Quality of Life Research

, 18:1367 | Cite as

The Oxford Ankle Foot Questionnaire for children: responsiveness and longitudinal validity

  • Christopher MorrisEmail author
  • Helen Doll
  • Neville Davies
  • Andrew Wainwright
  • Tim Theologis
  • Keith Willett
  • Ray Fitzpatrick



To evaluate how scores from the Oxford Ankle Foot Questionnaire change over time and with treatment using both distribution-based and anchor-based approaches.


Eighty children aged 5–16 and their parent or carer completed questionnaires at orthopaedic or trauma outpatient clinics. They were asked to complete and return a second set of questionnaires again within 2 weeks (retest), and then mailed a third set of questionnaires to complete again after 2 months (follow-up). The follow-up questionnaires included a global rating of change ‘transition’ item.


Child- and parent-reported mean domain scores (Physical, School & Play, and Emotional) were all stable at retest, whereas positive mean changes were observed at follow-up. As we hypothesised, trauma patients had poorer scores than elective patients at baseline, and showed greater improvement at follow-up. For trauma patients, mean changes in per cent scores were large (scores improved between 40 and 56 for the Physical and School & Play domains, and 17 and 21 for Emotional); all effect sizes (ES) were large (>0.8). For elective patients, the mean improvement in per cent scores were more moderate (Physical: child 10, ES = 0.4, parent 11, ES = 0.5; School & Play child 0, ES = 0, parent 9 ES = 0.4; Emotional: child 6, ES = 0.2; parents 8, ES > 0.3). Minimal detectable change (MDC90), an indication of measurement error, ranged from 6 to 8. Half the standard deviation of baseline scores ranged from 11 to 18. Minimal important difference could only be calculated for elective patients (9 child and 13 parent ratings), these ranged from 7 to 17.


The findings support the responsiveness and longitudinal validity of the scales. Changes in domain scores of, or exceeding, the MDC90 (6–8) are likely to be beyond measurement error; further work is required to refine the estimate of change that can be considered important.


Children Orthopaedics Foot Ankle Outcome Quality of life 



We are grateful to the children and families who participated, to nurses Bridget Gray and Lisa Fox for helping with recruitment, to Clare Shakeshaft for data entry, and to Andy King for assistance with data management.


This study was funded by the UK Medical Research Council through a Research Training Fellowship in Health Services Research held by Dr. Morris.

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.


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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Christopher Morris
    • 1
    • 2
    Email author
  • Helen Doll
    • 1
  • Neville Davies
    • 3
    • 4
  • Andrew Wainwright
    • 2
    • 3
  • Tim Theologis
    • 2
    • 3
  • Keith Willett
    • 3
    • 4
  • Ray Fitzpatrick
    • 1
  1. 1.Department of Public HealthUniversity of OxfordOxfordUK
  2. 2.Nuffield Orthopaedic CentreOxfordUK
  3. 3.Nuffield Department of Orthopaedic SurgeryUniversity of OxfordOxfordUK
  4. 4.Kadoorie CentreJohn Radcliffe HospitalOxfordUK

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