Fish skin grafts versus standard of care on wound healing of chronic diabetic foot ulcers: A systematic review and meta-analysis.

INTRODUCTION: This study will explore the effectiveness of fish skin grafts (FSG) in ulcer healing in diabetic foot disease compared to standard of care (SOC). METHODS: The systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. The electronic databases of PubMed, EMBASE, and Web of Science (WoS) internet were searched for the outcome rate of complete ulcer healing. The risk of bias assessment was conducted using the tool recommended by the Cochrane Collaboration. Statistical analysis included the individual and combined result of the studies, heterogeneity test, the effect size, sensitivity analysis, and publication bias tests. RESULTS: Five randomised controlled trials (RCTs) with a total of 411 patients were included in this study. This meta-analysis showed a higher rate of complete ulcer healing in groups receiving fish skin grafts (OR = 3.34, 95% CI 2.14-5.20, p < 0.01, I2 = 0%) compared to control groups. CONCLUSION: Fish skin grafts have been shown to be more effective for achieving complete ulcer healing compared to current conventional treatments in diabetic foot disease.

Predictive factors for foot pain in the adult population.

BACKGROUND: Foot pain has been associated to factors like: fat, body mass index, age increased, female gender and the presence of pathologies. Although evidence is limited. The purpose is to determine the predictive factors for foot pain in the adult population. METHODS: From January to December 2021, 457 patients were > 18 years, gave signed informed consent to take part to this cross sectional study. All completed demographic data and various questionnaires related to pain: Foot Function Index, EuroQoL-5D and Visual Analogue Scale (foot pain). Anthropometric measurements were obtained using McPoil platform and foot posture was assessed by the Foot Posture Index (FPI). To determine whether a volume change is a predictive factor for foot pain, a parameter was established: the volumetric index for footwear (VIF). Factors linked to the presence of pain, including the considered VIF variables, were analyzed through multivariable logistic regression. RESULTS: Among the study population, 40.7% were male and 59.3% female. The mean age of 39.06 years and a body mass index of 25.58 Kg/cm2. The logistic regression model had a classification capability of 72.4%, a sensitivity of 72.3% and a specificity of 73%, in which, the predictors considered were the variables found to have a significant association with FFI-pain > 45 points,, showed that younger women, with a higher BMI, higher values of right FPI (pronation), poorer overall perceived health and with problems in walking were more likely to experience foot pain. CONCLUSION: Predictive factors for foot pain in the adult population include gender, age, Body Mass Index, FPI on the right foot, perceived health and mobility. Clinical implication, the presented measure aids physicians in assessing their patients´ foot pain likelihood.

Ultrasound Strain Elastography Reliability in the Assessment of the Plantar Fascia and Its Relationship with the Plantar Thickness in Healthy Adults: An Intra and Interobserver Reliability Study in Novice Evaluators.

PURPOSE: This study was aimed at verifying both the intraobserver and interobserver reliability of measuring plantar fascia stiffness for a given image in healthy active adults. METHODOLOGY: This study is reported following the Guidelines of Reporting Reliability and Agreement Studies. A total of 20 plantar fascia from healthy volunteers were analyzed. The thickness of the plantar fascia was measured vertically from the anterior edge of the inferior calcaneal border to the inferior border of the plantar fascia and the ultrasound elastography measurement was taken at the calcaneal insertion of the plantar fascia with the region of interest one centimeter away from the insertion. RESULTS: The ultrasound strain elastography measurements: the right intraobserver 1 showed an ICC value of 0.9 and the left intraobserver 1 showed an ICC value of 0.78, while the right intraobserver 2 showed an ICC value of 0.91 and the left intraobserver 2 showed an ICC value of 0.83. Interobserver measurements showed excellent reliability with a right ICC value of 0.8 and a left ICC value of 0.9 for the plantar fascia thickness measurements. DISCUSSION: The results of this study showed a strong correlation between left and right plantar fascia thickness. The intraobserver reliability was excellent for both plantar fascia ultrasound strain elastography and thickness measurements, with interobserver measurements showing excellent reliability.

Systematic review of the methodological quality of patient-reported outcome measure for patients with chronic ankle instability.

