Translation, Cross-cultural Adaptation, and Clinimetric Testing of Instruments Used to Assess Patients With Ankle Sprain in the Brazilian Population

STUDY DESIGN: Clinical measurement study. BACKGROUND: Ankle sprain is a common condition. Therefore, translated, culturally adapted, and clinimetrically tested instruments for measuring the ankle are needed. OBJECTIVES: To translate and cross-culturally adapt the Sports Athlete Foot and Ankle Score (SAFAS) and the global rating of change (GROC) into Brazilian Portuguese. This study also aimed to test the measurement properties of the SAFAS, the GROC, and the existing Brazilian-Portuguese versions of the numeric pain-rating scale (NPRS) and the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) in a group with ankle sprain. METHODS: The SAFAS and GROC instruments were cross-culturally adapted into Brazilian Portuguese and pretested in this population (n = 18). The measurement properties of the SAFAS, GROC, NPRS, and AOFAS (internal consistency, ceiling and floor effects, construct validity, reproducibility, and responsiveness) were tested in a test-retest design in patients with ankle sprain at baseline (n = 63) and at follow-up periods of 48 to 72 hours (n = 53) and 4 weeks (n = 43) after baseline. RESULTS: The SAFAS, GROC, NPRS, and AOFAS yielded considerable internal consistency (Cronbach alpha ranging from .76 to .97), moderate reliability (intraclass correlation coefficient model 2,1 ranging from 0.59 to 0.80), and dubious agreement (percentage of the standard error of measurement ranging from 13% to 22.43%). The highest correlations on construct validity were observed among the 4 SAFAS subscales (Pearson r = 0.75 to 0.86, P <. 01), but statistically significant values appeared in the intercorrelation of instruments. There were no observed floor or ceiling effects in any of the instruments. All of their scores of change showed moderate correlation with the GROC (r = -0.48 to 0.30, P <. 05) and could be classified as responsive. CONCLUSION: The Brazilian-Portuguese versions of the SAFAS, GROC, NPRS, and AOFAS had acceptable measurement properties in high-performing athletes.