The Foot Function Index revisited

NewsBot · Jul 18, 2006

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Theoretical model and rasch analysis to develop a revised foot function index.
Foot Ankle Int. 2006 Jul;27(7):519-27

BACKGROUND: The Foot Function Index (FFI) is a widely used self-reported measure of health-related foot function. Several areas have been identified for potential improvement, and this study responds to such criticisms. The objectives of this study were to: (1) develop a theoretical model of foot functioning, (2) develop a revised FFI (FFI-R), and (3) field-test the FFI-R.

METHODS: A literature review was conducted to develop the theoretical model. The FFI-R items were developed from the original 23 FFI items, and more items were added as a result of the literature review. A focus group discussion with clinicians and pilot interviews with patients resulted in a final draft of the FFI-R. This draft consisted of four subscales and comprised 68 items with a six-point response scale. The FFI-R was field tested on 92 patients in the podiatry clinic of a Veterans Administration Hospital in the Midwest. Psychometric analyses were conducted with modern item response theory (IRT) methods.

RESULTS: A theoretical model of foot functioning was developed. The FFI-R response scale was revised from six to five categories since confusion was found between categories 4 and 5. Rasch analyses indicated a person reliability of 0.96 and item reliability of 0.93. The subscale reliability of pain and stiffness, psychosocial, and disability were all >0.80; the exception was assistive devices (>0.50). Construct validity of FFI-R was supported based on the correlation of 50-ft walk time with an FFI-R total of 0.306, p = 0.018, N = 59. Rasch analyses indicated several items with poor fit statistics and a short form with 34 items was developed.

CONCLUSION: The FFI was revised, and new items were added to compose the FFI-R. The chief theoretical change was adding a psychosocial scale. Both long and short forms had very good psychometric properties.
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Admin2 · Feb 1, 2013

Outcome measures

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

NewsBot · Feb 1, 2013

A review of the Foot Function Index and the Foot Function Index -- revised
Elly Budiman-Mak, Kendon J Conrad, Jessica Mazza and Rodney M Stuck
Journal of Foot and Ankle Research 2013, 6:5 doi:10.1186/1757-1146-6-5 Published: 1 February 2013

Background
The Foot Function Index (FFI) is a self-report, foot-specific instrument measuring pain and disability and has been widely used to measure foot health for over twenty years. A revised FFI (FFI-R) was developed in response to criticism of the FFI. The purpose of this review was to assess the uses of FFI and FFI-R as were reported in medical and surgical literature and address the suggestions found in the literature to improve the metrics of FFI-R.

Methods
A systematic literature search of PubMed/Medline and Embase databases from October 1991 through December 2010 comprised the main sources of literature. To enrich the bibliography, the search was extended to BioMedLib and Scopus search engines and manual search methods. Search terms included FFI, FFI scores, FFI-R. Requirements included abstracts/full length articles, English-language publications, and articles containing the term "foot complaints/problems." Articles selected were scrutinized; EBM abstracted data from literature and collected into tables designed for this review. EBM analyzed tables, KJC, JM, RS reviewed and confirmed table contents. KJC and JM reanalyzed the original database of FFI-R to improve metrics.

Results
Seventy-eight articles qualified for this review, abstracts were compiled into 10 tables. FFI and FFI-R were used in studies of foot and ankle disorders in 4700 people worldwide. FFI Full scale or the Subscales and FFI-R were used as outcome measures in various studies; new instruments were developed based on FFI subscales. FFI Full scale was adapted/translated into other cultures. FFI and FFI-R psychometric properties are reported in this review. Reanalysis of FFI-R subscales' confirmed unidimensionality, and the FFI-R questionnaires' response categories were edited into four responses for ease of use.

Conclusion
This review was limited to articles published in English in the past twenty years. FFI is used extensively worldwide; this instrument pioneered a quantifiable measure of foot health, and thus has shifted the paradigm of outcome measure to subjective, patient-centered, valid, reliable and responsive hard data endpoints. Edited FFI-R into four response categories will enhance its user friendliness for measuring foot health.
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NewsBot · May 22, 2013

Reliability, validity and responsiveness of the Italian version of the Foot Function Index in patients with foot and ankle diseases.
Martinelli N, Scotto GM, Sartorelli E, Bonifacini C, Bianchi A, Malerba F.
Qual Life Res. 2013 May 21.

