title: Reliability and validity of the Foot and Ankle Outcome Score: a validation study from Iran Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments Psychometric Comparison of the PROMIS Physical Function CAT With the FAAM and FFI for Measuring Patient-Reported Outcomes Evaluation of the Dutch version of the Foot and Ankle Outcome Score (FAOS): responsiveness and Minimally Important Change Validation of the Turkish version of the foot and ankle outcome score Single data extraction generated more errors than double data extraction in systematic reviews. The foot function index with verbal rating scales (FFI-5pt): A clinimetric evaluation and comparison with the original FFI. Validation of the Foot and Ankle Outcome Score for Hallux Rigidus Responsiveness and Validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in End Stage Ankle Arthritis An Evaluation of Two Foot-Specific, Health-Related Quality-of-Life Measuring Instruments Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle. Publication bias in clinical research The Foot Function Index: a measure of foot pain and disability. French validation of the Foot Function Index (FFI). Validation of the Foot and Ankle Outcome Score in Adult Acquired Flatfoot Deformity Reliability and Validity of 6 Measures of Pain, Function, and Disability for Ankle Arthroplasty and Arthrodesis
abstract: The aims of this study were to culturally adapt and vali date the Persian version of Foot and Ankle Outcome Score ( FAOS ) and present data on its psychometric properties for patients with different foot and ankle problems . The Persian version of FAOS was developed after a st and ard forward – backward translation and cultural adaptation process . The sample included 93 patients with foot and ankle disorders who were asked to complete two question naires : FAOS and Short-Form 36 Health Survey ( SF-36 ) . To determine test – retest reliability , 60 r and omly chosen patients completed the FAOS again 2 to 6 days after the first administration . Test – retest reliability and internal consistency were assessed using intraclass correlation coefficient ( ICC ) and Cronbach ’s alpha , respectively . To evaluate convergent and divergent validity of FAOS compared to similar and dissimilar concepts of SF-36 , the Spearman ’s rank correlation was used . Dimensionality was determined by assessing item – subscale correlation corrected for overlap . The results of test – retest reliability show that all the FAOS subscales have a very high ICC , ranging from 0.92 to 0.96 . The minimum Cronbach ’s alpha level of 0.70 was exceeded by most subscales . The Spearman ’s correlation coefficient for convergent construct validity fell within 0.32 to 0.58 for the main hypotheses presented a priori between FAOS and SF-36 subscales . For dimensionality , the minimum Spearman ’s correlation coefficient of 0.40 was exceeded by most items . In conclusion , the results of our study show that the Persian version of FAOS seems to be suitable for Iranian patients with various foot and ankle problems especially lateral ankle sprain . Future studies are needed to establish stronger psychometric properties for patients with different foot and ankle problems Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields Background : Selecting optimal patient-reported outcome ( PRO ) instruments is critical to improving the quality of health care . The purpose of this study was to compare the reliability , responsiveness , and efficiency of three PRO measures : the Foot and Ankle Ability Measure – Activity of Daily Living subscale ( FAAM_ADL ) , the Foot Function Index 5-point verbal rating scale ( FFI-5pt ) , and the PROMIS Physical Function computerized adaptive test ( PF CAT ) . Methods : Data were aggregated from 10 clinical sites in the AOFAS ’s National Orthopaedic Foot and Ankle Research ( OFAR ) Network from 311 patients who underwent elective surgery for a disorder of the foot or ankle . Patients were administered the FAAM_ADL , FFI-5pt , and PF CAT at their preoperative visit and at 6 months after surgery . Reliabilities were evaluated using a Rasch model . Responsiveness was calculated using paired sample s t test and efficiency was recorded as number of seconds to complete the instrument . Results : Similar reliabilities were found for the three instruments . Item reliabilities for FAAM_ADL , FFI-5pt , and PF CAT were all .99 . Pearson reliabilities for FAAM_ADL , FFI-5pt , and PF CAT were .95 , .93 , and .96 , respectively . On average , patients completed the FAAM_ADL in 179 seconds , the FFI-5pt in 194 seconds , and the PF CAT in 44 seconds , ( P < .001 ) . The PF CAT and FAAM_ADL showed significant improvement ( P = .01 and P = .001 , respectively ) in patients ’ physical function after treatment ; the FFI-5pt did not show improvement . Conclusions : Overall , the PF CAT performed best in terms of reliability , responsiveness , and efficiency in this broad sample of foot and ankle patients . It can be a potential replacement for the conventional PRO measures , but further validation is needed in conjunction with