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AOFAS Position Statement Regarding the Future of the AOFAS Clinical Rating Systems

Validated outcome measures are useful tools in orthopaedic clinical practice and research for evaluating the effect of a treatment intervention on patient status. There are a wide range of measures used in the evaluation of foot and ankle surgery and attempts to consolidate and standardize them are under way. Unfortunately, not all outcome measures have shown measurement properties that meet recommended quality criteria.13 This makes choosing an appropriate outcome measure all the more difficult and, at this point in time, puts the onus on the researcher to carefully review the evidence for a particular measure. Despite the limited evidence supporting the validity of the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Systems7 and the interpretation of their scores, they continue to be among the most commonly used measures selected by researchers.1,2,4,6,9,11,13,17 Based on the basic algorithm used by the earliest orthopaedic outcome measures, the Iowa Hip Score8 and its successor the Harris Hip Score,5 the framework for the AOFAS Clinical Rating Systems combines physical examination criteria with self-reported pain and function items.11 When a clinical examination is part of a scoring system, this introduces a high risk of inter-observer variability as different examiners may have different measuring techniques.14 This can affect the reliability of a score, i.e., its measurement consistency. Intra-observer and inter-observer relations have not yet been evaluated for the AOFAS Clinical