Translation and cultural adaptation of the revised foot function index for the Portuguese language: FFI-R Brazil

Abstract

INTRODUCTIONMusculoskeletal injuries in the ankle and foot cause functional limitations that have a negative impact on quality of life.1 Classification of the degree of dysfunction is fundamental for characterization of patients' status and enables quantification of the effect of treatment. 2 The main assessment tools used to evaluate the functionality of the feet, such as the foot function index (FFI), foot and ankle outcome score (FAOS), foot health status questionnaire (FHSQ) andManchester foot pain and disability index (MFPDI), were developed in the English language. 3,4 For these assessment tools to be used in different countries with different languages, it is necessary to perform translation and cultural adaption and to test the psychometric properties of the adapted tools. 5The FFI is considered to be one of the main assessment tools for evaluation of the functionality of the ankle and foot, because all its psychometric properties have been validated. 1,6,7 Subsequently, adjustments and new domains were added to broaden its scope, thereby creating the revised foot function index (FFI-R). 8 In this version, the visual analogue scale (VAS) was replaced with a Likert scale. The domains and items of the original questionnaire were maintained and others regarding psychosocial characteristics were added. The FFI-R has five domains containing 68 items, with questions relating to pain (11 items), stiffness (8 items), problems (20 items), activity limitation (10 items) and social issues (19 items). 8Because of the importance of standardization when using evaluation measurements, questionnaires developed in foreign languages need to be translated and their psychometric properties evaluated, to create equivalence between studies. This process makes it possible for physicians and other professionals working in a given field to obtain a reliable tool for patient evaluations.Thus, the FFI-R can become available for assessing patients with foot and ankle musculoskeletal disorders.The FFI has been translated and validated for use in several countries, such as Germany, ABSTRACTBACKGROUND: The revised foot function index (FFI-R) is used to evaluate the functionality of patients with conditions that affect the feet. The objective here was to produce the Brazilian Portuguese version of this index. DESIGN AND SETTING: Translation and validation study conducted at the Federal University of São Paulo, Brazil. METHODS:The translation and cultural adaptation process involved translation by two independent translators, analysis by an expert committee, back translation into the original language, analysis by the expert committee again and a pretest. The Portuguese-language version was administered to 35 individuals with plantar fasciitis and metatarsalgia to determine their level of understanding of the assessment tool. RESULTS: Changes were made to the terms and expressions of some original items to achieve cultural equivalence. Terms not understood by more than 10% of the sample were altered based on the suggestions of the pati...

The Brazilian version of the Bournemouth questionnaire for low back pain: translation and cultural adaptation

“… 10 The translation and cross-cultural adaptation methods used in the present study have become well established in the literature and have been applied in several studies. 20 , 21 , 22 , 23 Versions of the Bournemouth questionnaire translated to other languages have been provided through previous studies 14 , 15 , 16 using the same methodology. The cross-cultural adaptation process was successfully completed in all cases.…”

“…Although the guidelines (2000) 10 highly recommend that, after the translation and adaptation process, the reliability and construct validity of the product should be verified, several studies have reported the translation and cross-cultural adaptation phases without analysis on the psychometric properties. 22 , 23 , 25 , 26 , 27 It is valuable to report a detailed description of the translation and cultural adaptation process before the validation, in order to prevent occurrences of multiple translations of the same tool and to avoid the extensive amount of work that would be entailed in translating and/or validating the same tool more than once.…”

“…The author of the original Bournemouth questionnaire confirmed the originality of this study. The translation and cultural adaptation procedures were based on previous studies 20 , 21 , 22 , 23 and followed the proper guidelines. 10 , 11 , 24 The procedures were divided into the following stages: translation, back-translation, expert committee review and pre-testing ( Figure 1 ).…”

“…Then, the researcher asked whether they comprehended the questions, what they understood and whether they had any suggestion for modifying the questions, in the event that any topic remained unanswered. 20 , 21 , 22 , 23 …”

“…Then, the researcher asked whether they comprehended the questions, what they understood and whether they had any suggestion for modifying the questions, in the event that any topic remained unanswered. [20][21][22][23] This study was approved by the Human Research Ethics Committee (approved on September 9, 2014, under protocol no. 31477314.0.0000.5512).…”