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 6,000 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, the Spanish and Estonian versions 2023 and the Danish version in 2024. Thus, the validated and published language-specific scoreversions cover 14 languages in total (Danish, Dutch, English, Estonian, German, Finnish, French, Italian, Polish, Portuguese, Persian, Spanish, Swedish and Turkish) comprising 460 million or 65% 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 including non-native European languages are under validation (Hungarian, Norwegian, Cantonese, Mandarin).

Read full Score article here.


Supplementary Materials
EFAS Score Committee
Member Function Language Start End
Martinus Richter Head, Core member all, German 2013 -
Per Henrik Agren Core member all, Swedish 2013 -
Jean-Luc Besse Core member all, French 2013 -
Maria Cöster Core member all, Swedish 2013 -
Hakon Kofoed Core member all 2013 -
Nicola Maffulli Core member all 2013 -
Martijn Stjeultjens Statistician, Core member all 2013 -
Dieter Rosenbaum Technical advisor, Core member all 2013 2018
Michael Stephens National affiliate member English 2014 2018
Fernando Alvarez National affiliate member Spanish 2015 2023
Andrzej Boszczyk  National affiliate member Polish 2015 2018
Kris Buedts  National affiliate member Dutch 2015 2018
Jeanette Penny National affiliate member Danish 2015 2022
Marco Guelfi National affiliate member Italian 2015 2018
Angelique Witteveen  National affiliate member Dutch 2015 2018
Jussi Repo  National affiliate member Finnish 2015 2020
Elena Samaila  National affiliate member Italian 2015 2018
Jan Willem Louwerens  National affiliate member Dutch 2015 2018
Esat Uygur  National affiliate member Turkish 2016 2020
Jeanette Penny  National affiliate member Danish 2015 2018
Amir Reza Vosoughi  National affiliate member Persian 2018 2021
Nuno Corte Real  National affiliate member Portuguese 2018 2022
Sandor Paior  National affiliate member Hungarian 2018 -
Martin Nsubuga  National affiliate member Norwegian 2015 2018
Mick Nielsen  National affiliate member Danish 2015 2024
Vahur Metsna  National affiliate member Estonian 2018 2023
Benjamin Hickey  National affiliate member Welsh 2020 -
Zhu Yongzhan  National affiliate member Mandarin, Cantonese 2023 -
Rosa Busquets  National affiliate member Catalan 2023 -