Cross-Cultural Adaptation and Validation of the Russian-Language Version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS)

Abstract

Background. Developed in 1994 by H. Kitaoka et al. the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS-AHS) allows to assess pain, function, deformity and alignment of the foot and ankle. There is no Russian-language AOFAS-AHS questionnaire adapted according to current standards in the scientific literature.

The aim of this paper is to perform the cross-cultural adaptation and to assess the validity of the Russian-language version of the AOFAS-AHS scale, including the evaluation of its psychometric properties.

Methods. The original English version of the AOFAS-AHS scale was translated from English into Russian by a native Russian speaker. Then the questionnaire was back-translated into English by another translator whose native language is English. The next stage was the comparison of the original and back-translated versions, followed by the presentation of a pre-final cross-culturally adapted version, which was tested on 10 patients to ensure that the questions were comprehensible. The next step was the approval of the final version and its completion by patients to be operated on the hindfoot or ankle. The printed copy of the final version of the questionnaire was completed by the patients with an interval of 3 days. Total of 44 consecutive patients were enrolled, including 18 women (41%) and 26 men (59%), with a mean age of 61.7 (32-78) years. The psychometric properties of the Russian-language version of the AOFAS-AHS questionnaire (internal consistency, retest reliability, measurement error, responsiveness, and construct validity) were assessed based on the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) principles.

Results. The mean score according to the AOFAS-AHS scale was 49.6 (min 2; max 82) out of a possible 100. The average time to complete the questionnaire was 4.2 minutes. All hypotheses formulated showed correlations of varying moderate to strong degrees. The Cronbach’s alpha coefficient was 0.76, which indicates a high level of internal consistency of the elements of the validated questionnaire. A good intra-class consistency of 0.83 was obtained, which shows a high degree of reliability of the questionnaire’s reproducibility. The ceiling and floor effects for the primary results of the questionnaires did not exceed 15%. The mean value of the Russian-language version of the AOFAS-AHS increased to 86.6 after surgical treatment. The values of standardized effect size (ES) and standardized response mean (SRM) were 5.56 and 4.83, respectively.

Conclusion. The adapted Russian-language version of the AOFAS-AHS scale showed good psychometric properties and can be recommended for assessment of the physical activity in patients with ankle and hindfoot-related pathology and can also be used for monitoring the changes during the treatment.

Keywords

hindfoot / ankle / AOFAS-AHS / reliability / cross-cultural adaptation / psychometric properties / validity

References

[1] Horwitz D.S., Richard R.D., Suk M. The reporting of functional outcome instruments in the journal of orthopaedic trauma over a 5-year period. J Orthop Trauma. 2014;28:2-5. doi: 10.1097/BOT.0000000000000026.

[2] ВИСКАРРА МОЛЛИНЕДО ЭРЛАН [и др.]. Валидизация шкал и вопросников для оценки функционального состояния и качества жизни пациентов с переломовывихами голеностопного сустава // РОССИЙСКИЕ МЕДИЦИНСКИЕ ВЕСТИ. 2011. № 2 (16). C. 61–71.

[3] Pynsent P.B. Choosing an Outcome Measure. J Bone Joint Surg. 2001;83(6):792-794. doi: 10.1302/0301-620X.83B6.11973.

[4] Alhadhoud M. [и др.]. Cross-cultural adaptation and validation of an Arabic version of the American Orthopedics Foot and Ankle Score (AOFAS). // Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. 2020. № 8 (26). C. 876–882.

[5] Hunt K.J., Hurwit D. Use of Patient-Reported Outcome Measures in Foot and Ankle Research. J Bone Joint Surg. 2013;95(16):e118(1-9). doi: 10.2106/JBJS.L.01476.

[6] Amri M. I. [и др.]. Cross-cultural adaptation and validation of the Arabic version of the foot function index in patients with chronic lateral ankle instability // Journal of Foot and Ankle Research. 2022. № 1 (15). C. 21.

[7] Kitaoka H.B., Alexander I.J., Adelaar R.S., Nunley J.A., Myerson M.S., Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15(7):349-353. doi: 10.1177/107110079401500701.

[8] Analay Akbaba Y., Celik D., Ogut R. T. Translation, Cross-Cultural Adaptation, Reliability, and Validity of Turkish Version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale // The Journal of Foot and Ankle Surgery. 2016. № 6 (55). C. 1139–1142.

[9] Madeley N.J., Wing K.J., Topliss C., Penner M.J., Glazebrook M.A., Younger A.S. Responsiveness and Validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int. 2012;33(1):57-63. doi: 10.3113/FAI.2012.0057.

[10] Beaton D. E. [и др.]. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures // Spine. 2000. № 24 (25). C. 3186–3191.

