Oxford ankle foot questionnaire - for children

NewsBot · Aug 30, 2007

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Development of the Oxford ankle foot questionnaire: finding out how children are affected by foot and ankle problems.
Morris C, Liabo K, Wright P, Fitzpatrick R.
Child Care Health Dev. 2007 Sep;33(5):559-68.

Background A large number of children are affected by foot and ankle problems owing to congenital deformities, clinical syndromes, neuromuscular conditions or trauma. This study aimed to identify how children's lives are affected by foot and ankle problems from the child's perspective as the first stage in developing a family-assessed instrument.

Methods This was a qualitative study using focus groups involving children with a variety of foot and ankle problems aged 5-7, 8-11 and 12-15 years, and separate concurrent groups for their parents. The focus groups were child-centred and involved creative activities; there were two main exercises. The first activity involved agreeing or disagreeing with several statements about children with foot and ankle problems; the second activity explored a typical 'day in the life' of a child with a foot or ankle problem. All the groups were audio-recorded and transcribed; grounded theory and comparative content analysis were used to identify and code themes participants reported as important.

Results The groups ran successfully with children in all ages. Consistent themes identified by all groups were; (i) specific activities that were more difficult; (ii) physical symptoms; (iii) reduced participation in certain life situations; and (iv) self-consciousness. There were few differences in the issues raised by each age group although the life situations children encounter tend to become more complex as they get older; there is also the difficulty of negotiating a larger school campus at senior compared with junior school. There were no differences in the issues raised by children and their parents.

Conclusions Focus groups involving creative child-centred activities were used successfully to elicit children's experience of their health problems. In addition to expected activity limitations and physical symptoms some children with foot or ankle problems endure participation restrictions and self-consciousness that are exacerbated by the behaviour of other people or their environment, particularly at school. The findings of this study informed the development of a questionnaire to measure how severely children are affected by foot or ankle problems from the child's perspective.
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Admin2 · Aug 30, 2007

Related threads:
Another bl....y outcome measure for the foot
The Foot Function Index revisited
Foot problem outcome measures in older people
Outcomes measures for foot conditions
Measuring outcomes

gavw · Aug 31, 2007

Foot pain measures/quality of life in children with foot problems

From the same issue of Child: care health and development as this article

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=4404

is this: Development of the Oxford ankle foot questionnaire: finding out how children are affected by foot and ankle problems.

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Interesting stuff. I have been looking at doing some work around measuring the impact on quality of life in children with foot problems, and the impact on quality of life of foot orthoses for those with foot pathology leading to pain. One instrument I did find is known as the PODCI. See here: http://www.aaos.org/research/outcomes/outcomes_peds.asp

Does anyone have any experience/knowlege of these types of quality of life outcomes in children with regard to the foot?

Regards

NewsBot · Oct 31, 2008

The Oxford ankle foot questionnaire for children
SCALING, RELIABILITY AND VALIDITY
C. Morris; H. A. Doll; A. Wainwright; T. Theologis and R. Fitzpatrick
Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 11, 1451-1456.

We developed the Oxford ankle foot questionnaire to assess the disability associated with foot and ankle problems in children aged from five to 16 years. A survey of 158 children and their parents was carried out to determine the content, scaling, reliability and validity of the instrument. Scores from the questionnaire can be calculated to measure the effect of foot or ankle problems on three domains of children’s lives: physical, school and play, and emotional. Scores for each domain were shown to be internally consistent, stable, and to vary little whether reported by child or parent. Satisfactory face, content and construct validity were demonstrated. The questionnaire is appropriate for children with a range of conditions and can provide clinically useful information to supplement other assessment methods. We are currently carrying out further work to assess the responsiveness of questionnaire scores to change over time and with treatment.
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NewsBot · Nov 5, 2009

The Oxford Ankle Foot Questionnaire for children: responsiveness and longitudinal validity.

Morris C, Doll H, Davies N, Wainwright A, Theologis T, Willett K, Fitzpatrick R.
Qual Life Res. 2009 Nov 3.

PURPOSE: To evaluate how scores from the Oxford Ankle Foot Questionnaire change over time and with treatment using both distribution-based and anchor-based approaches.