OBJETIVE: Chronic ankle instability is generally associated with ankle sprain. Its consequences can be measured by means of patient-reported outcome measures (PROMs). The aim of this review is to identify the PROMs specifically available for chronic ankle instability and to evaluate their methodological quality and that of the cross-cultural adaptations made. DATA SOURCES: Papers were retrieved from PubMed, Embase, Scopus and Google Scholar databases, with no time limit applied, based on the following inclusion criteria: (1) type of participants: patients with chronic ankle instability, over 18 years of age; (2)type of study: those specifically focused on this pathology, using PROMs specific to chronic ankle instability and published in English; (3) type of outcome: measurement properties based on COSMIN criteria in patient-reported outcomes associated with chronic ankle instability. METHODS: This systematic review, following the COSMIN checklist, was conducted to determine the methodological quality of PROMs specific to foot and ankle pathologies, for patients presenting chronic ankle instability. RESULTS: Of the 576 studies identified in the initial search, 34 were included in the final analysis of measurement properties. Four - the Ankle Instability Instrument, the Chronic Ankle Instability Scale, the Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability - were original questionnaires, and the remaining 30 were cross-cultural adaptations. CONCLUSION: The Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability questionnaires can be useful instruments for evaluating chronic ankle instability, both in patients with this condition and also in non-pathological patients.

Transcultural adaptation and validation of the Spanish version of the Global Pain Scale.

The aim of this study was to perform a cross-cultural adaption and validation of the Global Pain Scale (GPS) to produce a Spanish-language version (GPS-Sp) and to determine the psychometric properties of this instrument. The GPS was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. The initial study population was composed of 384 patients recruited from February to May 2021. All participants were aged at least 18 years and were currently experiencing pain. All gave signed informed consent to take part and completed the Brief Inventory-Sp and GPS-Spain questionnaires. Cronbach's É‘ and test/retest reliability values were calculated and floor/ceiling effects analyzed. Construct validity was assessed by confirmatory factor analysis (CFA). The 370 patients included in the final analysis presented the following characteristics: 36.2% were male and 63.8% were female; mean age 42.6 (19-88) years; mean body mass index 24.99. Internal consistency was good. The Cronbach's ɑ for GPS-Sp was 0.86 and the intraclass correlation coefficient was 0.94 (95% CI; 0.87-0.97). Five main explanatory factors were identified by CFA, which produced the following values: RMSEA = 0.057; CFI = 0.807; GFI = 0.809; NFI = 0.763. No floor/ceiling effect was observed. The GPS-Sp is a valid, reliable and sensitive instrument for assessing pain in a Spanish-speaking population and could facilitate pain relief in this population.

Transcultural Adaptation and Validation of the Spanish Version of the Visual Analogue Scale for the Foot and Ankle (VASFA).

BACKGROUND: The main aim of this study is to perform a cross-cultural adaptation and validation of the Visual Analogue Scale for the Foot and Ankle (VASFA) questionnaire, creating a Spanish-language version (VASFA-Sp), and to determine the measurement properties of this instrument. METHODS: VASFA was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The study sample was composed of 228 participants who were recruited from February to May 2022. All were at least 18 years old, gave signed informed consent to take part and properly completed the Foot and Ankle Ability Measures-Sp and VASFA-Sp questionnaires. Cronbach's alpha and test/re-test reliability values were calculated. Structural validity was assessed via exploratory factor analysis. RESULTS: The 228 patients included in the final analysis presented the following characteristics: 35.53% were male and 64.47% were female; the mean age was 35.95 (18-81) years; and the mean body mass index was 23.79. Internal consistency was excellent. The Cronbach's alpha for VASFA-Sp was 0.96 and the intraclass correlation coefficient was 0.932 (95% CI; 0.84 to 0.97). Exploratory factor analysis identified one main factor. CONCLUSIONS: VASFA-Sp is a reliable, valid and sensitive questionnaire that is suitable for measuring perceived foot and ankle function impairment in a Spanish-speaking population.

The Influence of Stud Characteristics of Football Boots Regarding Player Injuries.

BACKGROUND: the main aim of this study was to analyze the relationship between sole pattern parameters of football boots with the frequency of injuries that occur in semiprofessional and amateur footballers. METHODS: The study sample was composed of 77 male football players. All were at least 18 years old, played at least 10 h per week, gave signed informed consent to take part and properly completed the Visual Analogue Scale. This study analysed data from each player's medical history, including age, injuries, years of practice, field type and surface condition information. RESULTS: The visual analogic score in semiprofessional players was higher (2.05 ± 2.43) than in amateur players (1.00 ± 1.1). A total of 141 lesions were collected, equivalent to 1.81 injuries for each football player studied (n = 77). The result of the ROC curve indicated that the player's years of practice could predict significantly (p < 0.05) the presence of lower limb injuries, with an area under the curve of 0.714. CONCLUSIONS: This study described the predictive capacity of sole pattern characteristics concerning lower limb injuries in amateur and semiprofessional footballers. Football boot variables associated with the number of studs were associated with foot and ankle overload injuries.