PURPOSE:
The purpose of this study was to translate the Foot Function Index (FFI) into Italian, to perform a cross-cultural adaptation and to evaluate the psychometric properties of the Italian version of FFI.

METHODS:
The Italian FFI was developed according to the recommended forward/backward translation protocol and evaluated in patients with foot and ankle diseases. Feasibility, reliability [intraclass correlation coefficient (ICC)], internal consistency [Cronbach's alpha (CA)], construct validity (correlation with the SF-36 and a visual analogue scale (VAS) assessing for pain), responsiveness to surgery were assessed. The standardized effect size and standardized response mean were also evaluated.

RESULTS:
A total of 89 patients were recruited (mean age 51.8 ± 13.9 years, range 21-83). The Italian version of the FFI consisted in 18 items separated into a pain and disability subscales. CA value was 0.95 for both the subscales. The reproducibility was good with an ICC of 0.94 and 0.91 for pain and disability subscales, respectively. A strong correlation was found between the FFI and the scales of the SF-36 and the VAS with related content, particularly in the areas of physical function and pain was observed indicating good construct validity. After surgery, the mean FFI improved from 55.9 ± 24.8 to 32.4 ± 26.3 for the pain subscale and from 48.8 ± 28.8 to 24.9 ± 23.7 for the disability subscale (P < 0.01).

CONCLUSIONS:
The Italian version of the FFI showed satisfactory psychometric properties in Italian patients with foot and ankle diseases. Further testing in different and larger samples is required in order to ensure the validity and reliability of this score.
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NewsBot · Nov 16, 2013

Cross-Cultural Adaptation and Validation of the Foot Function Index to Spanish
Joaquin Paez-Moguer, Elly. Budiman-Mak, I. Antonio Cuesta-Vargas
Foot and Ankle Surgery; Available online 16 November 2013

Background
The purpose of this study was to adapt and validate the Foot Function Index to the Spanish (FFI-Sp) following the guidelines of the American Academy of Orthopædic Surgeons.

Methods
A cross-sectional study 80 participants with some foot pathology. A statistical analysis was made, including a correlation study with other questionnaires (the Foot Health Status Questionnaire, EuroQol 5-D, Visual Analogue Pain Scale, and the Short Form SF-12 Health Survey). Data analysis included reliability, construct and criterion-related validity and factor analyses.

Results
The principal components analysis with varimax rotation produced 3 principal factors that explained 80% of the variance. The confirmatory factor analysis showed an acceptable fit with a Comparative Fit Index of 0.78. The FFI-Sp demonstrated excellent internal consistency on the three subscales: pain 0.95; disability 0.96; and activity limitation 0.69, the subscale that scored lowest. The correlation between the FFI-Sp and the other questionnaires was high to moderate.

Conclusions
The Spanish version of the Foot Function Index (FFI-Sp) is a tool that is a valid and reliable tool with a very good internal consistency for use in the assessment of pain, disability and limitation of the function of the foot, for use both in clinic and research.
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NewsBot · Oct 3, 2014

Cross-cultural adaptation and reliability of the Italian version of the Foot Function Index (FFI-I) for patients with plantar fasciitis.
Vetrano M, Vulpiani MC, Erroi D, Vadalà A, Ferretti A, Saraceni VM.
J Sports Med Phys Fitness. 2014 Oct;54(5):636-43.

AIM:
The aim of this paper was to translate and cross-culturally adapt the FFI to the Italian language, and to assess the reliability of the Italian version of the FFI (FFI-I) for plantar fasciitis.
METHODS:
Fifty symptomatic patients affected by plantar fasciitis completed the FFI-I scale twice, at interval of one week. The translation of the FFI was performed according to international standards for translation of questionnaires. Test-retest reliability was evaluated using intraclass correlation coefficient (ICC). Internal consistency was measured by Cronbach α coefficient. Ceiling and floor effects were assessed.
RESULTS:
The process resulted in an intelligible version of the questionnaire. The reliability of the FFI-I was adequate, with an ICC ranging from 0.86 to 0.98 for test-retest reliability. The FFI-I showed an excellent internal consistency, ranging from 0.93 to 0.99 for all subscales. Three items involving disability and four items involving activities restrictions had highest proportion of floor score.
CONCLUSION:
The FFI-I is a reliable and valid instrument to assess clinical severity in patients with plantar fasciitis and it is suitable for daily practice. We suggest evaluating the total FFI-I score along with the distinct scores of the three subscales of the FFI-I in order to interpret more correctly minor changes in patient status during repetitive outcome assessments.
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NewsBot · Oct 11, 2014