METHODS: Eighty children aged 5-16 and their parent or carer completed questionnaires at orthopaedic or trauma outpatient clinics. They were asked to complete and return a second set of questionnaires again within 2 weeks (retest), and then mailed a third set of questionnaires to complete again after 2 months (follow-up). The follow-up questionnaires included a global rating of change 'transition' item.

RESULTS: Child- and parent-reported mean domain scores (Physical, School & Play, and Emotional) were all stable at retest, whereas positive mean changes were observed at follow-up. As we hypothesised, trauma patients had poorer scores than elective patients at baseline, and showed greater improvement at follow-up. For trauma patients, mean changes in per cent scores were large (scores improved between 40 and 56 for the Physical and School & Play domains, and 17 and 21 for Emotional); all effect sizes (ES) were large (>0.8). For elective patients, the mean improvement in per cent scores were more moderate (Physical: child 10, ES = 0.4, parent 11, ES = 0.5; School & Play child 0, ES = 0, parent 9 ES = 0.4; Emotional: child 6, ES = 0.2; parents 8, ES > 0.3). Minimal detectable change (MDC(90)), an indication of measurement error, ranged from 6 to 8. Half the standard deviation of baseline scores ranged from 11 to 18. Minimal important difference could only be calculated for elective patients (9 child and 13 parent ratings), these ranged from 7 to 17.

CONCLUSIONS: The findings support the responsiveness and longitudinal validity of the scales. Changes in domain scores of, or exceeding, the MDC(90) (6-8) are likely to be beyond measurement error; further work is required to refine the estimate of change that can be considered important.
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NewsBot · Jun 10, 2010

The Oxford Ankle Foot Questionnaire for Children: Review of development and potential applications.
Morris C, Doll H, Wainwright A, Davies N, Theologis T, Fitzpatrick R.
Prosthet Orthot Int. 2010 Jun 9. [Epub ahead of print]

There is increasing recognition of the credibility and utility of patient reported outcome measures, both in research and as routine quality indicators. This paper reviews the development of a questionnaire for children with foot or ankle problems and integrates the findings from three previously published studies in a cohesive way for the orthotic community. The Oxford Ankle Foot Questionnaire for Children was designed to evaluate the effectiveness of interventions. The development process was conducted in three phases. First the items were devised through focus groups with children affected by foot and ankle problems, and their parents. Second, test versions of child and parent questionnaires were evaluated to enable scales to be developed and tested for validity and reliability. Finally, findings from a prospective study assessing how scores changed over time and/or with treatment supported the longitudinal validity and responsiveness of the scales. The questionnaire offers an inexpensive and expedient means to evaluate the effectiveness of orthoses and other interventions used to treat children's foot or ankle problems. The Oxford Ankle Foot Questionnaire for Children has broad utility both in routine clinical settings, or applied research to evaluate treatment programmes and interventions used in paediatric orthopaedics, trauma and rheumatology.
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Bug · Jun 10, 2010

This is a lovely tool for kids. We are currently using it for foot pain and also in a RCT for Sever's treatment. It is super easy to use and would be great to see it used more.

I think we can underestimate how pain and deformity changes the quality of life with kids.

gendel99 · Jan 3, 2012

It's possible use this scale after foot surgery in children?

Bug · Jan 5, 2012

Have a look at it, can't see why not. It is free for clinical use.

stewartm · Jan 27, 2012

Hi,

I believe it is free of charge but a licence is required for use. Isis Innovation (University of Oxford) is the owner of the copyright

Stewart

Bug · Jan 27, 2012

You can contact them here also: http://www.publichealth.ox.ac.uk/research/hsru/Ankle/Ankle

I thought it was free to use on the individual/clinical setting but if you are using them in large amounts in a research study there was a license fee. Probably best to check. I know we have a license for use as we are using it for research.

NewsBot · Mar 5, 2015

Validation of the translated Oxford ankle foot questionnaire in 82 Danish children aged between five and 16 years.
Martinkevich P, Møller-Madsen B, Gottliebsen M, Kjeldgaard Pedersen L, Rahbek O
Bone Joint J. 2015 Mar;97-B(3):420-6. doi: 10.1302/0301-620X.97B3.34355.

