The foot and ankle outcome score (FAOS) has been evaluated for many conditions of the foot and ankle. We evaluated its construct validity in 136 patients with osteoarthritis of the ankle, its content validity in 37 patients and its responsiveness in 39. Data were collected prospectively from the registry of patients at our institution.

All FAOS subscales were rated relevant by patients. The Pain, Activities of Daily Living, and Quality of Life subscales showed good correlation with the Physical Component score of the Short-Form-12v2. All subscales except Symptoms were responsive to change after surgery.

We concluded that the FAOS is a weak instrument for evaluating osteoarthritis of the ankle. However, some of the FAOS subscales have relative strengths that allow for its limited use while we continue to seek other satisfactory outcome instruments.

Cite this article: Bone Joint J 2015; 97-B:662–7.

Background and purpose of study: Communication between clinicians and patients forms an integral part of any treatment session. To promote positive treatment outcomes, this communication must be effective. To date, research into back pain management has tended to focus on the nature of interventions, neglecting the vital communication that co-exists.

This study aimed to measure verbal communication between clinicians and patients and identify trends in non-verbal communication. With a clearer understanding of how clinicians and patients interact, it is anticipated that this knowledge can be used to maximise health gain in subsequent treatments.

Methods: Following an assessment, the first follow-up treatment session was video recorded for 21 patients (aged 17–65 years), attending a hospital outpatient physiotherapy clinic. Patients with serious spinal pathology or those, whose first language was not English, were excluded.

Verbal communication during the interaction was measured using the validated Medical Communication Behaviour System (MCBS). Trends in non-verbal behaviour were analysed at 40-second intervals, using Heintzman’s classification (smiling, forward leaning, affirmative head nodding, touching and eye gaze). A brief semi-structured interview was undertaken with clinicians to determine the perceived effect of the presence of the video camera.

Results: In 21 treatment sessions, 2055 statements were observed, with clinicians spending approximately twice as long talking as patients. Using the MCBS categories, the majority of clinician and patient interaction related to ‘content’ behaviours (52% and 26% respectively). For the clinician, this includes history-taking, advice etc. The highest frequency of clinicians’ non-verbal behaviour was touch (n=352) and for patients, was eye gaze (n=36).

In a secondary analysis, age, gender and experience of the clinician were all shown to influence the communication that occurred.

Conclusion: Validated outcome measures can be used to analyse the complex communication that occurs between clinicians and patients with back pain. Video recording clinical sessions can provide valuable feedback for clinicians and students on their communication skills.