Skip to main content

Cross-cultural adaptation and multi-centric validation of the Italian version of the Achilles tendon Total Rupture Score (ATRS)

Knee Surgery, Sports Traumatology, Arthroscopy volume 26, pages 854–861 (2018)Cite this article

Abstract

Purpose

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).

Conclusion

The Italian version of the ATRS is a valid instrumentation to assess the functional limitations of Italian patients after Achilles tendon rupture.

Level of evidence

III.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Ansari NN, Naghdi S, Hasanvand S, Fakhari Z, Kordi R, Nilsson-Helander K (2016) Cross-cultural adaptation and validation of Persian Achilles tendon Total Rupture Score. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3977-x

    PubMed  Google Scholar 

  2. Apolone G, Mosconi P (1998) The Italian health survey: translation, validation and norming. J Clin Epidemiol 51:1025–1036

    CAS  Article  PubMed  Google Scholar 

  3. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25:3186–3191

    CAS  Article  PubMed  Google Scholar 

  4. Budiman-Mak E, Conrad KJ, Roach KE (1991) The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol 44:561–570

    CAS  Article  PubMed  Google Scholar 

  5. Cacchio A, De Blasis E, Necozione S, Rosa F, Riddle DL, di Orio F, De Blasis D, Santilli V (2010) The Italian version of the lower extremity functional scale was reliable, valid, and responsive. J Clin Epidemiol 63:550–557

    Article  PubMed  Google Scholar 

  6. Carmont MR, Silbernagel KG, Nilsson-Helander K, Mei-Dan O, Karlsson J, Maffulli N (2013) Cross cultural adaptation of the Achilles tendon Total Rupture Score with reliability, validity and responsiveness evaluation. Knee Surg Sports Traumatol Arthrosc 21:1356–1360

    Article  PubMed  Google Scholar 

  7. Cronbach LJ (1951) Coefficient alpha and internal structure of tests. Psychometrika 16:297–334

    Article  Google Scholar 

  8. Deshpande PR, Rajan S, Sudeepthi BL, Abdul Nazir CP (2011) Patient-reported outcomes: a new era in clinical research. Perspect Clin Res 2:137–144

    Article  PubMed  PubMed Central  Google Scholar 

  9. Duracinsky M, Lalanne C, Goujard C, Herrmann S, Cheung-Lung C, Brosseau JP, Schwartz Y, Chassany O (2014) Electronic versus paper-based assessment of health-related quality of life specific to HIV disease: reliability study of the PROQOL-HIV questionnaire. J Med Internet Res 16(4):e115

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fleiss JL, Shrout PE (1977) The effects of measurement errors on some multivariate procedures. Am J Public Health 67:1188–1191

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. Froberg DG, Kane RL (1989) Methodology for measuring healthstate preferences—II: scaling methods. J Clin Epidemiol 42:459–471

    CAS  Article  PubMed  Google Scholar 

  12. Ganestam A, Barfod K, Klit J, Troelsen A (2013) Validity and reliability of the Achilles tendon Total Rupture Score. J Foot Ankle Surg 52:736–739

    Article  PubMed  Google Scholar 

  13. Guillemin F (1995) Cross-cultural adaptation and validation of health measures. Scand J Rheumatol 24:61–63

    CAS  Article  PubMed  Google Scholar 

  14. Gwaltney CJ, Shields AL, Shiffman S (2008) Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health 11:322–333

    Article  PubMed  Google Scholar 

  15. Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468

    CAS  Article  PubMed  Google Scholar 

  16. Kaya Mutlu E, Celik D, Kiliçoglu Ö, Ozdincler AR, Nilsson-Helander K (2015) The Turkish version of the Achilles tendon Total Rupture Score: cross-cultural adaptation, reliability and validity. Knee Surg Sports Traumatol Arthrosc 23(8):2427–2432

