Translation, Cross-Cultural Adaptation, and Validation of the Arabic Foot and Ankle Outcome Score (FAOS-AR).

Abstract

The Foot and Ankle Outcome Score (FAOS) assesses pain, function, sports activity, and quality of life in patients with foot and ankle disorders. Its use in Arabic-speaking populations is limited by the absence of a validated Arabic version. To translate, culturally adapt, and validate an Arabic version of the FAOS (FAOS-AR). Prospective validation study. The FAOS was translated and culturally adapted into Arabic using cross-cultural methodology, including forward translation, reconciliation, back-translation, review, and pilot testing. Adults aged ≥18 years with foot or ankle pain were recruited from two outpatient clinics and completed the FAOS-AR and the Arabic American Orthopaedic Foot and Ankle Society score (AOFAS-AR). A clinically stable subgroup repeated the FAOS-AR after 5-10 days. Psychometric evaluation included internal consistency, test-retest reliability, measurement error, and content, structural, and convergent validity. Score distributions showed acceptable floor and ceiling effects. Internal consistency was excellent for Function/Activities of Daily Living (α=0.97), Sports/Recreation (α=0.90), and Pain (α=0.89); acceptable for Quality of Life (α=0.73); satisfactory for Stiffness (α=0.75); and low for Symptoms (α=0.34). Test-retest reliability was excellent for the total score (ICC=0.978) and all subscales except Symptoms (ICC=0.778). The standard error of measurement was 3.16, yielding a minimal detectable change of 8.76 points. Principal component analysis supported unidimensionality for most subscales, whereas Symptoms demonstrated multidimensionality. Convergent validity was shown by correlations with AOFAS-AR domains (ρ=0.516-0.673). The FAOS-AR is valid for assessing outcomes in patients with foot and ankle conditions. Level II.