A meta-analysis of outcome rating scales in foot and ankle surgery: Is there a valid, reliable, and responsive system?

Background: Rating scales that are valid, reliable, and responsive communicate the severity of a functional problem, facilitate the accurate study of treatment modalities, and provide a common language for those involved in research. The purpose of this study was to determine which outcome rating scales are currently used in the foot and ankle literature and to identify rating scales with proven reliability, validity, and responsiveness. Method: A meta-analysis of the foot and ankle literature from 1990 to 2001 was done. All referenced rating scales were reviewed to determine if any had proven to be reliable, valid, or responsive. Results: Forty-nine different rating scales were identified. The most frequently referenced scales were the subscales of the American Orthopaedic Foot and Ankle Society (AOFAS). No rating scale was identified that demonstrated reliability, validity, and responsiveness in patients with a variety of foot and ankle conditions. Conclusions: The development of a reliable, valid, and responsive rating scale would have value not only in assessing patient outcomes but also in reporting the results of clinical studies in foot and ankle surgery.