The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in nine European languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish). From other languages under validation, the Persian version finished data acquisition and underwent further validation.
The Persian version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Persian version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.
The internal consistency was confirmed in the Persian version (Cronbach’s Alpha 0.82). The Standard Error of Measurement (SEM) was 0.38 and is similar to other language versions. Between baseline and follow-up, 97% of patients showed an improvement on their EFAS score, with excellent responsiveness (effect size 1.93).
The Persian EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.
The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in nine European languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish) [1,2]. The EFAS score covers pain and physical function, and is internally consistent, unidimensional and responsive to change in samples of orthopaedic foot and ankle surgery patients [1,2]. The score contains six questions. The maximum score is 24 points (best possible), and the minimum 0 points (worst possible). Language-specific cross-cultural validation of a given score is necessary because simple translation of a validated score does not necessarily result in an instrument that provides valid scores in the target language [1,2]. This issue is especially important for Europe, where numerous languages are spoken . The most spoken mother tongues in Europe are German (18%), English (13%), Italian (13%), French (12%), Spanish (8%), Polish (8%), Romanian (5%) and Dutch (4%).10 In addition to all these native European languages, other languages, such as Persian and Arabic, are spoken as mother tongue by a growing number of immigrants.10 Therefore, a need for different language-specific (validated) scores was planned at the very inception . After having initially validated the EFAS Score in seven languages (English, German, French, Italian, Polish, Dutch, Swedish), the data acquisition in ten other languages (Arabic, Danish, Estonian, Finnish, Hungarian, Norwegian, Persian, Portuguese, Spanish, Turkish) started at different timepoints.