Transcultural adaptation and validation of the Spanish-French versions of the Self-reported Foot and Ankle Score (SEFAS).

OBJECTIVE: The study aim was to cross-culturally adapt the Self-reported Foot and Ankle Score (SEFAS) into Spanish and French-language versions, to validate them and to evaluate their psychometric properties. METHODS: The cross-cultural translation from the original SEFAS into French and Spanish was performed in accordance with the guidelines of the ISPOR. The participants were recruited from some private healthcare institutions in France and Sapin, from June to August 2019. The following inclusion criteria were applied: aged at least 18 years, with foot and/or ankle deformity, had a history of subtalar and/or ankle and/or talonavicular or hindfoot pain, did not make daily use of walking aids, and were able to achieve the normal range of motions in the ankle, subtalar and midtarsal joints. All patients gave signed informed consent and completed the SF-36 and SEFAS questionnaires in the Spanish or French version. RESULTS: The analysis was based on 319 participants. Internal consistency was excellent (Cronbach's alpha values of 0.94 for the Spanish version and 0.88 for the French version). No floor/ceiling effect was observed in any item, in either version. CONCLUSION: The Spanish and French versions of SEFAS are valid, reliable instruments for evaluating foot and ankle pain and function.IMPLICATIONS FOR REHABILITATIONSelf-report questionnaires specific to patients with rheumatoid arthritis are needed to assess the degree of pain, disability, and disability caused by foot problems.The Spanish and French versions of SEFAS show the necessary psychometric characteristics.Each version provides a valid, reliable tool ensuring the correct evaluation of pain, function and limitation of function in the foot and/or ankle in the target population.

Transcultural adaptation and validation of the Spanish version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Sp).

OBJECTIVE: The study aim was to cross-culturally adapt the Identification of Functional Ankle Instability (IdFAI) into a Spanish-language version (IdFAI-Sp), which would then be validated and its psychometric properties evaluated for use in possible cases of ankle instability. METHODS: The cross-cultural adaptation was performed following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Pearson correlations were calculated to assess the convergent validity between IdFAI and the Cumberland Ankle Instability Tool. Cronbach's alpha and test re-test reliability values were calculated and floor/ceiling effects analysed. Construct validity was assessed by confirmatory factor analysis (CFA). RESULTS: The study population was composed of 110 participants, with a mean age of 40.49 years (10.43) and of whom 62 (56.36%) were female. Good test-retest results were obtained, with an intraclass correlation coefficient of 0.85 (ICC2,1: 95% CI: 0.82 - 0.88). The structure matrix was examined by CFA, which revealed a three-factor solution that accounted for 79.89% of the variance. The IdFAI-Sp obtained an excellent fit (RMSEA 0.068, GFI 0.94, CFI 0.98 and NFI 0.97). CONCLUSIONS: This study validates the IdFAI-Sp questionnaire, corroborating its value to researchers and medical professionals as a self-reported outcomes measure for use with a Spanish-speaking population.IMPLICATIONS FOR REHABILITATIONThe Spanish-language version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Sp) is a valid and reliable tool.The IdFAI-Sp enables researchers and healthcare professionals to identify and classify chronic ankle instability among Spanish-speaking patients.Accordingly, it can be considered a useful clinical instrument.Aapplication of the questionnaire before and after treatment can reveal the patient's degree of recovery over time.

Morpho-structural characteristics of feet in patients with rheumatoid arthritis: A cross sectional study.

Objective: The aim of this study was to evaluate and classify the types and incidences of foot deformities in patients with Rheumatoid Arthritis (RA). Methods: A cross-sectional study with convenience sample was obtained of 220 patients with foot pain and RA classification criteria (approved by the American College of Rheumatology and the European League against Rheumatism in 2010). A series of outcomes were assessed to measure the morphological characteristics of the feet. The Foot Posture Index (FPI), the Manchester Scale of Hallux Valgus and the Nijmegen classification of forefoot disorders were assessed. Results: The most common foot posture according to the FPI assessment are the pronated position in the left foot (32.7% of participants) and the neutral position in the right foot (34.1% of participants). The disease progression causes more developed and serious foot deformities. 1.82% of patients present a severe level of Hallux Valgus before 10 years of disease evolution whereas 4.09% of patients present a severe level of Hallux Valgus after 10 years of disease evolution. Conclusions: The most common foot type in patients with RA is the pronated foot type with deformities in the MTP joints without Hallux Valgus. However, a percentage of patients with RA presents supinated foot type. The evolution of the disease shows some morphological changes in terms of patient's feet. The presence of more developed foot deformities is increased, such us Hallux Valgus or MTP joints deformity (Grade 3 in the Nijmegen classification scale).