the PROMIS Pain instruments . Level of Evidence : Level I , prospect i ve comparative outcome study Purpose The aim of this study was to evaluate the responsiveness of the Foot and Ankle Outcome Score ( FAOS ) and provide data on the Minimally Important Change ( MIC ) in patients 1 year after hindfoot and ankle surgery . Methods Prospect i ve pre-operative and 1 year post-operative FAOS scores were collected from 145 patients . A patient ’s global assessment and a longitudinal derived Function Change Score were used as external anchors . To assess responsiveness , effect sizes ( ES ) and St and ardized Response Means ( SRM ) were calculated and hypotheses on their magnitudes were formulated . Additional ROC curve analysis was performed , and the Area Under the Curve ( AUC ) was calculated as a measure of responsiveness . MIC values were estimated using two different methods : ( 1 ) the mean change method and ( 2 ) the optimal cut-off point of the ROC curve . Results Responsiveness was supported by confirmation of 84 % of the hypothesized ES and SRM and almost all AUCs exceeding 0.70 . MIC values ranged from 7 ( symptoms ) to 38 ( sport ) points . They varied between calculation methods and were negatively associated with baseline values . A considerable amount of MIC values did not exceed the smallest detectable change limit , indicating that the FAOS is more suitable at group level than for longitudinally following individual patients . Conclusions The FAOS demonstrated good responsiveness in patients 1 year after hindfoot and ankle surgery . Due to their wide variation , MIC estimates derived in this study should be interpreted with caution . However , these estimates can be of value to facilitate sample size calculation in future studies .Level of evidence Diagnostic study , Level The objective is to develop a Turkish version of the foot and ankle outcome score ( FAOS ) and to investigate its validity and reliability . The Turkish version of FAOS was developed after the translation and back-translation . The translated version was pretested on 20 patients with rheumatoid arthritis . Then , the Turkish FAOS was administered to 55 patients having foot and ankle problems . They were also evaluated by using the four subscales of the Turkish version of AIMS 2 , and the Turkish version of SF-36 question naire to test validity . Fifty patients filled out the FAOS for second time to determine test – retest reliability . Construct validity was investigated with use of Spearman ’s rank correlation coefficient . Test – retest reliability was assessed with use of the intraclass correlation coefficient ( ICC ) and Cronbach ’s alpha score . The psychometric properties of the Turkish FAOS were generally similar to the original FAOS . The r and om ICC for the five subscales ranged from 0.70 to 0.96 . The Cronbach ’s alpha coefficient ranged from 0.79 to 0.97 . Construct validity of the FAOS was good . The Turkish FAOS correlated with the SF-36 and AIMS 2 scales . The Turkish version of FAOS was valid and reliable instrument to assess the foot and ankle related problems . However , to assess its responsiveness further studies are needed BACKGROUND AND OBJECTIVE To conduct a pilot study to compare the frequency of errors that accompany single vs. double data extraction , compare the estimate of treatment effect derived from these methods , and compare the time requirements for these methods . METHODS Review ers were r and omized to the role of data extractor or data verifier , and were blind to the study hypothesis . The frequency of errors associated with each method of data extraction was compared using the McNemar test . The data set for each method was used to calculate an efficacy estimate by each method , using st and ard meta-analytic techniques . The time requirement for each method was compared using a paired t-test . RESULTS Single data extraction result ed in more errors than double data extraction ( relative difference : 21.7 % , P = .019 ) . There was no substantial difference between methods in effect estimates for most outcomes . The average time spent for single data extraction  was less than the average time for double data extraction ( relative difference : 36.1 % , P = .003 ) . CONCLUSION In the case that single data extraction is used in systematic review s , review ers and readers need to be mindful of the possibility for more errors and the potential impact these errors may have on effect estimates OBJECTIVE To assess the clinimetric value of the Dutch version of the Foot Function Index ( FFI ) in comparison with the original FFI using verbal rating scales ( FFI-5pt ) rather than visual analog scales ( VAS ) . METHODS A prospect i ve study was performed on 206 patients with nontraumatic forefoot complaints . Scoring , internal consistency , and construct validity of the FFI-5pt were compared with those of the original FFI , which rates all items on VAS . We also studied agreement between the scores at baseline and after one and 8 weeks and the scale scores with regard to sex , age , presence of osteoarthritis , limitation