Italian Foot Function Index with numerical rating scale: development, reliability, and validity of a modified version of the original Foot Function Index
Teresa Venditto, Lucrezia Tognolo, Rosaria Sabrina Rizzo, Cristina Iannuccelli, Luca Di Sante, Mauro Trevisan, Francesca Romana Maggiolini, Valter Santilli, Francesco Ioppolo
The Foot; Articles in Press

Highlights
•The painful foot and ankle conditions limit the activities of daily living and are the leading cause of immobility and disability.
•FFI is one of the most frequently used self-reported questionnaires that is used across national and international clinical and research communities.
•The adapted 17 Italian Foot Function index is a reliable and valid outcome measure that showed more specific and sensitive properties than a generic questionnaire such as the LEFS.
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BACKGROUND
Clinical research quantifies symptoms and signs of pain.

OBJECTIVE
To develop a brief outcome measure to assess foot and ankle conditions, the psychometric properties of a modified version of the original Foot Function Index (FFI) were examined.

METHODS
Eighty-six subjects with musculoskeletal foot and ankle disorders were enrolled. The internal consistency and test-retest reliability were evaluated by using Cronbach's α and intraclass correlation coefficient (ICC). Criterion validity was tested by Pearson‟s correlation coefficient between 17 items Italian FFI (17-IFFI) and Lower Extremity Functional Scale (LEFS). The responsiveness was calculated using the receiver operating characteristic curve (ROC).

RESULTS
Cronbach's Alpha was 0.95 (95% CI:0.92, 0.99). The intra-interviewer and inter-interviewer ICC values were respectively 0.92 (95% CI:0.88-10 0.96) and 0.90 (95% CI:0.89- 0.94). Correlations between the 17-IFFI scores and the LEFS scores were -0.564 and -0.456 at the initial and at the end of the treatment, respectively. The ROC analysis revealed an area under the curve of 0.732 (95% CI:0.61-0.82) for the 17-IFFI and 0.633 (95% CI:0.52-0.71) for the LEFS score.

CONCLUSIONS
The 17-IFFI is a reliable and valid scale and we recommend its application to evaluate the effectiveness of a treatment in patients with musculoskeletal foot and ankle disorders.
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NewsBot · Nov 5, 2014

Translation and validation of the Danish Foot Function Index (FFI-DK).
Jorgensen JE, Andreasen J, Rathleff MS.
Scand J Med Sci Sports. 2014 Nov 4.

The objective of this study was to translate the Foot Function Index (FFI) for use in Danish-speaking patients with foot complaints. The FFI consists of 23 items scored on a numeric rating scale from 0 to 10. The 23 items are grouped into three subscales: pain (nine items), activity limitation (five items), and disability (nine items). The Danish FFI was developed according to the recommended forward/backward translation protocol. The data analysis included reliability [intraclass correlation coefficient (ICC) 2.1] and internal consistency (Cronbach's alpha). Excellent internal consistency was shown for the three subscales: pain (0.99), disability (0.98), and activity limitation (0.98), as for the total score (0.97). The test-retest reliability was excellent: pain subscale: ICC 0.98 [95% confidence interval (CI): 0.97-0.99]; activity limitation subscale: ICC: 0.95 (95% CI: 0.91-0.98); disability subscale: ICC 0.97 (95% CI: 0.95-0.98); total score: ICC: 0.95 (95% CI: 0.91 to 0.98). The mean difference between test and retest was below 1 point and P > 0.08. Bland-Altman plots showed no significant or clinically relevant differences from test to retest in any of the subscales or in the total score. The Danish version of the FFI was found to be valid and reliable and therefore acceptable for use in the Danish population.
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NewsBot · Apr 9, 2016

