Cross-cultural adaptation and validation of a Spanish version of the self-administered foot evaluation questionnaire (SAFE-Q)

Orthopedic foot and ankle pathologies are quite common [[1], [2], [3]], and their impact on daily life can be assessed using several methods. Treatment outcomes can be assessed with a clinician- or patient-reported questionnaires. The American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Systems are the most widely used by clinicians [4,5]. However, they include physical exam parameters that have shown poor inter-observer and intraobserver reliability, and the inability to self-administration by patients increases the risk of bias [6]. Self-reported questionnaires are commonly used [1,7,8], of which patient-reported outcome measures (PROMs) are used to assess health status changes over time from the perspective of the patient [9,10]. There are four basic types of patient-based outcome instruments: generic, disease-specific, region-specific, and patient-specific. A region-specific instrument is used for diseases that affect a particular site [9]. The Manchester-Oxford foot questionnaire (MOXFQ) is a PROM for health-related quality of life assessment in patients undergoing foot or ankle surgery [2]. The MOXFQ exhibits good psychometric qualities [11] and is validated for use in Spanish [2]. However, it does not comprise a section regarding shoe usage despite its association with pain and foot disorders [12,13].

The Japanese Society for Surgery of the Foot developed a region-specific PROM for individuals with foot and ankle-related pathologies in 2013: the self-administered foot evaluation questionnaire (SAFE-Q), published in English [9]. The SAFE-Q consists of 34 items among the following five subscales: pain and pain-related (PP), physical functioning and daily living (PF), social functioning (SF), shoe-related (SH), and general health and well-being (GH). In addition, the instrument has nine optional items to derive a sports ability score [14].

The use of a PROM in a language other than English requires accurate translation along with cultural adaptation to preserve content validity and psychometric properties [2,15]. “Cross-cultural adaptation” ensures consistency in content and validity between the original and translated versions of the questionnaire [15], thereby allowing data comparisons among regions with different spoken languages and cultural roots [1,2,15].

Spanish is the mother tongue of more than 450 million people globally. However, a Spanish version of the SAFE-Q has not been created yet. The creation of a Spanish version of a valid and reliable SAFE-Q is clinically significant. Health practitioners can use the SAFE-Q as a complementary method to assess the interventions performed for ankle and foot disorders among native Spanish speakers. This may improve the treatment outcomes through an improved assessment by removing any possible language barriers. Therefore, this study aimed to develop a Spanish translation of the questionnaire with cross-cultural adaptation and content validation.

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