[11] Ibrahim T., Beiri A., Azzabi M., Best A.J., Taylor G.J., Menon D.K. Reliability and Validity of the Subjective Component of the American Orthopaedic Foot and Ankle Society Clinical Rating Scales. J Foot Ankle Surg. 2007;46(2):65-74. doi: 10.1053/j.jfas.2006.12.002.

[12] Boer A. S. de [и др.]. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale; translation and validation of the Dutch language version for ankle fractures // BMJ Open. 2017. № 8 (7). C. e017040.

[13] Beaton D.E., Bombardier C., Guillemin F., Ferraz M.B. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine (Phila Pa 1976). 2000;25(24):3186-3191. doi: 10.1097/00007632-200012150-00014.

[14] Cöster M. C. [и др.]. Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) // Foot & Ankle International. 2014. № 10 (35). C. 1031–1036.

[15] Amri M.I., Alzhrani M.M., Alanazi A.D., Alqahtani M.M., Kashoo F.Z. Cross-cultural adaptation and validation of the Arabic version of the foot function index in patients with chronic lateral ankle instability. J Foot Ankle Res. 2022;15(1):21. doi: 10.1186/s13047-022-00527-6.

[16] Deshpande P. R. [и др.]. Patient-reported outcomes: A new era in clinical research. // Perspectives in clinical research. 2011. № 4 (2). C. 137–44.

[17] Alhadhoud M., Alsiri N., Alsaffar M., Glazebrook M. Cross-cultural adaptation and validation of an Arabic version of the American Orthopedics Foot and Ankle Score (AOFAS). Foot Ankle Surg. 2020;26(8):876-882. doi: 10.1016/j.fas.2019.11.001.

[18] Erichsen J. [и др.]. Danish Language Version of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) in Patients with Ankle-Related Fractures // The Journal of Foot and Ankle Surgery. 2020. № 4 (59). C. 657–663.

[19] Rodrigues R.C., Masiero D., Mizusaki J.M., Imoto A.M., Peccin M.S., Cohen M. et al. Translation, cultural adaptation and validity of the “American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale”. Acta Ortop Bras. 2008;16(2):107-111. doi: 10.1590/S1413-78522008000200009.

[20] Horwitz D. S., Richard R. D., Suk M. The Reporting of Functional Outcome Instruments in the Journal of Orthopaedic Trauma Over a 5-Year Period // Journal of Orthopaedic Trauma. 2014. № 1 (28). C. 2–5.

[21] de Boer A.S., Tjioe R.J.C., Van der Sijde F., Meuffels D.E., den Hoed P.T., Van der Vlies C.H. et al. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale; translation and validation of the Dutch language version for ankle fractures. BMJ Open. 2017;7(8):e017040. doi: 10.1136/bmjopen-2017-017040.

[22] Hunt K. J., Hurwit D. Use of Patient-Reported Outcome Measures in Foot and Ankle Research // The Journal of Bone & Joint Surgery. 2013. № 16 (95). C. e118.

[23] Leigheb M., Janicka P., Andorno S., Marcuzzi A., Magnani C., Grassi F. Italian translation, cultural adaptation and validation of the “American Orthopaedic Foot and Ankle Society’s (AOFAS) ankle-hindfoot scale”. Acta Biomed. 2016;87(1):38-45.

[24] Husted J. A. [и др.]. Methods for assessing responsiveness: a critical review and recommendations. // Journal of clinical epidemiology. 2000. № 5 (53). C. 459–68.

[25] Kostuj T., Krummenauer F., Schaper K., Stief F., Zettersten K., Baums M.H. et al. Analysis of agreement between the German translation of the American Foot and Ankle Society’s Ankle and Hindfoot Scale (AOFAS-AHS) and the Foot Function Index in its validated German translation by Naal et al. (FFI-D). Arch Orthop Trauma Surg. 2014;134(9):1205-1210. doi: 10.1007/s00402-014-2046-0.

[26] Ibrahim T. [и др.]. Reliability and Validity of the Subjective Component of the American Orthopaedic Foot and Ankle Society Clinical Rating Scales // The Journal of Foot and Ankle Surgery. 2007. № 2 (46). C. 65–74.

[27] Sayyed-Hosseinian S.H., Hassankhani G.G., Bagheri F., Alavi N., Shojaie B., Mousavian A. Validation of the Persian Version of the American Orthopedic Foot and Ankle Society Score (AOFAS) Questionnaire. Arch Bone Jt Surg. 2018;6(3):233-239.

[28] Kitaoka H. B. [и др.]. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. // Foot & ankle international. 1994. № 7 (15). C. 349–53.

[29] Analay Akbaba Y., Celik D., Ogut R.T. Translation, Cross-Cultural Adaptation, Reliability, and Validity of Turkish Version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. J Foot Ankle Surg. 2016;55(6):1139-1142. doi: 10.1053/j.jfas.2016.06.001.