Reliability and Validity of the Korean Version of the Foot Function Index
Jung-Wook Huh, MD, Il-Soo Eun, MDl, Young-Chul Ko, MD, Man-Jun Park, MD, Keum-Min Hwang, MD, Sook-Hyun Park, MD, Tae-hong Park, MD, Joon-hyung Park, MD
JFAS; Article in Press

Although translated versions of the Foot Function Index (FFI) in several languages are available, the absence of a Korean version has precluded comparing the data from Korea with the data from other countries using the FFI. We, therefore, evaluated the reliability and validity of the adapted Korean version of the FFI. We translated the English version of the FFI into Korean and back into English. We mailed the Korean version of the visual analog scale, FFI, and the previously validated Medical Outcomes Study Short-Form 36-item questionnaire (SF-36) to 121 patients with treated foot complaints. To evaluate the test-retest reliability and internal consistency, we used the intraclass correlation coefficient and Cronbach's α, respectively. We also evaluated the concurrent and construct validity of Korean version of the FFI by comparing the visual analog scale and SF-36. Cronbach's α was 0.91 and 0.95 for the pain and disability subscales, respectively. The reproducibility was good, and a strong correlation between the FFI and the SF-36 and visual analog scale with related content was observed, indicating good construct validity.The Korean version of the FFI is a reliable and valid questionnaire for the self-assessment of pain and disability in Korean patients with foot complaints.
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NewsBot · Jul 20, 2016

Age- and Sex-Related Normative Data for the Foot Function Index FFI in a German-Speaking Cohort
Wolfgang Schneider et al
Foot & Ankle International July 19, 2016

Background: Despite increasing popularity of the Foot Function Index (FFI), normative values are still unavailable for this self-administered score. This study was designed to generate age- and sex-related normative values for the FFI-total and for both subscales FFI-pain and FFI-disability.
Methods: We used the cross-cultural adapted and validated German version of the FFI to generate a data pool using the results of 625 individuals, including staff and visitors to our hospital and excluding persons scheduled for foot surgery or in after-treatment.
Results: Mean values for FFI-total were calculated: 15.3 points (95% confidence interval [CI], 13.3-16.9), 14.9 points for FFI-pain (CI, 13.3-16.5), and 15.6 for FFI-disability (CI, 13.8-17.4). Results showed higher values for FFI-total, FFI-pain, and FFI-disability for individuals older than 40 years. In general, normative values showed a tendency for higher values with age. A slightly inconsistent distribution over different age groups with a peak for individuals in their 40s and 50s was observed, especially for FFI-pain. Men had better scores than women. Individuals with previous surgery showed lower scores in their respective score.
Conclusions: Our data calculated normative values for a German-speaking cohort for FFI-total as well as for both subscales FFI-pain and FFI-disability. Our data quantified the increase of FFI-total, FFI-pain, and FFI-disability normative values with age but also showed a slightly inconsistent distribution of normative values over all age groups. We demonstrated higher normative values for women and slightly higher normative values for individuals with previous foot or ankle surgery.
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NewsBot · Oct 25, 2016

Validity and reliability of the Foot Function Index (FFI) questionnaire Brazilian-Portuguese version
Martinez, B.R., Staboli, I.M., Kamonseki, D.H. et al.
SpringerPlus (2016) 5: 1810. doi:10.1186/s40064-016-3507-4

Purpose
To evaluate the validity and reliability of the Foot Function Index (FFI) in its Brazilian Portuguese version.

Methods
The validity and reliability of the FFI were tested in 50 volunteers, with plantar fasciitis, metatarsalgia and chronic ankle sprain. The FFI validity process used the Short Form-36 (SF-36) and Foot and Ankle Outcome Score (FAOS) questionnaires. The correlation between FFI, SF-36 and FAOS was done using the Pearson’s linear coefficient. The inter and intra-evaluator reliability was ascertained by means of the intraclass correlation coefficient (ICC) and the internal consistency by means of Cronbach’s alpha coefficient. The scores were used to assess the standard error measurement (SEM), minimal detectable change (MDC) and ceiling floor and effects.

