Nguyen Michael Quan, Iversen Marjolein Memelink, Harboe Knut, Dalen Ingvild, Paulsen Aksel
Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway.
J Patient Rep Outcomes. 2025 Feb 5;9(1):14. doi: 10.1186/s41687-025-00845-w.
Ankle fracture patients are a heterogenous group with differences in age, sex, fracture morphology, and treatment provided. With the increased focus on patient-centered treatment, patient-reported outcome measures (PROMs) are increasingly adopted by clinicians to facilitate best clinical practice. The Manchester Oxford Foot Questionnaire (MOXFQ) has demonstrated good measurement properties when used in patients with foot or ankle disease. The PROM has three domains: (1) Pain; (2) Walking/Standing; and (3) Social Interaction. One study found sufficient content validity for the Pain and Walking/Standing domains when used in the evaluation of ankle fracture patients. Another validation study demonstrated acceptable structural validity and reliability for the MOXFQ in ankle fracture patients 12 weeks after injury. The aim of this study is to assess the structural validity and reliability of the Norwegian version of the MOXFQ in the context of an ankle fracture patients one year after surgery and provide patient acceptable symptom state (PASS) estimates.
A pragmatic cross-sectional study design was used to collect the one-year MOXFQ follow-up data from patients surgically treated for an ankle fracture in the period 2017 to 2020 at (Stavanger University Hospital). The structural validity and internal consistency were assessed using confirmatory factor analysis. A separate test-retest study including patients at least one year since ankle surgery was used in the assessment of reliability and measurement error.
A confirmatory factor analysis of the three-factor model of the MOXFQ had a good model fit (TLI 0.94; CFI 0.95; RMSEA 0.094; SRMR 0.039). However, the measurement model demonstrated poor discriminant validity of the three factors. A unidimensional model of the 16 items had worse model fit, while a second-order factor model demonstrated strong factor loadings for a second-order factor. A bi-factor model also revealed a strong general factor but also unique variance in the Pain and Social Interaction domain. The domains had good internal consistency (McDonald's omega 0.80 to 0.95) and test-retest reliability (ICC 0.80 to 0.92). The standard errors of measurements for the three domains were between 6.5 and 7.5, and 5.5 for the MOXFQ-Index (scale 0 to 100). PASS estimates for the (sub)scales were: Pain 45; Walking/Standing 39; Social Interaction 19; and MOXFQ-Index 34.
The MOXFQ with three domains demonstrated sufficient structural validity and reliability when used in the evaluation of a one-year postoperative ankle fracture population. Reporting the scores of the Pain and Walking/Standing domains was best supported.
踝关节骨折患者是一个异质性群体，在年龄、性别、骨折形态和接受的治疗方面存在差异。随着对以患者为中心的治疗的关注度不断提高，临床医生越来越多地采用患者报告结局测量指标（PROMs）来促进最佳临床实践。曼彻斯特牛津足部问卷（MOXFQ）在用于足部或踝关节疾病患者时已显示出良好的测量特性。该PROM有三个领域：（1）疼痛；（2）行走/站立；（3）社交互动。一项研究发现，在评估踝关节骨折患者时，疼痛和行走/站立领域具有足够的内容效度。另一项验证研究表明，MOXFQ在踝关节骨折患者受伤12周后具有可接受的结构效度和信度。本研究的目的是评估挪威版MOXFQ在踝关节骨折患者术后一年的结构效度和信度，并提供患者可接受症状状态（PASS）估计值。
采用实用的横断面研究设计，收集2017年至2020年期间在（斯塔万格大学医院）接受踝关节骨折手术治疗的患者的MOXFQ一年随访数据。使用验证性因子分析评估结构效度和内部一致性。一项单独的重测研究包括踝关节手术后至少一年的患者，用于评估信度和测量误差。
对MOXFQ三因素模型的验证性因子分析显示模型拟合良好（TLI 0.94；CFI 0.95；RMSEA 0.094；SRMR 0.039）。然而，测量模型显示这三个因素的区分效度较差。16个条目的单维模型拟合更差，而二阶因子模型显示二阶因子的因子载荷很强。双因素模型也显示出一个很强的一般因子，但在疼痛和社交互动领域也存在独特的方差。这些领域具有良好的内部一致性（麦克唐纳ω系数0.80至0.95）和重测信度（ICC 0.80至0.92）。三个领域的测量标准误在6.5至7.5之间，MOXFQ指数的测量标准误为5.5（量表0至100）。（子）量表的PASS估计值为：疼痛45；行走/站立39；社交互动19；MOXFQ指数34。
当用于评估踝关节骨折患者术后一年时，具有三个领域的MOXFQ显示出足够的结构效度和信度。对疼痛和行走/站立领域得分的报告得到了最好的支持。