of mobility , bodily pain , and poor physical functioning ( using SF-36 ) . RESULTS Some items were not applicable ; removal of these items left 2 scales ( Pain and Disability ) with high internal consistency ( alpha = 0.88 to 0.94 ) and good agreement between both versions ( intraclass correlation coefficient 0.64 to 0.79 ) . Principal component analysis with varimax rotation using a forced 2 factor model fitted well ( 65 % explained variance ) . Test-retest reliability was high ( ICC 0.70 to 0.83 ) , while the stability over 8 weeks was lower , but still good ( ICC 0.63 to 0.71 ) . Responsiveness to change was low to moderate . However , a small number of patients reported an overall change ( 19 % ) . Scores of patients with limited mobility and poor physical health ( SF-36 ) were higher than those of patients with fewer physical problems , indicating good concurrent validity . CONCLUSION The FFI-5pt is a suitable generic measure . Its clinimetric properties are comparable with those of the original FFI . Its administration and data entry are less time consuming . However , responsiveness has to be more exactly assessed in an intervention study Background There is a clear call for improved patient-centered outcomes . The Foot and Ankle Outcome Score ( FAOS ) is a region-specific patient-reported measure that has been vali date d for a number of foot and ankle diagnoses , but not hallux rigidus . Questions / Purpose sThe aim of this study was to vali date the FAOS in patients with hallux rigidus . Methods From 2007 to 2013 , 211 patients with hallux rigidus ( HR ) were included in the study . For the construct validity portion of the study , 125 patients completed a Short-Form 12 ( SF-12 ) and FAOS survey . Forty additional HR patients were prospect ively given question naires to assess the relevance of each FAOS question as it pertained to their HR . Reliability was assessed in 36 HR patients via administration of a second FAOS an average 1 month following the first . In 55 patients , preoperative and postoperative FAOS scores were compared to determine responsiveness . Results All FAOS subscales demonstrated moderate correlation coefficients with the physical functioning , role physical , bodily pain , and physical health component scores of the SF-12 , with all subscales demonstrating poor correlation with the SF-12 mental health-related domains . Content validity was high for all FAOS scores , with the exception of the daily activities subscale . All subscales achieved acceptable test – retest reliability with correlation coefficients of ≥0.72 . Furthermore , all subscales were rated as responsive to change in postoperative patients ( p < 0.001 ) . Conclusion This study demonstrates the acceptable construct and content validity , reliability , and responsiveness of the FAOS for hallux rigidus . Due to its broad applicability and proven validation across multiple foot and ankle pathologies , the FAOS represents a patient-centered outcome measure that can be reliably used for the assessment of patients with hallux rigidus Background : We examined four commonly used scores , the SF-36 , the  Ankle Osteoarthritis Scale ( AOS )  , the  American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle Hindfoot Score  , and the  Foot Function Index ( FFI )  to determine their responsiveness and validity . Methods : Patients with end stage ankle arthritis were recruited into a prospect i ve multicenter cohort study and baseline and one year outcome scores were compared . The St and ardized Response Mean and Effect Size for the AOS , AOFAS , and FFI were calculated and the three region- or disease-specific scores were compared with the SF-36 to determine their criterion validity . Results : All four scores showed acceptable responsiveness , and when using the vali date d SF-36 as the st and ard the three region or disease specific scores all showed similar criterion validity . Conclusion : All four scores are responsive and can be considered for use in this population . The objective component of the AOFAS Ankle Hindfoot Score may make it harder to perform than the other three scores which have subjective components only , and as yet its objective component has not been shown to demonstrate reliability . We recommend use of a purely subjective score such as the Ankle Osteoarthritis Scale or Foot Function Index as the region- or disease-specific score of choice in this population . As the SF-36 shows acceptable responsiveness , using it alone could also be considered . Level of Evidence : II , Prospect i ve Comparative In the past decade ,  health-related quality -of-life ( HRQoL ) assessment  has become an important tool to measure change as a result of treatment in clinical trials . The aim of this project was to compare and contrast two foot-specific HRQoL question naires : the Foot Function Index ( FFI ) and the Foot Health Status Question naire ( FHSQ ) . To assist in this process , a quasi-experimental trial was performed to evaluate the effectiveness of foot orthoses in improving HRQoL  in people suffering from plantar