We present the validation of a translation into Danish of the Oxford ankle foot questionnaire (OxAFQ). We followed the Isis Pros guidelines for translation and pilot-tested the questionnaire on ten children and their parents. Following modifications we tested the validity of the final questionnaire on 82 children (36 boys and 45 girls) with a mean age of 11.7 years (5.5 to 16.0) and their parents. We tested the reliability (repeatability (test-retest), child-parent agreement, internal consistency), feasibility (response rate, time to completion, floor and ceiling effects) and construct validity. The generic child health questionnaire was used for comparison. We found good internal consistency for the physical and the school and play domains, but lower internal consistency for the emotional domain. Overall, good repeatability was found within children and parents as well as agreement between children and parents. The OxAFQ was fast and easy to complete, but we observed a tendency towards ceiling effects in the school and play and emotional domains. To our knowledge this is the first independent validation of the OxAFQ in any language. We found it valid and feasible for use in the clinic to assess the impact on children's lives of foot and/or ankle disorders. It is a valuable research tool.
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NewsBot · Nov 19, 2017

The Dutch version of the Oxford Ankle and Foot Questionnaire for Children: Useful for evaluation of pediatric foot problems in groups
EliseBurgeraRuudSellesaShellyvan NieuwkasteeleaGertBessemsbVirginiePolletbStevenHoviusaChristiannevan Nieuwenhovena
Foot and Ankle Surgery; 4 November 2017

Highlights
•The Dutch OxAFQ-c allows evaluation of pediatric foot and ankle problems.
•The Dutch OxAFQ-c has sufficient measurement properties to compare patient groups.
•The OxAFQ-c has limited sensitivity to show changes in individual patients.
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Background
The purpose of this study is to develop a Dutch version of the Oxford Ankle and Foot Questionnaire for Children (OxAFQ-c) to allow evaluation of pediatric foot care.

Methods
The OxAFQ-c was translated into Dutch, according to the ISPOR-guidelines. Children with different foot and ankle complaints completed the OxAFQ-c at baseline, after two weeks, and after 4–6 months. Measurement properties were assessed in terms of reliability, responsiveness, and construct validity.

Results
Test–retest reliability showed moderate intraclass correlation coefficients. Bland–Altman plots showed wide limits of agreement. After 4–6 months, the group that experienced improvement also showed improved questionnaire outcomes, indicating responsiveness. Moderate correlation between the OxAFQ-c and the Kidscreen and foot-specific VAS-scores were observed, indicating moderate construct validity.

Conclusions
The Dutch OxAFQ-c showed moderate to good measurement properties. However, because we observed limited sensitivity to changes and wide limits of agreement in individual patients, we think the questionnaire should only be used in groups.
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NewsBot · May 5, 2020

Transcultural adaptation and validation of a Korean version of the Oxford Ankle Foot Questionnaire for children.
Cho SH et al
Health Qual Life Outcomes. 2020 May 1;18(1):118

BACKGROUND:
The purpose of this study was to translate and transculturally adapt the original English version of the Oxford Ankle Foot Questionnaire (OAFQ) into a Korean version, and to evaluate its psychometric properties.

METHODS:
A Korean OAFQ for children was developed according to established guidelines. To test validity, 169 consecutive patients with foot and ankle problems and their caregivers each completed the OAFQ. The children also completed a Korean version of the KIDSCREEN-52 health related quality of life questionnaire (KIDSCREEN-52 HRQOL). To validate the Korean version of the OAFQ, reliability (child-parent agreement and internal consistency), feasibility (floor and ceiling effects), and construct validity were evaluated, and factor analysis was performed.

RESULTS:
In terms of reliability, Cronbach's α values were > 0.7 in all subscales of the OAFQ (0.765 to 0.901). Child-parent agreement was confirmed by high intraclass correlation coefficients for all subscales (0.791 to 0.863). In terms of construct validity, there were moderate correlations between the subscales of the OAFQ and the subscales of the KIDSCREEN-52 HRQOL. Factor analysis revealed a three-component solution for both the child/adolescent and parent-proxy version, by combining the school and play, and footwear items into one subscale. In terms of feasibility, no floor effects were found for all subscales. However, ceiling effects were observed for the school and play, and emotional subscales for child/adolescent and parent-proxy versions.

