EFAS Score — Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS)

Martinus Richter*, Per-Henrik Agren, Jean-Luc Besse, Maria Cöster, Hakon Kofoed, Nicola Maffulli, Dieter Rosenbaum, Martijn Steultjens, Fernando Alvarez, Andrzej Boszczyk, Kris Buedts, Marco Guelfi, Henryk Liszka, Jan-Willem Louwerens, Jussi P. Repo, Elena Samaila, Michael Stephens, Angelique G.H. Witteveen

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: A scientifically sound validated foot and ankle specific score validated ab initio for different languages is missing. The aim of a project of the European Foot and Ankle Society (EFAS) was to develop, validate, and publish a new score(the EFAS-Score) for different European languages.
Methods: The EFAS Score was developed and validated in three stages: (1) item (question) identification, (2) item reduction and scale exploration, (3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0–4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre-operatively and at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory.
Results: Stage 1 resulted in 31 general and 7 sports related questions. In stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach’s Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement.No sound EFAS Sports Score could be constructed.
Conclusions: The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.
Original languageEnglish
Pages (from-to)185-204
Number of pages20
JournalFoot and Ankle Surgery
Volume24
Issue number3
Early online date23 May 2018
DOIs
Publication statusPublished - Jun 2018

Keywords

  • foot
  • ankle
  • PROM
  • foot surgery patients

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    Richter, M., Agren, P-H., Besse, J-L., Cöster, M., Kofoed, H., Maffulli, N., Rosenbaum, D., Steultjens, M., Alvarez, F., Boszczyk, A., Buedts, K., Guelfi, M., Liszka, H., Louwerens, J-W., Repo, J. P., Samaila, E., Stephens, M., & Witteveen, A. G. H. (2018). EFAS Score — Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS). Foot and Ankle Surgery, 24(3), 185-204. https://doi.org/10.1016/j.fas.2018.05.004