Results
The validity process showed that there were correlations between FFI and the “pain” and “social aspects” subscales of SF-36 and all subscales of FAOS, except for “other symptoms”. The Brazilian-Portuguese version of FFI showed excellent intra and interevaluator correlations, with an ICC range of 0.99–0.97 and score reliability that was considered highly satisfactory, with Cronbach’s alpha range of 0.80–0.61. The SEMs for inter and intra-evaluator reliability were 1.32 and 1.08, respectively. The MDC was 2.42 (90 % confidence interval). No ceiling and floor effect were detected.

Conclusions
The Brazilian-Portuguese version of the FFI questionnaire was found to be a valid and reliable instrument for foot function evaluation, and can be used both in scientific settings and in clinical practice.
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NewsBot · Feb 18, 2017

The reliability and validity of the Korean version of the foot function index for patients with foot complaints.
In TS, Jung JH, Kim K, Jung KS, Cho HY
J Phys Ther Sci. 2017 Jan;29(1):53-56. doi: 10.1589/jpts.29.53

[Purpose] The purpose of this study was to establish the reliability and validity of the Foot Function Index translated into Korean for use in patients with plantar fasciitis and foot/ankle fracture. [Subjects and Methods] Thirty-six subjects with foot complaints, 14 males and 22 females, participated in the study. Reliability was determined by using the intra-class correlation coefficient and Cronbach's alpha for internal consistency. Validity was examined by correlating Foot Function Index scores with the Short Form-36 and the Visual Analog Scale scores. [Results] Test-retest reliability was 0.90 for the pain subscale, and 0.94 and 0.91 for the disability and activity limitation subscales, respectively. The criterion-related validity was established by comparison with the Korean version of the Short Form-36 and Visual Analog Scale. [Conclusion] The Korean version of the Foot Function Index was shown to be a reliable and valid instrument for assessing foot complaints.
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NewsBot · May 13, 2017

Chinese cross-cultural adaptation and validation of the Foot Function Index as tool to measure patients with foot and ankle functional limitations.
González-Sánchez M et al
Disabil Rehabil. 2017 May 11:1-6. doi: 10.1080/09638288.2017.1325944

PURPOSE:
To perform a cross-cultural adaptation and validation of the Foot Function Index (FFI) questionnaire to develop the Chinese version.
MATERIALS AND METHODS:
Three hundred and six patients with foot and ankle neuromusculoskeletal diseases participated in this observational study. Construct validity, internal consistency and criterion validity were calculated for the FFI Chinese version after the translation and transcultural adaptation process.
RESULTS:
Internal consistency ranged from 0.996 to 0.998. Test-retest analysis ranged from 0.985 to 0.994; minimal detectable change 90: 2.270; standard error of measurement: 0.973. Load distribution of the three factors had an eigenvalue greater than 1. Chi-square value was 9738.14 (p < 0.001). Correlations with the three factors were significant between Factor 1 and the other two: r = -0.634 (Factor 2) and r = -0.191 (Factor 1). Foot Function Index (Taiwan Version), Short-Form 12 (Version 2) and EuroQol-5D were used for criterion validity. Factors 1 and 2 showed significant correlation with 15/16 and 14/16 scales and subscales, respectively.
CONCLUSIONS:
Foot Function Index Chinese version psychometric characteristics were good to excellent. Chinese researchers and clinicians may use this tool for foot and ankle assessment and monitoring. Implications for rehabilitation A cross-cultural adaptation of the FFI has been done from original version to Chinese. Consistent results and satisfactory psychometric properties of the Foot Function Index Chinese version have been reported. For Chinese speaking researcher and clinician FFI-Ch could be used as a tool to assess patients with foot disease.
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NewsBot · Dec 14, 2017

Translation and cultural adaptation of the revised foot function index for the Portuguese language: FFI-R Brazil.
Yi LC et al
Sao Paulo Med J. 2017 Dec 7:0. doi: 10.1590/1516-3180.2017.0183030817.

BACKGROUND:
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 patients themselves.

CONCLUSION:
The translation and cultural adaptation of the FFI-R for the Portuguese language were completed and the Brazilian version was obtained.
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NewsBot · Jul 2, 2019

Foot Function Index: a promising questionnaire for patients with Charcot-Marie-Tooth disease type 1A.
Bihel L et al
Arch Phys Med Rehabil. 2019 Jun 27

OBJECTIVE:
To evaluate in a preliminary methodological study, the Foot Function Index (FFI), a 3-subscale (pain, disability and activity restriction) foot disability assessment questionnaire, in patients with Charcot-Marie-Tooth disease type 1A (CMT1A).