    Article  PubMed  Google Scholar 

  17. Kearney RS, Achten J, Lamb SE, Plant C, Costa ML (2012) A systematic review of patient-reported outcome measures used to assess Achilles tendon rupture management: what’s being used and should we be using it? Br J Sports Med 46:1102–1109

    Article  PubMed  Google Scholar 

  18. Kearney RS, Achten J, Lamb SE, Parsons N, Costa ML (2012) The Achilles tendon Total Rupture Score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures. Health Qual Life Outcomes 10:24

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353

    CAS  Article  PubMed  Google Scholar 

  20. Maffulli N, Longo UG, Testa V, Oliva F, Capasso G, Denaro V (2008) Italian translation of the VISA-A score for tendinopathy of the main body of the Achilles tendon. Disabil Rehabil 30(20–22):1635–1639

    Article  PubMed  Google Scholar 

  21. Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF (2003) A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol 56:730–735

    Article  PubMed  Google Scholar 

  22. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC (2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 63:737–745

    Article  PubMed  Google Scholar 

  23. Nilsson-Helander K, Thomeé R, Silbernagel KG, Thomeé P, Faxén E, Eriksson BI, Karlsson J (2007) The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med 35:421–426

    Article  PubMed  Google Scholar 

  24. Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22:788–794

    CAS  Article  PubMed  Google Scholar 

  25. Stone AA, Shiffman S, Schwartz JE, Broderick JE, Hufford MR (2002) Patient non-compliance with paper diaries. BMJ 324(7347):1193–1194

    Article  PubMed  PubMed Central  Google Scholar 

  26. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  27. Venditto T, Tognolo L, Rizzo RS, Iannuccelli C, Di Sante L, Trevisan M, Maggiolini FR, Santilli V, Ioppolo F (2015) 17-Italian Foot Function Index with numerical rating scale: development, reliability, and validity of a modified version of the original Foot Function Index. Foot (Edinb) 25:12–18

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the following people who supported the study: Andrea Cavallaro of the Department of Materials of the Imperial College of London, UK, Mara Buoro, Michela Furlanetto and Vanna Vendrame of the Orthopaedic and Traumatology Department of the Oderzo Hospital, Gianluigi Bertoni and Carlo Busatto of the Orthopaedic and Traumatology Department of the Treviso Regional Hospital.

Author information

Affiliations

  1. Orthopaedic and Traumatology Department, Oderzo Hospital, Oderzo, Treviso, Italy

    Alberto Vascellari

  2. IRCCS Policlinico San Donato, San Donato, Milan, Italy

    Pietro Spennacchio

  3. Orthopaedic and Traumatology Department, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

    Alberto Combi

  4. 2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy

    Alberto Grassi & Stefano Zaffagnini

  5. Department of Orthopaedics and Traumatology, Bari University Hospital, Bari, Italy

    Silvio Patella

  6. Orthopaedic Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy

    Salvatore Bisicchia

  7. Centre of Sports Traumatology, Koelliker Hospital, Turin, Italy

    Gian Luigi Canata

Authors
  1. Alberto Vascellari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pietro Spennacchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Combi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silvio Patella
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Salvatore Bisicchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gian Luigi Canata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefano Zaffagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

SIGASCOT Sport Committee

Corresponding author

Correspondence to Alberto Vascellari.

Ethics declarations

Conflict of interest

All the authors declare that they have no conflict of interest related to the topic of this article.

Appendix 1: Italian version of the Achilles tendon Total Rupture Score (ATRS)

Appendix 1: Italian version of the Achilles tendon Total Rupture Score (ATRS)

figure a
figure b

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vascellari, A., Spennacchio, P., Combi, A. et al. Cross-cultural adaptation and multi-centric validation of the Italian version of the Achilles tendon Total Rupture Score (ATRS). Knee Surg Sports Traumatol Arthrosc 26, 854–861 (2018). https://doi.org/10.1007/s00167-016-4152-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4152-8

Keywords

  • Achilles tendon rupture
  • ATRS
  • Cross-cultural
  • Validity
  • Reliability
  • Italian