fasciitis . The results from this study found that the FFI is generally less responsive to change , particularly in the domain of Activity Limitation . Nevertheless , significant improvements were found for two out of the three domains ( Pain and Disability , but not Activity Limitation ) for the FFI , as well as the overall score of FFI . In contrast , all four domains ( Pain , Function , Footwear and General Foot Health ) of the FHSQ showed significant improvement . Our experience with the question naires also revealed that certain questions in the Activity Limitation domain of the FFI can lead to inconsistent scoring , thus casting doubts over the suitability of this domain for use with patients with plantar fasciitis . Therefore , the FHSQ has several advantages when evaluating  HRQoL in patients being treated with foot orthoses for plantar fasciitis , and should be viewed as the preferred question naire 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 prospect ively 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 In a retrospective survey , 487 research projects approved by the Central Oxford Research Ethics Committee between 1984 and 1987 , were studied for evidence of publication bias . As of May , 1990 , 285 of the studies had been analysed by the investigators , and 52 % of these had been published . Studies with statistically significant results were more likely to be published than those finding no difference between the study groups ( adjusted odds ratio [ OR ] 2.32 ; 95 % confidence interval [ Cl ] 1.25 - 4.28 ) . Studies with significant results were also more likely to lead to a greater number of publications and presentations and to be published in journals with a high citation impact factor . An increased likelihood of publication was also associated with a high rating by the investigator of the importance of the study results , and with increasing sample size . The tendency towards publication bias was greater with observational and laboratory-based experimental studies ( OR = 3.79 ; 95 % Cl = 1.47 - 9.76 ) than with r and omised clinical trials ( OR = 0.84 ; 95 % Cl = 0.34 - 2.09 ) . We have confirmed the presence of publication bias in a cohort of clinical research studies . These findings suggest that conclusions based only on a review of published data should be interpreted cautiously , especially for observational studies . Improved strategies are needed to identify the results of unpublished as well as published studies A Foot Function Index ( FFI ) was developed to measure the impact of foot pathology on function in terms of pain , disability and activity restriction . The FFI is a self-administered index consisting of 23 items divided into 3 sub-scales . Both total and sub-scale scores are produced . The FFI was examined for test-retest reliability , internal consistency , and construct and criterion validity . A total of 87 patients with rheumatoid arthritis were used in the study .  Test-retest reliability of the FFI total and sub-scale scores ranged from 0.87 to 0.69 . Internal consistency ranged from 0.96 to 0.73 . With the exception of two items , factor analysis supported the construct validity of the total index and the sub-scales . Strong correlation between the FFI total and sub-scale scores and clinical measures of foot pathology supported the criterion validity of the index . The FFI should prove useful for both clinical and research purpose OBJECTIVE French validation of the Foot Function Index ( FFI ) , self- question naire design ed to evaluate rheumatoid foot according to 3 domains : pain , disability and activity restriction . METHODS The first step consisted of translation/back translation and cultural adaptation according to the vali date d methodology . The second stage was a prospect i ve validation on 53 patients with rheumatoid arthritis who filled out the FFI . The following data were collected :  pain ( Visual Analog Scale ) , disability ( Health Assessment Question naire ) and activity restrictions ( McMaster Toronto Arthritis question naire ) . A test/retest procedure was performed 15 days later . The statistical analyses focused on acceptability , internal consistency ( Cronbach 's alpha and Principal Component Analysis ) , test-retest reproducibility ( concordance coefficients ) , external validity ( correlation coefficients ) and responsiveness to change . RESULTS The FFI-F is a culturally acceptable version for French patients with rheumatoid arthritis . The Cronbach 's alpha ranged from 0.85 to 0.97 . Reproducibility was correct ( correlation coefficients>0.56 ) . External validity and responsiveness to change were good . CONCLUSION The use of a rigorous methodology allowed the validation of the FFI in the French language ( FFI-F ) . This tool can be used in routine practice and clinical research for evaluating the rheumatoid foot . The FFI-F could be used in other pathologies with foot-related functional impairments Introduction : The American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Score has been under recent scrutiny . The Foot and Ankle Outcome