Development and validation of the ankle fracture outcome of rehabilitation measure (A-FORM).
METHODS
Delphi panel and cohort study.


OBJECTIVE
To develop and refine a condition-specific, patient-reported outcome measure, the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), and to examine its psychometric properties, including factor structure, reliability, and validity, by assessing item fit with the Rasch model.


BACKGROUND
To our knowledge, there is no patient-reported outcome measure specific to ankle fracture with a robust content foundation.


METHODS
A 2-stage research design was implemented. First, a Delphi panel that included patients and health professionals developed the items and refined the item wording. Second, a cohort study (n = 45) with 2 assessment points was conducted to permit preliminary maximum-likelihood exploratory factor analysis and Rasch analysis.


RESULTS
The Delphi panel reached consensus on 53 potential items that were carried forward to the cohort phase. From the 2 time points, 81 questionnaires were completed and analyzed; 38 potential items were eliminated on account of greater than 10% missing data, factor loadings, and uniqueness. The 15 unidimensional items retained in the scale demonstrated appropriate person and item reliability after (and before) removal of 1 item (anxious about footwear) that had a higher-than-ideal outfit statistic (1.75). The "anxious about footwear" item was retained in the instrument, but only the 14 items with acceptable infit and outfit statistics (range, 0.5-1.5) were included in the summary score.


CONCLUSIONS
This investigation developed and refined the A-FORM (Version 1.0). The A-FORM items demonstrated favorable psychometric properties and are suitable for conversion to a single summary score. Further studies utilizing the A-FORM instrument are warranted. J Orthop Sports Phys Ther 2014;44(7):488-499. Epub 22 May 2014. doi:10.2519/jospt.2014.4980.
Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia.
Steven M
SM
McPhail
Cylie M
CM
Williams
Michael
M
Schuetz
Brett
B
Baxter
Peter
P
Tonks
Terry P
TP
Haines
D000328:Adult; D064386:Ankle Fractures / Q000534:rehabilitation*; D015331:Cohort Studies; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Rasch; internal consistency; orthopaedics; patient-reported outcome; quality of life