Cross-Cultural Adaptation and Validation of the Russian-Language Version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS)

Background. Developed in 1994 by H. Kitaoka et al. the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS-AHS) allows to assess pain, function, deformity and alignment of the foot and ankle. There is no Russian language AOFAS-AHS questionnaire adapted according to current standards in the scientific literature.The aim of this paper is to perform the cross-cultural adaptation and to assess the validity of the Russian-language version of the AOFAS-AHS scale, including the evaluation of its psychometric properties.Methods. The original English version of the AOFAS-AHS scale was translated from English into Russian by a native Russian speaker. Then the questionnaire was back-translated into English by another translator whose native language is English. The next stage was the comparison of the original and back-translated versions, followed by the presentation of a pre final cross-culturally adapted version, which was tested on 10 patients to ensure that the questions were comprehensible. The next step was the approval of the final version and its completion by patients to be operated on the hindfoot or ankle. The printed copy of the final version of the questionnaire was completed by the patients with an interval of 3 days. Total of 44 consecutive patients were enrolled, including 18 women (41%) and 26 men (59%), with a mean age of 61.7 (32-78) years. The psychometric properties of the Russian-language version of the AOFAS-AHS questionnaire (internal consistency, retest reliability, measurement error, responsiveness, and construct validity) were assessed based on the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) principles.Results. The mean score according to the AOFAS-AHS scale was 49.6 (min 2; max 82) out of a possible 100. The average time to complete the questionnaire was 4.2 minutes. All hypotheses formulated showed correlations of varying moderate to strong degrees. The Cronbach's alpha coefficient was 0.76, which indicates a high level of internal consistency of the elements of the validated questionnaire. A good intra-class consistency of 0.83 was obtained, which shows a high degree of reliability of the questionnaire's reproducibility. The ceiling and floor effects for the primary results of the questionnaires did not exceed 15%. The mean value of the Russian-language version of the AOFAS-AHS increased to 86.6 after surgical treatment. The values of standardized effect size (ES) and standardized response mean (SRM) were 5.56 and 4.83, respectively.Conclusion. The adapted Russian-language version of the AOFAS-AHS scale showed good psychometric properties and can be recommended for assessment of the physical activity in patients with ankle and hindfoot-related pathology and can also be used for monitoring the changes during the treatment.