DESIGN:
Monocentric exploratory cross-sectional study with 2 identical evaluations by the same Physical Medicine and Rehabilitation physician at 14-day intervals (test-retest) according to international guidelines for validating health-related patient-reported outcomes (COSMIN criteria).

SETTING:
Physical Medicine and Rehabilitation and Neurology departments in a French academic hospital.

PARTICIPANTS:
Twenty-six patients with CMT1A confirmed by molecular biology.

INTERVENTION:
The FFI and a health-related quality of life questionnaire (Medical Outcomes Study Short Form 36 [SF-36] with mental and physical composite scores) combined with quantitative walk analysis by GAITRite® and evaluation of isokinetic quadriceps and hamstrings peak torque by CybexHumanNorm®.

MAIN OUTCOME MEASURES:
FFI score and its dimensions.

RESULTS:
Acceptability was satisfactory, with less than 5% missing data and good distribution of results. Internal consistency was very satisfactory, with Cronbach alpha 0.95. Reproducibility was very satisfactory, with Lin concordance coefficient 0.82. External consistency was satisfactory, with expected correlation coefficients: the FFI was significantly correlated with the SF-36 physical composite score and gait parameters (cadence) (r=-0.58 and r=-0.52, p<0.005) but not with peak torque or SF-36 mental composite score.

CONLUSION:
This study confirms the very good metrological properties of the FFI in patients with CMT1A. The FFI could be a promising questionnaire to assess foot-related disability in a neurologic disease. Complementary studies are still needed to confirm these promising preliminary results.
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NewsBot · Jul 19, 2019

Reliability and Validity of the Persian Version of the Foot Function Index in Patients with Foot Disorders.
Mousavian A et al
Arch Bone Jt Surg. 2019 May;7(3):291-296.

BACKGROUND:
Foot function index (FFI) is a worthy subjective patient reported outcome measures (PROM) tool for evaluation of the outcomes of medical interventions on foot and ankle. This study was conducted to assess the validity of the Persian version of the foot function index (FFI).

METHODS:
After translating the original FFI into Persian, back-translation was performed on the agreed Persian version and the final version was established. A total of 113 Persian-speaking patients with foot and ankle problems were enrolled in this study and were asked to fill in the FFI.

RESULTS:
The Cronbach's alpha for subsections of FFI and MOXFQ was above 0.8 and 0.7, respectively, while it was 0.95 and 0.93 for total FFI and MOXFQ, respectively. The ICC for all subsections of MOXFQ and FFI was above 0.7. The Pearson's correlation coefficient for all subsections of FFI and MOXFQ was significant (P<0.01).

CONCLUSION:
The Persian version of FFI is valid and reproducible in Persian speaking population.
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NewsBot · Sep 13, 2020

Thai version of the foot function index: a cross-cultural adaptation with reliability and validity evaluation
Sunee Bovonsunthonchai, Suthasinee Thong-On, Roongtiwa Vachalathiti, Warinda Intiravoranont, Sarawut Suwannarat & Richard Smith
BMC Sports Science, Medicine and Rehabilitation volume 12, Article number: 56 (2020)

Background
The study aimed to translate the foot function index (FFI) questionnaire to Thai and to determine psychometric properties of the questionnaire among individuals with plantar foot complaints.

Methods
The Thai version of the FFI (FFI-Th) was adapted according to a forward and backward translation protocol by two independent translators and analyzed by a linguist and a committee. The FFI-Th was administered among 49 individuals with plantar foot complaints to determine internal consistency, reliability, and validity. Cronbach’s alpha and the Intraclass Correlation Coefficient (ICC3,1) were used to test the internal consistency and test-retest reliability. The Principal Component Analysis with varimax rotation method was used to test the factor structure and construct validity. Furthermore, the criterion validity was tested using Pearson’s correlation coefficient (rp) between the FFI-Th and the visual analogue pain scale (pain-VAS) as well as the EuroQol five-dimensional questionnaire (EQ-5D-5L).

