Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2025; 16(4): 103463
Published online Apr 18, 2025. doi: 10.5312/wjo.v16.i4.103463
Validity of the Arabic version of AAOS-foot and ankle outcomes questionnaire in patients with traumatic foot and ankle injuries
Sulaiman A AlMousa, Mohammad M Alzahrani, Bandar A Alzahrani, Ahmed K Alsenan, Abdulraheem A Altalib, Hashem Abdulkarim Alkhamis
Sulaiman A AlMousa, Mohammad M Alzahrani, Bandar A Alzahrani, Abdulraheem A Altalib, Department of Orthopedics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia
Ahmed K Alsenan, Department of Orthopedic Surgery, Eastern Health Cluster, E1, Dammam 32065, Saudi Arabia
Hashem Abdulkarim Alkhamis, Department of Orthopedic Surgery, Asir Central Hospital, General Directorate of Health Affairs, Abha 32056, Saudi Arabia
Author contributions: Alzahrani BA, AlMousa SA designed the research study; Alzahrani BA performed the research; Alzahrani BA, AlMousa SA, Alzahrani MM, Altalib AA, Alsenan AK, Alkhamis HA analyzed the data and wrote the manuscript. All authors critically examined and approved the final text, and agreed to be responsible for the manuscript's content and similarity index.
Institutional review board statement: The study was reviewed and approved by the King Fahad Hospital of the university Institutional Review Board (Approval No. IRB-2024-01-026).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: "The authors declare that they have no conflicts of interest to disclose."
STROBE statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at dr.bander.zah@gmail.com. Participants gave informed consent for data sharing. No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bandar A Alzahrani, Department of Orthopedics, College of Medicine, Imam Abdulrahman bin Faisal University, King Faisal Road, Dammam 34212, Saudi Arabia. dr.bander.zah@gmail.com
Received: November 25, 2024
Revised: February 7, 2025
Accepted: March 4, 2025
Published online: April 18, 2025
Processing time: 148 Days and 17 Hours
Abstract
BACKGROUND

Arabic-speaking patients are underrepresented in orthopedic clinical studies, particularly in foot and ankle trauma research. The lack of validated Arabic language tools hinders their inclusion, creating a need for culturally and linguistically adapted instruments. The American Academy of Orthopedic Surgeons Foot and Ankle Outcomes Questionnaire (AAOS-FAOQ) is a widely used tool but has not been adapted for Arabic-speaking patients.

AIM

To translate, cross-culturally adapt, and validate the AAOS-FAOQ for Arabic-speaking patients with traumatic foot and ankle injuries.

METHODS

The cross-cultural adaptation followed established guidelines, involving forward and backward translations, expert review, and pre-testing. The final Arabic version was administered alongside the Arabic Short-Form 36 (SF-36) to 100 patients for validity testing. Reliability was assessed through test-retest methods with 20 patients completing the questionnaire twice within 48 hours. Pearson correlation coefficients measured convergent and divergent validity with SF-36 subscales, while Cronbach's alpha and intraclass correlation coefficients (ICC) determined internal consistency and reliability.

RESULTS

Out of 100 patients, 92 completed the first set of questionnaires. The Arabic AAOS-FAOQ showed strong correlations with the SF-36 subscales, particularly in physical function and bodily pain (r > 0.6). Test-retest reliability was robust, with ICCs of 0.69 and 0.66 for the Global Foot and Ankle Scale and Shoe Comfort Scale, respectively. Cronbach's alpha for internal consistency ranged from 0.7 to 0.9.

CONCLUSION

The Arabic version of the AAOS-FAOQ demonstrated validity and reliability for use in Arabic-speaking patients with traumatic foot and ankle injuries. This adaptation will enhance the inclusion of this population in orthopedic clinical studies, improving the generalizability of research findings and patient care.

Keywords: Arabic version; American Academy of Orthopedic; Foot and Ankle Outcomes; Orthopedic; Trauma

Core Tip: The Arabic version of the American Academy of Orthopedic Surgeons Foot and Ankle Outcomes Questionnaire has been successfully translated, cross-culturally adapted, and validated. It demonstrated strong validity and reliability for Arabic-speaking patients with traumatic foot and ankle injuries. This adaptation addresses the gap in outcome measures for this population, facilitating their inclusion in clinical studies and improving the generalizability of research findings in orthopedic care.