Systematic review of the psychometric properties of the Victorian Institute of Sports Assessment - Achilles tendinopathy questionnaire.

OBJECTIVE: To review the different versions of The Victorian Institute of Sports Assessment - Achilles questionnaire for Achilles tendinopathy to evaluate its psychometric properties and the methodological quality of these studies. METHODS: This study is a systematic review. SETTING: A search was conducted in the PubMed, SCOPUS, CINAHL, Physiotherapy Evidence Database and Google Scholar databases, based on the following inclusion criteria: population with Achilles tendinopathy >18 years; validation studies of the Victorian Institute of Sports Assessment-Achilles questionnaire, in different languages, with no time limit. Two of the present authors independently assessed the quality of the studies located and extracted the relevant data. Terwee's criteria and the COSMIN checklist were employed to ensure adequate methodological quality. RESULTS: Eleven instruments met the inclusion criteria for this review. Significant methodological flaws were detected, mostly regarding construct validity and responsiveness. CONCLUSIONS: The cultural adaptation of the Spanish-language and Brazilian-Portuguese-language VISA-A presents adequate methodological quality. However, further studies are required, with greater methodological rigor, of the cultural adaptations of measurement instruments.IMPLICATIONS FOR REHABILITATIONOn available evidence, the Spanish-language and Brazilian-Portuguese language versions of the Victorian Institute of Sports Assessment - Achilles questionnaire are the most appropriate for patients with Achilles tendinopathy.Robust methods should be designed and implemented to obtain higher quality instruments for patients with Achilles tendinopathy to be used systematically in daily clinical practice.Most previous transcultural versions of the Victorian Institute of Sports Assessment - Achilles tendinopathy questionnaire have presented inadequate evidence of their psychometric properties and should be used with caution for patients with Achilles tendinopathy.

Measuring stress in podiatric students in Spain: psychometric validation and adaptation of the KEZKAK questionnaire.

OBJECTIVE: The study aim was to develop a linguistic-cultural adaptation of the KEZKAK questionnaire to be completed during the practicum of podiatric medical students in Spain, to validate the questionnaire and to evaluate its psychometric properties. METHODS: The cross-sectional study was carried out in two stages: 1. Cross-cultural adaptation; 2. Clinimetric validation based on assessments of interobserver reliability, test-retest reliability and internal consistency. The participants were podiatric medical students at the universities of Malaga and Miguel Hernandez, Alicante (Spain) and were recruited during the period February-October 2019. The following inclusion criteria were applied: aged at least 18 years, studying the third or fourth year of a university degree in Podiatry. All gave signed informed consent and completed the State-Trait Anxiety Inventory and the Podiatry version of the KEZKAK questionnaire. No sampling was performed and thus the entire eligible population was included in the study. RESULTS: The analysis was based on 205 participants (33.5% male, 66.5% female), with a mean age of 23.05 (SD 5.37) years. Internal consistency was excellent, with a Cronbach's alpha of 0.95. This version of the questionnaire had five factorial structures (61.18%). No floor/ceiling effect was observed in any item. The KEZKAK presented high test-retest reliability after 21 days, with an overall ICC of 0.95 (95% CI [0.93-0.98]). CONCLUSION: For university students of podiatry in Spain, the KEZKAK Podiatry version questionnaire is a valid, reliable instrument for measuring stressors during the practicum.

Conservative Treatment for Acute Ankle Sprain: A Systematic Review.

The aim was to identify conservative treatments available for acute ankle sprain and to evaluate their effectiveness with respect to pain relief and short-term recovery of functional capacity. A systematic review of the relevant literature was conducted via a data search of the PROSPERO, PubMed, Scopus, CINAHL, PyscINFO and SPORTDiscus databases, from inception until December 2019, focusing on randomised control trial studies. Two of the authors independently assessed the quality of each study located and extracted the relevant data. The quality of each paper was assessed using the Cochrane risk of bias tool included in RevMan 5. In all, 20 studies met the inclusion criteria. In terms of absence of bias, only nine papers were classed as "high quality". Studies (75%) were of low quality in terms of the blinding of participants and personnel and uncertainty in blinding of outcome assessment and all presented one or more other forms of bias. Despite the generally low quality of the studies considered, it can be concluded that conservative treatment for acute ankle sprain normally achieves pain relief and rapidly improved functionality. Research based on higher-quality study designs and procedures would enable more definitive conclusions to be drawn.