Results
The FFI-Th showed good to excellent internal consistency and test-retest reliability in the total score, pain, disability, and activity limitation subscales. The Principal Component Analysis produced 4 principal factors from the FFI-Th items. Criterion validity of the FFI-Th total score showed moderate to strong correlations with pain-VAS and EQ-5D-5L, and EQ-VAS scores.

Conclusion
The FFI-Th was a reliable and valid questionnaire to assess the foot function in a Thai population.
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NewsBot · Apr 9, 2022

Foot Function Index for Arabic-speaking patients (FFI-Ar): translation, cross-cultural adaptation and validation study
Shershah Khan et al
J Orthop Surg Res. 2022 Apr 7;17(1):212

Background: Foot Function Index (FFI) is a valid and reliable outcome measure, which is widely used to measure the foot and ankle functional level and disorders. Until now, no validated Arabic version of the FFI is available. This study was conducted at a tertiary care hospital in Riyadh, Saudi Arabia. The purpose of this project was to translate and adapt the FFI into Arabic and to evaluate its psychometric properties of validity and reliability.

Methods: The study consisted of two phases. The first phase was the translation and cultural adaptation of the FFI to Arabic. The next phase involved, testing the psychometric properties of the Arabic version of the FFI on a sample of 50 consecutive participants which included internal consistency, test-retest reliability, floor and ceiling effects and construct validity.

Results: The mean age of the study participants was 38 ± 12.94 years. Both the genders were evenly enrolled with 50% of the participants as male and 50% as female. Majority of them complained of plantar fasciopathy (32%) followed by pes planus (22%) and ankle sprain (18%). The scores of FFI-Ar were normally distributed, confirmed by a significant Shapiro-Wilk test. The mean value of FFI-Ar total score was 47.73 ± 19.85. There were no floor or ceiling effects seen in any of the subscales and total score. The internal consistency was good with the Cronbach's alpha value of 0.882, 0.936 and 0.850 for the pain, disability and activity limitation subscales, respectively. The reproducibility of the FFI-Ar was analysed by intra-class correlation coefficient which revealed good to excellent test-retest reliability. A significant correlation was found between FFI-Ar and SF-36 and numeric rating scale (NRS) confirming its construct validity.

Conclusion: The FFI-Arabic version showed good validity and reliability in patients with foot and ankle problems. This tool can be used in usual practice and research for analysing foot and ankle disorders in Arabic-speaking people.
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NewsBot · May 11, 2022

"Psychometric properties of the Norwegian foot function index revised short form"
Marianne Mørk et al
BMC Musculoskelet Disord. 2022 May 3;23(1):416

Background: Foot disorders affect up to one quarter of the adult population. Plantar fasciopathy is a common cause of foot pain associated with decreased activity level and quality of life. Patient-reported outcome measures are important in assessing the burden of a condition as well as in research on the effects of interventions. The Foot Function Index revised short form (FFI-RS) is a region specific questionnaire frequently used in research. This study aimed to cross-culturally adapt the FFI-RS into Norwegian and to test its psychometric properties.

Methods: The FFI-RS was translated into Norwegian (FFI-RSN) following international guidelines. 139 patients with foot disorders (88% with plantar fasciopathy) were included at baseline to measure internal consistency, explorative factor analysis, construct validity and floor and ceiling effects. 54 patients were included after 1 week for test-retest reliability and smallest detectable change analyses. 100 patients were included for responsiveness and minimal important change at 3 months.

Results: Cronbach's alpha for internal consistency was 0.97 and factor analysis supported the use of the total score of the FFI-RSN. Two out of three predefined hypotheses were confirmed by assessing the construct validity with Spearman's correlation coefficient. Quadratic weighted Kappa for test-retest reliability showed 0.91 (95% CI 0.86-0.96) and the smallest detectable change was 6.5%. The minimal important change was 8.4% and the area under the receiver operating characteristic curve for responsiveness was 0.78 (95% CI 0.69-0.87). We found no floor or ceiling effects on the total score of the FFI-RSN.

