Transcultural adaptation and psychometric properties of the Korean Version of the Foot and Ankle Outcome Score(FAOS)

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1 Transcultural adaptation and psychometric properties of the Korean Version of the Foot and Ankle Outcome Score(FAOS) Kyoung Min Lee*, Chin Youb Chung*, Soon Sun Kwon**, Ki Hyuk Sung, Seung Yeol Lee*, Sung Hun Won*, Damian J. Lee, DDS, Seoryong C. Lee, and Moon Seok Park* *Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea **Biomedical Research Institute, Seoul National University Bundang Hospital, Kyungki, Korea Department of Orthopaedic Surgery, Kwandong University Myungji Hospital, Kyungki, Korea Department of Restorative Dentistry, University of Illinois at Chicago, College of Dentistry, IL, USA Department of Educational Psychology, University of Illinois at Chicago, College of Education, IL, USA

2 Introduction Psychometric questionnaires Subjective symptoms Social function Quality of life Improvement following the treatment Foot and Ankle Outcome Score(FAOS) (five subscales) Symptom Pain Function in daily living Function in sport and recreation Foot and ankle-related quality of life

3 Purpose of study To translate and transculturally adapt the English version of FAOS into Korean To test psychometric properties of the Korean FAOS Internal consistency Test-retest reliability Convergent validity

4 Forward translation Two persons (native Korean speakers fluent in English) separately translated original version into Korean Panel discussion T1 + T2 => T12

5 Back translation Reconciled Korean version of FAOS => Back translated into English Two bilingual native English speakers (Korean-American) 1 st Back translator No medical background 2 nd Back translator Medical background

6 Harmonization Reviewed by consensus committee Scoring the equivalence Not equivalent at all (0) Mildly equivalent (1) Moderately equivalent (2) Nearly equivalent (3) Totally equivalent (4) Average equivalence score of less than 3 were discussed and revised

7 Participants Consecutive patients VAS score Excluded patients Neuromuscular problems Congenital deformities Cognitive disorder Test-retest reliability : 21 patients, 3 weeks later

8 Testing the psychometric properties of the final version of Korean FAOS Internal consistency, test-retest reliability, Convergent validity Dimensionality & Component analysis Floor or ceiling effect

9 Summary of data Total no. of patients 294 Mean age (years) 48.1 (SD 14.5) Gender (M/F) 98:196 Diagnosis (no. of patients) Plantar fascitis 94 (32.0%) Ankle instability 88 (29.9%) Hallux valgus 61 (20.7%) Ankle osteoarthritis 17 (5.8%) Achilles tendinitis 13 (4.4%) Diabetic foot 12 (4.1%) Other diseases 9 (3.1%) FAOS subscale scores Symptoms 74.2 (SD 17.3) Pain 65.4 (SD 19.5) Function in daily living 79.9 (SD 18.9) Function in sports and recreation 61.5 (SD26.3) Quality of life 41.6 (SD 27.0)

10 Translation and transcultural adaptation Q3: How much are you troubled with lack of confidence in your foot/ankle? Two back translation Are you afraid to move your foot/ankle? Are you afraid to use your foot/ankle? Final Korean version of FAOS How much are you troubled with being unconfident of your foot/ankle?

11 Internal consistency of the five subscales of the Korean FAOS FAOS subscale (number of items) Cronbach s alpha Symptoms (7) Pain (9) Function in daily living (17) Function in sports and recreation (5) Quality of life (4) 0.615

12 Test-retest reliability of each subscale FAOS subscale (number of items) Baseline median (IQR) (n=21) Retest median (IQR) (n=21) ICC (95 % CI) Symptoms (7) 75.0 ( ) 75.0 ( ) 0.833(0.638 to 0.928) Pain (9) 66.7 ( ) 69.4 ( ) 0.785(0.545 to 0.906) Function in daily living (17) 83.8 ( ) 80.9 ( ) 0.851(0.670 to 0.936) Function in sports and recreation (5) 65.0 ( ) 55.0 ( ) 0.774(0.525 to 0.901) Quality of life (4) 43.8 ( ) 43.8 ( ) 0.718(0.420 to 0.876)

13 Convergent validity of each subscale with pain VAS FAOS subscale (number of items) Correlation coefficient (γ) p value Symptoms (7) <0.001 Pain (9) <0.001 Function in daily living (17) <0.001 Function in sports and recreation (5) <0.001 Quality of life (4) <0.001

14 Dimensionality & Component analysis The seven-factor solution of the Korean FAOS explained 69.83% of variance No floor or ceiling effect Of the respondents 7.6, 3.0, 10.9, 8.2, and 1.5% showed the highest score Of the respondents 0,0,0,2.7 and 2.7% showed the lowest score

15 Conclusions The Korean version of FAOS was shown to have relevant internal consistency, test-retest reliability. Some minor revision might be needed to enhance the internal consistency of Q subscale and reduce the redundancy of ADL subscale We suggest that Q1 be modified for internal consistency of Q subscale and some questions be eliminated to reduce redundancy in ADL subscale

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