**2. Patient-based outcome measures: the importance of quantifying patient's perspectives about health treatments**

Throughout the history of orthopedic field, the main focus of clinical relevant outcome measures used to be those related to body structure and function, quantifying movement restrictions, such as range of motion or functional impairments like muscle strength. By this point of view, treatment goals and definitions of successful interventions captured mainly what is direct important for the healthcare professional rather than for the patient. However, what is crucial and naturally understandable for patients is functionality and disability, which brings a clear necessity

to measure dysfunction at this level. Furthermore, the International Classification of Functionality (ICF) proposed by the World Health Organization (WHO) suggests that health issues should be considered by taking into account individual function, activity, and social participation. The impact that injuries, illnesses, and any other harm might have upon health, especially over functionality and quality of life, must be considered in a context of clinical evaluation in the health area.

Usually, ankle dysfunctions require the involvement of a wide variety of healthcare professionals in order to achieve excellence in recovery and functionality. This is particularly true when the treatment plan includes surgery, medications, rehabilitation program, and many other interventions carried out by different professionals. Multidisciplinary healthcare thus requires instruments that work across distinct disciplines in a sense of combining them and unifying perspectives.

The health team may have priorities that can diverge from patient-specific needs or beliefs. This may happen often because both look for a health condition from different backgrounds and starting points and this communication noise may lead to inappropriate treatment plan and can decrease patient's compliance.

Focusing on the patient, who is most interested in full recovering of his/her health, quantifying subjective perception of functional status as well as healthrelated quality of life represents a challenge both for clinicians and researches, particularly in the field of rehabilitation. A patient-centered or also called clientbased assessment tool is needed and should meet the clinical needs of both the patient and the healthcare team, in such a way that it must be practical and accepted by everyone involved in a treatment context [1–17].

Client-based assessment instruments, like questionnaires, are tools suitable to comprise the domains of activity and social participation being commonly the selected instrument for the assessment of health-related quality of life. They have the ultimate goal of transforming subjective measures into objective data that can be quantified and analyzed. Self-report questionnaires are useful both for clinical and scientific research purposes once they combine efficiency, reliability, and low cost and, at the same time, meeting the necessity to quantify patient-centered clinical outcome measures.

### **3. Practical scenario: clinical use of self-report assessment tools**

Every clinical outcome measure may have five goals in order to be useful in a clinical-based scenario. The acronym that exemplifies this feature is known as SMART goals and can be visualized in **Figure 1**.

#### **3.1 Target population and purpose of the measurement tool**

One way to classify questionnaires and functional scales is by their assessment application (see **Figure 2**). In this case, they can be categorized as being generic or specific. Generic questionnaires measure overall health, within biopsychosocial approach, and are intended to be applicable across a wide spectrum of diseases, interventions, demographic, and cultural subgroups. The most famous and used instrument that encompasses this properties is the 36-item short-form health survey (SF-36), which measure health-related quality of life in two main domains of mental and physical health. On the other hand, disease-specific measures aim to assess the most important traits usually affected by a condition of interest and that can be used to determine clinical improvement or deterioration. The foot and ankle outcome score (FAOS) and the American Orthopedic Foot and Ankle Society anklehindfoot scale (AOFAS) are both examples of condition-specific measures.

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**Figure 1.**

**Figure 2.**

*SMART goals for a clinical assessment tool.*

in which the instrument is intended to be used.

*Questionnaires and functional scale classification schema.*

*Patient-Report Outcome Measures for Ankle-Related Functionality*

Another form in which self-report tools can be organized is in relation to the clinical function (see **Figure 2**). Within this context, they can be discriminative or evaluative instruments. The selection of one type over the other depends on the desired use of the instrument. Discriminative instruments, such as the Cumberland ankle instability tool (CAIT), can be used to identify individuals with a particular disorder, in this case, chronic ankle instability. Evaluative instruments are developed to follow up and measure an individual's change, thus assessing the effectiveness and outcome of treatment. The foot and ankle ability measure (FAAM) and lower extremity functional scale (LEFS) are examples of evaluative instruments. Information acquired from an evaluative instrument is useful only if evidence is available to support the interpretation of scores obtained in the specific population

*DOI: http://dx.doi.org/10.5772/intechopen.89509*

*Patient-Report Outcome Measures for Ankle-Related Functionality DOI: http://dx.doi.org/10.5772/intechopen.89509*