Conclusions: The present study showed excellent reliability of the FFI-RSN and supports the use of the total score of the questionnaire. Furthermore, we found the FFI-RSN to have acceptable responsiveness in relation to change in general health. Smallest detectable change, minimal important change and responsiveness were presented as novel results of the total score of the FFI-RS. FFI-RSN can be used to evaluate global foot health in clinical or research settings with Norwegian patients suffering from plantar fasciopathy.
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NewsBot · May 15, 2022

The Importance of Foot Function Assessment Using the Foot Function Index-Revised Short Form (FFI-RS) Questionnaire in the Comprehensive Treatment of Patients with Rheumatoid Arthritis
Radosław Rutkowski, Małgorzata Gizińska, Małgorzata Gałczyńska-Rusin, Magdalena Paulina Kasprzak, Elly Budiman-Mak
J Clin Med. 2022 Apr 20;11(9):2298

Background: Foot problems may have a substantial negative impact on rheumatoid arthritis (RA) patients' mobility. They affect walking and the functional capacity to perform daily tasks.

Methods: This study included 61 patients with RA and foot pain or swelling. The study group comprised 37 patients (aged 54.3 ± 9.5 years) with foot lesions, as demonstrated in an ultrasound, and the control group comprised 24 patients (aged 57.3 ± 11.5 years) without foot lesions. The patients' health statuses were evaluated with the Foot Function Index-Revised Short Form (FFI-RS), the Polish version of the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Disease Activity Score 28 (DAS 28).

Results: The FFI-RS showed significant differences between the study and control groups in total results, as well as in the pain and stiffness subscales. Subsequent analyses showed numerous significant correlations. The FFI-RS total results correlated with the HAQ's standing up, walking, and total results. The FFI-RS pain results correlated with the social issues and HAQ's total results. The FFI-RS difficulty results correlated with the disease's duration. In the study group, there were significant correlations of the FFI-RS stiffness, difficulty, and social issues results with the HAQ's standing up, walking, and total results, and also of the FFI-RS activity limitation results with the HAQ's standing up results. In the control group, there were correlations of the FFI-RS stiffness, difficulty, and activity limitation results with the HAQ's walking and total results. Finally, in the study group, we also found correlations of the FFI-RS total, pain, stiffness, difficulty, and social issues results with the Visual Analog Scale (VAS) results, as well as of the FFI-RS total results with the DAS 28 results.

Conclusions: The FFI-RS is an effective tool for assessing RA patients' functional status and can be used to evaluate treatment effects. The FFI-RS detected RA-related changes in the foot joint function in patients without foot lesions, as assessed by ultrasound.
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NewsBot · Oct 17, 2022

Many-faceted rasch calibration of the foot function index-revised short form
Seungho Ryu et al
J Foot Ankle Res. 2022 Oct 17;15(1):77

Background: The Foot Function Index Revised Short version (FFI-RS) is a foot- and ankle- patient-reported outcome measure (PROM), developed from the Foot Function Index (FFI). Previous studies, estimating item parameters and multidimensional properties, have limitations properly establishing the measurement properties of the FFI-RS. A multi-faceted Rasch analysis with a larger sample would allow for a more robust validation approach to improve the clinical interpretation of the FFI-RS using a multidimensional perspective. Therefore, the purpose of this study was to assess the psychometric properties of the FFI-RS as a PROM of foot function.

Method: A total of 2184 patients with foot pathology who completed the FFI-RS were included in the data. Data were extracted from the cloud-based orthopedic and sports medicine global registry Surgical Outcome System (SOS). The psychometric properties of the FFI-RS were assessed using a many-faceted Rasch analysis that included model-data fit, rating scale function, item-person map (distribution of item difficulty and person ability), and item difficulty of the subscale.

Results: Two misfit items were discovered and deleted; 32-items from the original FFI-RS were retained. The 4-item Likert scale functioned effectively and item difficulty (-0.58 to 1.48), subscale difficulty (-0.58 to 1.15), and person's foot function (-6.62 to 6.24) had wide distributions.

Conclusions: Many-faceted Rasch analysis revealed the FFI-RS had sound psychometric properties using the many-faceted Ranch analysis and retained 32 of the original items. Clinicians and researchers should consider weaknesses identified with items in the 'Difficulty" subscale and future work should be conducted to modify or develop items that will more accurately evaluate a wide range of foot function levels.
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