title: Cross-cultural adaptation and multi-centric validation of the Italian version of the Achilles tendon Total Rupture Score (ATRS).
abstract: OBJECTIVE
  The purpose of this study was to translate the Achilles tendon Total Rupture Score (ATRS) into Italian and establish its cultural adaptiveness and validity.
  
  
  METHODS
  The original version of the ATRS was translated into Italian in accordance with the stages recommended by Guillemin. A web-based survey was developed to test the construct validity of the Italian ATRS. Eighty patients with an average age of 45.5 years (SD 11) were included in the study. The ATRS was completed twice at 5 days intervals for test-retest reliability. The intraclass correlation coefficient was used to calculate the test-retest reliability, and Cronbach's α coefficient was used for internal consistency. Validity was evaluated by external correlation (Spearman's rank correlation coefficient, r) of the ATRS with the Italian versions of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A), the 17-Italian Foot Function Index (17-FFI), the Lower Extremity Functional Scale (LEFS), and the Short-Form 36 (SF-36).
  
  
  RESULTS
  The internal consistency (α = 0.97) and the test-retest reliability (ICC = 0.96) were excellent. The correlation coefficient showed strong correlation of the Italian ATRS with the VISA-A and the LEFS (r = 0.72 and r = 0.70, respectively, p < 0.0001), a weak correlation with the 17-FFI (r = -0.30, p = 0.007), and high-to-moderate correlation with the physical functioning, bodily pain, physical role functioning, social functioning, role emotional, and vitality of the SF-36 (r = 0.75, r = 0.61, r = 0.52, r = 0.49, r = 0.40 and r = 0.34, respectively, p < 0.0001).
  
  
  CONCLUSIONS
  The Italian version of the ATRS is a valid instrumentation to assess the functional limitations of Italian patients after Achilles tendon rupture.
  
  
  METHODS
  III.
authors.affiliation: Orthopaedic and Traumatology Department, Oderzo Hospital, Oderzo, Treviso, Italy. mascvoz@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vascellari
authors.affiliation: IRCCS Policlinico San Donato, San Donato, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Spennacchio
authors.affiliation: Orthopaedic and Traumatology Department, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Combi
authors.affiliation: 2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Grassi
authors.affiliation: Department of Orthopaedics and Traumatology, Bari University Hospital, Bari, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Patella
authors.affiliation: Orthopaedic Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Bisicchia
authors.affiliation: Centre of Sports Traumatology, Koelliker Hospital, Turin, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Canata
authors.affiliation: 2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaffagnini
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries*; D000328:Adult; D000368:Aged; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000175:diagnosis*; D014175:Translating; D015599:Trauma Severity Indices
keywords: ATRS; Achilles tendon rupture; Cross-cultural; Italian; Reliability; Validity