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SEFAS The Self-Reported Foot and Ankle Score

Publiceringsår: 2015
Språk: Engelska
Publikation/Tidskrift/Serie: Lund University, Faculty of Medicine Doctoral Dissertation Series
Volym: 2015:54
Dokumenttyp: Doktorsavhandling
Förlag: Department of Orthopaedics, Lund University


Background: Patient-reported outcome (PRO) instruments are used in all medical disciplines to evaluate patients with

different diseases and also to follow results after treatments such as surgery. Currently there is no generally accepted

and fully validated PRO instrument for the foot and ankle.

Aims: To translate the New Zealand Ankle Questionnaire into a Swedish version, [the Self-Reported Foot and Ankle

Score (SEFAS)] and to evaluate the validity, reliability and responsiveness of SEFAS in patients with disabilities in the

foot and/or ankle. The second aim was to compare SEFAS with four other PRO instruments: EQ-5D, SF-36, Foot

and Ankle Outcome Score (FAOS) and American Orhopaedic Foot and Ankle Society (AOFAS) score.

Methods: In study I, we translated SEFAS into Swedish. We then included 135 patients registered in the Swedish

Ankle Registry with osteoarthritis or inflammatory arthritis in the ankle joint. These patients completed SEFAS,

FAOS, EQ-5D and SF-36. In study II we included 224 patients scheduled for surgery with a variety of foot and ankle

disabilities who completed the same PRO instruments as in study I. In study III we included 206 patients scheduled

for surgery with a variety of foot and ankle disabilities who completed SEFAS and AOFAS. Validity, reliability and

responsiveness in addition to time to complete the instruments were then evaluated in studies I–III. In study IV we

included 21 patients scheduled for surgery due to a flatfoot deformity. These patients completed SEFAS, EQ-5D and

SF-36 before surgery and 6 and 24 months after surgery.

Results: In studies I-III we found good validity, reliability and responsiveness for SEFAS in patients with disorders in

the forefoot, hindfoot and ankle. The results for SEFAS were better than or comparable to EQ-5D, SF-36, FAOS and

AOFAS. In study IV we found that SEFAS was able to capture an improvement by surgery in patients with flatfoot

deformity and that the improvement continued up to 24 months after surgery.

Conclusion: SEFAS is a PRO instrument with good validity, reliability and responsiveness. We recommend SEFAS as

a PRO instrument when evaluating surgery in the foot and ankle, also in national registries.


The Lecture Hall, level 5, Department of Orthopaedics, Skåne University Hospital, Inga Marie Nilssons gata 28, Malmö, Sweden
  • Ola Rolfson (Associate Professor)


  • Clinical Medicine
  • ankle
  • foot
  • measurement properties
  • patient-reported outcome measures
  • reliability
  • responsiveness
  • validity


  • Orthopedics - Clinical and Molecular Osteoporosis Research
  • Magnus Karlsson
  • Åke Carlsson
  • Björn Rosengren
  • ISSN: 1652-8220
  • ISBN: 978-91-7619-133-0

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