Translation, cross-cultural adaptation, reliability, and validation of the italian version of the Foot and Ankle Disability Index (FADI)

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Massimiliano Leigheb
Emanuele Rava
Dario Vaiuso
Elena Manuela Samaila
Francesco Pogliacomi
Michela Bosetti
Federico Alberto Grassi
Maurizio Sabbatini


evaluation scale, validation, cultural adaptation, foot, ankle, disability, Quality of Life, questionnaire, FADI, Italian.


Background and Aim of the work: Foot-and-Ankle-Disability-Index (FADI) is one of the most
widely used evaluation questionnaires for this anatomical district, but an italian validated version lacks and is
necessary to properly evaluate italian people. In fact a correct interpretation of the items by patients is essential
to obtain a precise subjective response, making the questionnaire valid to evaluate patients’ satisfaction and
wellness. Our purpose was to translate and culturally adapt into Italian the FADI questionnaire, and to check
its reproducibility and validity. Materials and Methods: The original english version of FADI questionnaire
was translated into Italian and checked for medical part coherence. It was submitted to 10 italian randomized
patients to verify a correct cultural adaptation, and then to other 50 randomized patients operated at their
ankle or hallux to assess intra- and inter-observer reproducibility by the Pearson’s-Correlation-Coefficient
(PCC) and the Intra-Class-Correlation (ICC) coefficient. Moreover, Short-Form-36 (SF36) questionnaire
for Quality-of-Life and Visual-Analogue-Scale (VAS) for pain were also administered to the same 60 people
and compared to italian-FADI to perform validation analysis by PCC and ICC coefficient. Results: Cultural
adaptation of the translated version of the scale resulted good in terms of understandability by patients. An
optimal correlation of the inter- and intra-observer reproducibility was obtained. The correlation obtained
between FADI and SF-36 as well as between FADI and VAS indicates success in the validation process.
Conclusions: Validation of the FADI italian version has been performed successfully, its use can be considered
appropriate and is indicated in italian clinical practice. (


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