[30] Kostuj T. [и др.]. Analysis of agreement between the German translation of the American Foot and Ankle Society’s Ankle and Hindfoot Scale (AOFAS-AHS) and the Foot Function Index in its validated German translation by Naal et al. (FFI-D) // Archives of Orthopaedic and Trauma Surgery. 2014. № 9 (134). C. 1205–1210.

[31] Cöster M.C., Rosengren B.E., Bremander A., Brudin L., Karlsson M.K. Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS). Foot Ankle Int. 2014;35(10):1031-1036. doi: 10.1177/1071100714543647.

[32] Leigheb M. [и др.]. Italian translation, cultural adaptation and validation of the «American Orthopaedic Foot and Ankle Society’s (AOFAS) ankle-hindfoot scale». // Acta bio-medica : Atenei Parmensis. 2016. № 1 (87). C. 38–45.

[33] Вискарра Моллинедо Э., Зимина Э.В., Гурина С.А., Ярыгин Н.В. Валидизация шкал и вопросников для оценки функционального состояния и качества жизни пациентов с переломовывихами голеностопного сустава. Российские медицинские вести. 2011;16(2):61-71. Viskarra Mollinedo E., Zimina E.V., Gurina S.A., Yarygin N.V. Scale validation and questionnaires for assessment of functional state and quality of life of patients with ankle joint fractures. Rossijskie medicinskie vesti. 2011;16(2):61-71.

[34] Lieshout E. M. M. Van [и др.]. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version. // BMJ open. 2017. № 2 (7). C. e012884.

[35] Mokkink L.B., Terwee C.B., Patrick D.L., Alonso J., Stratford P.W., Knol D.L. et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539-549. doi: 10.1007/s11136-010-9606-8.

[36] Madeley N. J. [и др.]. Responsiveness and Validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in End Stage Ankle Arthritis // Foot & Ankle International. 2012. № 1 (33). C. 57–63.

[37] Terwee C.B., Bot S.D.M., de Boer M.R., van der Windt D.A.W.M., Knol D.L., Dekker J. et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. doi: 10.1016/j.jclinepi.2006.03.012.

[38] Mokkink L. B. [и др.]. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study // Quality of Life Research. 2010. № 4 (19). C. 539–549.

[39] Tavakol M., Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53-55. doi: 10.5116/ijme.4dfb.8dfd.

[40] Pynsent P. B. Choosing an Outcome Measure // The Journal of Bone and Joint Surgery. 2001. № 6 (83). C. 792–794.

[41] Husted J.A., Cook R.J., Farewell V.T., Gladman D.D. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000;53(5): 459-468. doi: 10.1016/s0895-4356(99)00206-1.

[42] Rodrigues R. C. [и др.]. Translation, cultural adaptation and validity of the «American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale». // Acta Ortopédica Brasileira. 2008. № 2 (16). C. 107–111.

[43] Deshpande P.R., Rajan S., Sudeepthi B.L., Abdul Nazir C.P. Patient-reported outcomes: A new era in clinical research. Perspect Clin Res. 2011;2(4): 137-144. doi: 10.4103/2229-3485.86879.

[44] Sayyed-Hosseinian S.-H. [и др.]. Validation of the Persian Version of the American Orthopedic Foot and Ankle Society Score (AOFAS) Questionnaire. // The archives of bone and joint surgery. 2018. № 3 (6). C. 233–239.

[45] Van Lieshout E.M.M., De Boer A.S., Meuffels D.E,. Den Hoed P.T,. Van der Vlies C.H., Tuinebreijer W.E. et al. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version. BMJ Open. 2017;7(2):e012884. doi: 10.1136/bmjopen-2016-012884.

[46] Tavakol M., Dennick R. Making sense of Cronbach’s alpha. // International journal of medical education. 2011. (2). C. 53–55.

[47] Erichsen J., Froberg L., Viberg B., Damborg F., Jensen C. Danish Language Version of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) in Patients with Ankle-Related Fractures. J Foot Ankle Surg. 2020;59(4):657-663. doi: 10.1053/j.jfas.2019.08.027.

[48] Terwee C. B. [и др.]. Quality criteria were proposed for measurement properties of health status questionnaires. // Journal of clinical epidemiology. 2007. № 1 (60). C. 34–42.

[49] Vosoughi A.R., Roustaei N., Mahdaviazad H. American Orthopaedic Foot and Ankle Society ankle–hindfoot scale: A cross-cultural adaptation and validation study from Iran. Foot Ankle Surg. 2018;24(3):219-223. doi: 10.1016/j.fas.2017.02.007.

[50] Vosoughi A. R., Roustaei N., Mahdaviazad H. American Orthopaedic Foot and Ankle Society ankle–hindfoot scale: A cross-cultural adaptation and validation study from Iran // Foot and Ankle Surgery. 2018. № 3 (24). C. 219–223.

RIGHTS & PERMISSIONS

Eco-Vector