS
  Most patients reported positive outcomes, but few (15%) experienced resolution of all symptoms and limitations. Current PROs focus on achieving low levels of symptoms and limitations, but miss an important achievement when patients are brought to a level of residual deficits with which they can cope. Patients' perceptions of satisfactory outcomes were not predicated on the resolution of all limitations; thus, the conventional definition of "satisfactory" outcomes should be expanded accordingly.
  
  
  METHODS
  Level II, prospective cohort study.
authors: Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada pinskere@smh.ca.|Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors: Ellie
authors: E
authors: Pinsker
authors: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors: Taucha
authors: T
authors: Inrig
authors: Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.|Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors: Timothy R
authors: TR
authors: Daniels
authors: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors: Kelly
authors: K
authors: Warmington
authors: Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.|Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.|Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada.|Institute for Work & Health, Toronto, Ontario, Canada.
authors: Dorcas E
authors: DE
authors: Beaton
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D058737:Arthroplasty, Replacement, Ankle; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011446:Prospective Studies
keywords: ankle arthroplasty; ankle fusion; attitude to health; behavioral adaptation; cognitive coping; outcome assessment; quality of life; recovery; satisfaction; theoretical models