Score ( FAOS ) is an alternative subjective survey , assessing outcomes in 5 subscales . It is vali date d for lateral ankle instability and hallux valgus patients . The aim of our study was to vali date the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity ( AAFD ) . Methods : Patients from the authors ’ institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study . In all , 126 patients who completed the FAOS and the Short-Form 12 ( SF-12 ) on the same visit were included in the construct validity component . Correlation was deemed moderate if the Spearman ’s correlation coefficient was .4 to .7 . Content validity was assessed in 63 patients by a question naire that asked patients to rate the relevance of each FAOS question , with a score of 2 or greater considered acceptable . Reliability was measured using intraclass correlation coefficients ( ICCs ) in 41 patients who completed a second FAOS survey . In 49 patients , preoperative and postoperative FAOS scores were compared to determine responsiveness . Results : All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains . Mental health related domains showed poor correlation . Content validity was high for the Quality of Life ( QoL ; mean 2.26 ) and Sports/Recreation subscales ( mean 2.12 ) . All subscales exhibited very good test – retest reliability , with ICCs of .7 and above . Symptoms , QoL , pain , and daily activities ( ADLs ) were responsive to change in postoperative patients ( P < .05 ) . Conclusion : This study has vali date d the FAOS for AAFD with acceptable construct and content validity , reliability , and responsiveness . Given its previous validation for patients with ankle instability and hallux valgus , the additional findings in this study support its use as an alternative to less reliable outcome surveys . Level of Evidence : Level II , prospect i ve comparative study Background : Patient-reported outcome measures are increasingly used evaluating clinical care . Many measures used to assess operative hindfoot interventions vary in content , and some have not been psychometrically vali date d in this population . The purpose of this study was to compare measurement properties of  6 lower-extremity patient-reported outcome measures  , and to evaluate their reliability and validity in light of patients ’ preferences . Methods : Cross-sectional survey of 42 preoperative and 100 postoperative patients completed 6 lower-extremity outcome measures  on 2 occasions : Foot Function Index ( FFI ) , Ankle Osteoarthritis Scale ( AOS ) , patient-reported items of the  American  Orthopaedic Foot & Ankle Society Question naire ( AOFAS ) , Lower Extremity Functional Scale ( LEFS ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the Short Musculoskeletal Function Assessment ( SMFA ) , as well as measures of preference , and symptoms . Results : Internal consistency was good to excellent for all scales and subscales ( α = .84-.97 ; ICC [ 2,1 ] = .81-.96 ) . Correlations between scales ranged from .50 ( WOMACStiffness and FFIActivity Limitations ) to .92 ( LEFS and SMFAOverall , WOMACPain and AOSOverall , FFIOverall and AOFASOverall ) . Higher correlations occurred within instruments ( r = .97 AOSPain and AOSOverall ) and between similar subscales from different instruments ( r = .91 WOMACPain and AOSPain ) . Construct validity showed moderate to high correlations to global ratings of Pain , Stiffness , and difficulty performing Daily Activities . The highest correlations ( r > .75 ) occurred between Pain and AOSOverall ( r = .84 ) , stiffness and WOMACStiffness ( r = .81 ) , and Daily Activities and AOSDisability ( r = .87 ) . Patients rated instruments by preference . FFI , WOMAC , LEFS , and SMFA rated favorably for length . FFI , WOMAC , LEFS , and AOFAS rated high for underst and ability . FFI was rated by postoperative patients as most likely to capture change due to surgery . SMFA rated the best overall . Conclusions : Direct comparison of instruments revealed similarity between scales in construct validity and reliability . Patient preferences supported the use of these scales . Foot-specific instruments offered no clear advantage over lower-extremity instruments . Level of Evidence : Level II , prospect i ve comparative study
target: More evidence was available for the measurement properties of the FAOS and the FAAM , but overall evidence supporting all measurement properties is not yet sufficient .
background: Purpose In the foot and ankle literature , a wide range of patient-reported outcome measures ( PROMs ) is used , however , consensus as to which PROMs are preferred is lacking .
  Selection of a PROM is among other reasons , often based on measurement properties without considering the method ological quality of the studies that evaluate these measurement properties .
  The aim of current study was first to identify the most frequently used foot and ankle-specific PROMs in recent orthopaedic foot and ankle literature , and second to conduct a systematic review to synthesize and critically appraise the measurement properties of these PROMS .