title: Spanish translation, cross-cultural adaptation, and validation of the Questionnaire for Diabetes-Related Foot Disease (Q-DFD).
abstract: OBJECTIVE
  To translate, cross-culturally adapt, and validate the Questionnaire for Diabetes-Related Foot Disease (Q-DFD), originally created and validated in Australia, for its use in Spanish-speaking patients with diabetes mellitus.
  
  
  METHODS
  The translation and cross-cultural adaptation were based on international guidelines. The Spanish version of the survey was applied to a community-based (sample A) and a hospital clinic-based sample (samples B and C). Samples A and B were used to determine criterion and construct validity comparing the survey findings with clinical evaluation and medical records, respectively; while sample C was used to determine intra- and inter-rater reliability.
  
  
  RESULTS
  After completing the rigorous translation process, only four items were considered problematic and required a new translation. In total, 127 patients were included in the validation study: 76 to determine criterion and construct validity and 41 to establish intra- and inter-rater reliability. For an overall diagnosis of diabetes-related foot disease, a substantial level of agreement was obtained when we compared the Q-DFD with the clinical assessment (kappa 0.77, sensitivity 80.4%, specificity 91.5%, positive likelihood ratio [LR+] 9.46, negative likelihood ratio [LR-] 0.21); while an almost perfect level of agreement was obtained when it was compared with medical records (kappa 0.88, sensitivity 87%, specificity 97%, LR+ 29.0, LR- 0.13). Survey reliability showed substantial levels of agreement, with kappa scores of 0.63 and 0.73 for intra- and inter-rater reliability, respectively.
  
  
  CONCLUSIONS
  The translated and cross-culturally adapted Q-DFD showed good psychometric properties (validity, reproducibility, and reliability) that allow its use in Spanish-speaking diabetic populations.
authors.affiliation: School of Medicine, Universidad Espíritu Santo-Ecuador, Samborondón, Guayas, Ecuador. wcastillo@uees.edu.ec
authors.forename: Wilson
authors.initials: W
authors.lastname: Castillo-Tandazo
authors.forename: Adolfo
authors.initials: A
authors.lastname: Flores-Fortty
authors.forename: Lourdes
authors.initials: L
authors.lastname: Feraud
authors.forename: Daniel
authors.initials: D
authors.lastname: Tettamanti
mesh_terms: D000368:Aged; D032882:Comprehension; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D017719:Diabetic Foot / Q000175:diagnosis*; D004484:Ecuador; D005260:Female; D006306:Health Surveys; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014175:Translating
keywords: diabetes mellitus; diabetic neuropathy; foot ulcers; peripheral vascular disease
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