gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015)

20.10. - 23.10.2015, Berlin

The role of patient expectations in traumatic orthopedic outcomes – Validation of the TEFTOM questionnaire in European and Asian countries

Meeting Abstract

  • presenting/speaker Reto Babst - Luzerner Kantonsspital, Unfallchirurgie, Luzern, Switzerland
  • Andreas Platz - Triemli Spital, Zürich, Switzerland
  • Lars Müller - Universitaetsklinikum Köln, Köln, Germany
  • Thomas Chandy - Hosmat Hospital, Karnataka, India
  • Luo Cong-Feng - Shanghai Sixth People's Hospital, Shanghai, China
  • Josep María Munoz Vives - Hospital Universitari Girona, Girona, Germany
  • Christian Fang - Queen Mary Hospital, Hong Kong, China
  • Frankie Leung - Queen Mary Hospital, Hong Kong, China

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015). Berlin, 20.-23.10.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocWI43-1223

doi: 10.3205/15dkou292, urn:nbn:de:0183-15dkou2923

Veröffentlicht: 5. Oktober 2015

© 2015 Babst et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objectives: Clinical orthopedic research lacks an instrument designed for trauma populations to assess patient expectations with regard to surgery outcomes. The aim of this study was the validation of a patient self-rating scale, the Trauma Expectation Factor Trauma Outcomes Measure (TEFTOM) questionnaire in European and Asian countries, which was previously validated in a Pan-American population.

Methods: A multicenter prospective cohort study was conducted with adults who had a distal tibia fracture or a malleolar fracture classified as AO 43 or AO44 and who were scheduled for surgery. Regression analyses were used to determine the predictive validity of TEF on one-year TOM, AAOS and FAOS. TEFTOM internal consistency was assessed by means of Cronbach's alpha [CA]; reproducibility by means of intra-class correlation coefficient [ICC]. Non-parametric correlation assessed TOM criterion validity; likelihood ratio tests and mixed-effects linear regression assessed TOM change over time. TOM responsiveness was measured using effect size (ES), standardized response mean (SRM) and minimal detectable change (MDC). Cross-cultural differences in answering the TEFTOM questionnaire were evaluated by performing a differential item functioning analysis. Patients were followed up for 12 months.

Results and Conclusion: Of a total of 199 patients enrolled, 41 patients were lost to follow up. Patients' mean age (SD) was 43.9 (15.6) years. Baseline patient TEF score showed predictive validity on 1 year TOM score (p = < 0.0001). TEF, age, race, cause of fracture and surgery procedure were prognostic factors for 1 year TOM scores. Hence, a 44 year old Asian patient who underwent ORIF with an average baseline TEF score of 33.6 points would report a 1 year TOM score of 34.4 points. For each additional TEF score point at baseline, the 1-year TOM score should increase by 0.2 points. Predictive validity of TEF on 1-year AAOS and FAOS was also shown. Both TEF and TOM showed good internal consistency at 6 months (CA = 0.89 for both). Good to excellent TEFTOM reproducibility was shown for all timepoints (ICC for TEF: 0.92-1.00; ICC for TOM: 0.96-0.99). Strong significant correlations (r ≥ 0.70) of TOM with AAOS, FAOS and SF-36 could be shown. High responsiveness of TOM scores was shown from 3 months on (standardized response mean: 1.18, 1.73 and 2.25 at 3, 6 and 12 months, respectively) as well as true changes (score change at 3, 6 and 12 months >MDC). No cultural differences in interpreting the TEFTOM questionnaire were found.

Beyond ankle fractures, TOM could be also a promising general trauma outcome and performance measure. With TEF being an indicator of patient expectation fulfilment, TEFTOM might have powerful implications on the assessment of healthcare quality within the field, supporting its validation for other fractures.