CONCLUSIONS:
The OAFQ was successfully translated and transculturally adapted into the Korean language; the Korean version of the OAFQ represents a reliable and valid instrument for evaluating children's foot or ankle problems. However, factor analysis suggested the use of a three-subscale questionnaire.
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NewsBot · Jun 12, 2020

Cross-cultural adaptation, validity and reliability of Turkish version of Oxford Ankle Foot Questionnaire for children with congenital talipes equinovarus
FarzinHajebrahimi et al
Foot and Ankle Surgery; 12 June 2020

Highlights
•Congenital talipes equinovarus is one of the most common congenital deformities in children.
•The Oxford Ankle Foot Questionnaire for children was developed as a site-specific (ankle/foot) instrument.
•The Oxford Ankle Foot Questionnaire for children is a proper tool as a PROM to assess foot and ankle problems in children.
•The Turkish version of Oxford Ankle Foot Questionnaire is a valid, reliable and useful questionnaire for quality of life in patients with congenital talipes equinovarus.
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Background
The purpose of the study was to evaluate the reliability and validity of the Turkish version of the Oxford Ankle Foot Questionnaire (OxAFQ) to provide cultural adaptation.

Methods
This study involved translation, back translation, and cross-cultural adaptation. Forty-nine patients with congenital talipes equinovarus were evaluated using the Turkish version of OxAFQ. Turkish version of the Childhood Health Assessment Questionnaire (CHAQ) was used as a gold standard to validate the Turkish version of the OxAFQ. The validation was assessed with Spearman correlation analysis by using CHAQ. The reliability of the questionnaire was assessed with Cronbach alpha (internal consistency) and exploratory factor analysis.

Results
High validity was found between OxAFQ and CHAQ (r = -0.422−0.292) (p < 0.01). Reliability analysis showed that OxAFQ had a high level of Cronbach alpha (α = 0.88−0.96) and internal consistency (ICC = 0.90−0.96).

Conclusion
The Turkish version of OxAFQ is a valid, reliable and useful quality of life questionnaire in patients with congenital talipes equinovarus and it is proper for use by health professionals and researchers.
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NewsBot · Mar 3, 2022

Cross-cultural adaptation and validation of the Arabic version of oxford ankle foot questionnaire for children
Shayek S Alotaibi et al
Disabil Rehabil. 2022 Mar 2;1-7

Purpose: The purpose of this study was to translate and cross-culturally adapt the original English version of the Oxford Ankle Foot Questionnaire (OxAFQ-c) into the Arabic language, and to evaluate its psychometric properties among Arabic speaking children aged from 5 to 16 years in Saudi Arabia.

Materials and methods: An Arabic OxAFQ-c for children was developed according to established guidelines (ISPOR). The Arabic OxAFQ-c version was completed by eighty-seven patients with foot and ankle problems and their caregivers. Construct validity of the Arabic OxAFQ-c was also examined.

Results: The reliability analysis of OxAFQ-Ar exhibited good internal consistency in both children's and parent's versions for all domains (α = 0.80-0.89) and excellent test-retest reliability in both versions for all domains. (ICC = 0.87-0.94). A moderate correlation between the OxAFQ-Ar and PedsQL 4.0 was observed indicating moderate construct validity.

Conclusions: The OxAFQ-c was successfully translated and cross-cultural adapted into the Arabic language. The OxAFQ-Ar is a valid, reliable and useful quality of life questionnaire for evaluating children's ankle foot problems.IMPLICATION OF REHABILITATION OF OxAFQ-c ARABIC VERSIONThe Arabic version of the OxAFQ-c is an acceptable, clear and comprehensible outcome measure.The Arabic version of the OxAFQ-c demonstrated evidence supporting its internal consistency, test-retest reliability and construct validity as a measure to evaluate foot and ankle pathologies in patients aged 5-16 years.The Arabic OxAFQ-c has very good internal consistency, test-retest reliability, and acceptable measurement error with no floor and ceiling effects.The Arabic version of the OxAFQ-c can be used in daily clinical practice and in research studies to assess children aged from 5 to 16 years in Arabic speakers with ankle-foot conditions.
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