Elsevier

Foot and Ankle Surgery

Volume 24, Issue 6, December 2018, Pages 481-485
Foot and Ankle Surgery

Reliability, validity and responsiveness of the German Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery

https://doi.org/10.1016/j.fas.2017.05.007Get rights and content

Highlights

  • German translation of the Manchester-Oxford Foot Questionnaire (MOXFQ) with evaluation of reliability, validity and responsiveness.

  • The German version of the MOXFQ showed excellent reliability and responsiveness.

  • The German MOXFQ is a valid and reliable patient-reported outcome measure for use in foot and ankle patients.

Abstract

Background

Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopaedic procedures. The intention of this study was to develop and culturally adapt a German version of the Manchester-Oxford Foot Questionnaire (MOXFQ) and to evaluate reliability, validity and responsiveness.

Methods

According to guidelines forward and backward translation has been performed. The German MOXFQ was investigated in 177 consecutive patients before and 6 months after foot or ankle surgery. All patients completed MOXFQ, Foot and Ankle Outcome Score (FAOS), Short form 36 and numeric scales for pain and disability (NRS). Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed.

Results

The German MOXFQ demonstrated excellent test-retest reliability with ICC values >0.9 Cronbach’s alpha (α) values demonstrated strong internal consistency. No floor or ceiling effects were observed. As hypothesized MOXFQ subscales correlated strongly with corresponding FAOS and SF-36 domains. All subscales showed excellent (ES/SRM >0.8) responsiveness between preoperative assessment and postoperative follow-up.

Conclusions

The German version of the MOXFQ demonstrated good psychometric properties. It proofed to be a valid and reliable instrument for use in foot and ankle patients.

Introduction

Patient reported outcome measurements (PROMS) can provide reliable and valid measures of patient’s degree of pain, impairment, disability, and quality of life. They are a critical tool in evaluating the efficacy of orthopaedic procedures and are increasingly used in clinical trials to assess outcomes of health care [1]. The Manchester-Oxford Foot Questionnaire (MOXFQ) is a PROM for surgery of the foot and ankle, initially assessed in patients undergoing hallux valgus surgery [2], [3]. Further evaluation provided evidence in support of the reliability and validity using data from a large sample of patients undergoing surgery of a wide range of foot or ankle conditions [4], [5]. The MOXFQ contains three sub-scores for pain, walking/standing and social interaction dimensions as well as a summary index score (MOXFQ-Index). Currently it has been translated and evaluated in English, Italian, Dutch, Turkish, Persian and Spanish [2], [6], [7], [8], [9], [10].

The aim of this study was to translate the MOXFQ into German language, culturally adapt it according to international guidelines, and to evaluate reliability, validity and responsiveness.

Section snippets

Methods

The study was approved by the local research ethics committee (ref 15-252) and performed in accordance with the Declaration of Helsinki. Written informed consent from all participants was obtained. Use and translation of the English MOXFQ has been approved by ISIS Innovation Limited.

Results

177 patients, 130 women and 47 men, with a mean age of 57 years (18–92) undergoing surgery of the foot or ankle were consecutively recruited at a single institution and completed the baseline 3–14 days before surgery (t1). On the morning before surgery (t2) 145 patients completed MOXFQ to determine reliability. 6 months after surgery (t3) 117 patients completed MOXFQ, FAOS, SF-36 and NRS to test responsiveness. 118 patients were undergoing forefoot, 56 patients hindfoot or ankle surgery.

Discussion

Patient related outcome measures have become an important tool in clinical practice and clinical trials to assess outcome of health care [1], [22]. The MOXFQ is an increasingly used PROM in foot and ankle surgery which has been extensively tested and translated into Italian, Dutch, Turkish, Persian and Spanish [2], [3], [4], [5], [6], [7], [8], [9], [10], [23], [24].

In this study the English version of the MOXFQ was cross-culturally adapted and translated to German according to the official

Conflict of interest

All authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References (24)

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