Multilingual Development and Validation of a Patient-Reported Outcome Measure (PROM) by the Score Committee of the European Foot and Ankle Society (EFAS)

In 2013, the development and validation of the EFAS Score started. As there was no adequate validated foot and ankle score in different European languages, EFAS created a committee (Score Committee), inaugurated and headed by Martinus Richter, to develop, validate and publish a new score in common European mother tongues.

Language-specific validation

Validating a new score in different languages requires language-specific validation, not just the translation of an already validated score into another language. Therefore, validation in particular has been a very elaborate statistical process involving more than 2800 questionnaires of different languages. In 2018, development and validation of the EFAS Score was completed in 7 languages (Dutch, English, French, German, Italian, Swedish, Polish). The Finnish and Turkish score versions followed 2020, the Persian version 2021, the Portuguese version 2022 and the Spanish and Estonian versions 2023. Thus, the validated and published language-specific scoreversions cover 13 languages in total (Dutch, English, Estonian, German, Finnish, French, Italian, Polish, Portuguese, Persian, Spanish, Swedish and Turkish) comprising 454 million or 61% of all mother tongues in Europe. When looking at total speakers (mother tongue and secondary languages, the EFAS Score is validated for 3 billion total speakers. Not necessary to mention that the validated EFAS Score versions cover by far the most mother tongues and total speakers of all foot and ankle scores worldwide. Other language versions are under validation (Arabic, Danish, Hungarian, Norwegian). Non-native European languages such as Persian, Arabic or Chinese (Mandarin,  have also been considered for validation to reflect the growing immigration.

Read full Score article here.