Review of Terms and Definitions Used in Descriptions of Running Shoes.

OBJECTIVE: Our study aim is to identify and describe the definitions used for different types of running shoes. In addition, we highlight the existence of gaps in these concepts and propose possible new approaches. Methods: This review was undertaken in line with the guidelines proposed by Green et al., based on a literature search (until December 2019) of the PubMed, Web of Science, Scopus, SPORTDiscus and Google Scholar databases. A total of 23 papers met the inclusion criteria applied to identify the definition of running shoes. RESULTS: Although there is a certain consensus on the characteristics of minimalist footwear, it is also described by other terms, such as barefoot-style or barefoot-simulating. Diverse terms are also used to describe other types of footwear, and in these cases, there is little or no consensus regarding their characteristics. CONCLUSIONS: The terms barefoot-simulated footwear, barefoot-style footwear, lightweight shoes and full minimalist shoes are all used to describe minimalist footwear. The expressions partial minimalist, uncushioned minimalist and transition shoes are used to describe footwear with non-consensual characteristics. Finally, labels such as shod shoes, standard cushioned running shoes, modern shoes, neutral protective running shoes, conventional, standardised, stability style or motion control shoes span a large group of footwear styles presenting different properties.

Systematic review of measurement instruments for patients with juvenile idiopathic arthritis in the foot and ankle.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. The part of the body most commonly affected, and where cysts are most likely to form, is in the small joints of the foot. The aim of this review was to identify self-reported outcome measures specific to the foot and ankle in patients with JIA and to investigate the methodological quality and psychometric properties of these measures. EVIDENCE ACQUISITION: A search was conducted for JIA in the PubMed, SCOPUS, CINAHL, PEDro and Google Scholar databases. The systematic review performed was based on the following inclusion criteria: population (with JIA) aged under 16 years; validation studies of patient-reported outcomes specific to the foot and ankle, in various languages, with no time limit. Two authors independently evaluated and assessed the quality of the studies, and extracted data using Terwee's criteria and the COSMIN checklist. No meta-analysis was carried out, due to the heterogeneity of the dimensions and outcomes included in each study. EVIDENCE SYNTHESIS: Of the initial 67 studies considered, only five met the inclusion criteria for this review. Many of these studies presented significant methodological flaws, in areas such as construct validity, responsiveness, floor/ceiling effect and interpretability. CONCLUSIONS: Despite the very low quality of the available evidence, the Italian-language adaptation of the Oxford Ankle Foot Questionnaire presents acceptable methodological quality. However, further studies, with greater methodological rigor, are required. A review of psychometric properties and methodological quality of evidence for each Patient Reported Outcome Measures specific for the foot and ankle affected by juvenile idiopathic arthritis is provided.

Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review.

The aim was to identify effective surgical treatments for patients with rheumatoid arthritis in the foot and/or ankle. A systematic review of the literature was conducted via a data search of the PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PROSPERO databases, from their inception until June 2019. Only non-randomized controlled trials and cohort studies were included in this review. Two of the present authors independently assessed the quality of each study and extracted the relevant data. A quality assessment of all articles was performed using the methodological index for non-randomized studies criteria. In addition, the Newcastle Ottawa scale was used for cohort studies. Thirteen studies met the inclusion criteria (five cohort studies and eight NRCTs). The total population considered was 923 patients (570 patients had RA), with a mean age of 58.8 years. Regarding the risk of bias, both the NRCTs and the cohort studies had a moderate level of quality. Despite the relatively low quality of these studies, surgical treatment for the foot and/or ankle is shown to reduce pain and improve functionality in patients with RA, in the short term (6-12 months).

Systematic review of the psychometric properties of patient-reported outcome measures for rheumatoid arthritis in the foot and ankle.

OBJECTIVE: To identify self-reported outcome measures specific to the foot and ankle in patients with rheumatoid arthritis and to investigate the methodological quality and psychometric properties of these measures. METHOD: A systematic review focusing on patients with rheumatoid arthritis. SETTING: The search was conducted in the PubMed, SCOPUS, CINAHL, PEDro and Google Scholar databases, based on the following inclusion criteria: population (with rheumatoid arthritis) > 18 years; psychometric or clinimetric validation studies of patient-reported outcomes specific to the foot and ankle, in different languages, with no time limit. Two of the present authors independently assessed the quality of the studies located and extracted the relevant data. Terwee's criteria and the COSMIN checklist were employed to ensure adequate methodological quality. RESULTS: Of the initial 431 studies considered, 14 met the inclusion criteria, representing 7,793 patients (56.8 years). These instruments were grouped into three dimensions (pain, perceived health status and quality of life and disability). The time to complete any of the PROMs varies around 15 minutes. PROMs criterias with the worst scores by COSMIN, 92.85% and 85.71% were criterion validity, measurement error, internal consistency and responsiveness. 28.57% of PROMs were compared with the measurement properties. CONCLUSION: the Self-Reported Foot and Ankle Score achieved the highest number of positive criteria (according to Terwee and COSMIN), and is currently the most appropriate for patients with Rheumatoid arthritis.

Patient-Reported Outcome Measures for Patients with Diabetes Mellitus Associated with Foot and Ankle Pathologies: A Systematic Review.

BACKGROUND: Diabetes mellitus (DM) is a chronic and complex disease, which is a major cause of morbidity and mortality and affects all age groups. It commonly produces secondary effects on the foot, often making daily activities impossible. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients' outlooks on their functional status and wellbeing. Although many instruments have been proposed for obtaining data on persons with DM whose feet are affected by the disease, in many cases the psychometric properties of the instrument have yet to be established. The principal objective of our review was to identify PROMs specific for patients with DM affecting the foot and ankle and to evaluate the psychometric properties and methodological quality of these instruments. METHODS: In this systematic review, we investigate studies (published in English or Spanish) based on the use of one or more PROMs specific to foot and ankle pathologies for patients with DM (type I or II). To do so, the databases PubMed, Scopus, CINAHL, PEDro and Google Scholar were searched for studies that analysed psychometric or clinimetric properties in this respect. These were assessed according to Terwee or COSMIN criteria. RESULTS: Of the 1016 studies identified in the initial search, only 11 were finally included in the qualitative review. Analysis according to Terwee and COSMIN criteria showed that the Foot Health Status Questionnaire (FHSQ) presented the greatest number of positive values. CONCLUSIONS: The FHSQ is the highest-quality PROM currently available for the foot and ankle, for patients with DM.

Cross-cultural adaptation and validation of Spanish version of The Foot and Ankle Ability Measures (FAAM-Sp).

BACKGROUND: The Foot and Ankle Ability Measure (FAAM) is a Patient Reported Outcome (PRO) commonly used to determine the effectiveness of therapeutic interventions for patients with foot and ankle pathologies and associated impairments of body function and structure, activity limitations, and participation restrictions. The aim of this study was to cross-culturally adapt the FAAM into Spanish. METHODS: Cross-cultural adaptation was performed according to the international guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Cronbach's alpha, test re-test reliability, and item-total and inter-item correlations were analyzed. Confirmatory factor analysis (CFA) was carried out to test construct validity. Pearson correlations were calculated to assess the convergent validity between FAAM and EuroQol-5. RESULTS: Spanish data set comprised 194 patients, with a mean age of 38.45 (16.04) and 130 (67.1%) were female, seeing a podiatrist with a wide variety of foot and ankle related disorders. CFA was carried out to test structure matrix (which has three factors). The test-retest reliability was high with global ICC of 0.95 (95% CI: 0.93 to 0.98). A 15 items version of the FAAM-Sp Activities of Daily Living (ADL) obtained the best fit: relative chi-square (x2/df) of 2.46, GFI 0.90 CFI 0.95, NFI 0.93, and RMSEA 0.08 (90% CI 0.04 to 0.09). For exploratory factor analysis for the FAAM-Sp Sport, a one factor solution was obtained, which explained 76.70% of total variance. CFA corroborated this model with an excellent goodness of fit:: relative chi-square (x2/df) of 0.80, GFI 0.99 CFI 1.00, NFI 0.99, and RMSEA 0.00 (90% CI 0.00 to 0.75). CONCLUSIONS: This study validated a new 15-item FAAM-Sp ADL and FAAM-Sp Sport subscales, which can be used as a self-reported outcome measure in clinical practice and research for patients resident in Spain whose main language is Spanish.