Development and validation of the ankle fracture outcome of rehabilitation measure (A-FORM)

McPhail, Steven M., Williams, Cylie M., Schuetz , Michael A., Baxter, Brett , Tonks, Peter, & Haines, Terry P. (2014) Development and validation of the ankle fracture outcome of rehabilitation measure (A-FORM). Journal of Orthopaedic & Sports Physical Therapy, 44(7), pp. 488-499.

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Study Design Delphi panel and cohort study.


To develop and refine a condition-specific, patient-reported outcome measure, the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), and to examine its psychometric properties, including factor structure, reliability, and validity, by assessing item fit with the Rasch model.


To our knowledge, there is no patient-reported outcome measure specific to ankle fracture with a robust content foundation.


A 2-stage research design was implemented. First, a Delphi panel that included patients and health professionals developed the items and refined the item wording. Second, a cohort study (n = 45) with 2 assessment points was conducted to permit preliminary maximum-likelihood exploratory factor analysis and Rasch analysis.


The Delphi panel reached consensus on 53 potential items that were carried forward to the cohort phase. From the 2 time points, 81 questionnaires were completed and analyzed; 38 potential items were eliminated on account of greater than 10% missing data, factor loadings, and uniqueness. The 15 unidimensional items retained in the scale demonstrated appropriate person and item reliability after (and before) removal of 1 item (anxious about footwear) that had a higher-than-ideal outfit statistic (1.75). The “anxious about footwear” item was retained in the instrument, but only the 14 items with acceptable infit and outfit statistics (range, 0.5–1.5) were included in the summary score.


This investigation developed and refined the A-FORM (Version 1.0). The A-FORM items demonstrated favorable psychometric properties and are suitable for conversion to a single summary score. Further studies utilizing the A-FORM instrument are warranted. J Orthop Sports Phys Ther 2014;44(7):488–499. Epub 22 May 2014. doi:10.2519/jospt.2014.4980

Impact and interest:

2 citations in Scopus
1 citations in Web of Science®
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ID Code: 76245
Item Type: Journal Article
Refereed: Yes
Keywords: Internal consistency, Orthopaedics, patient-reported outcome, quality of life , Rasch
DOI: 10.2519/jospt.2014.4980
ISSN: 0190-6011
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Orthopaedics (110314)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Public Health and Health Services not elsewhere classified (111799)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > QUT Faculties and Divisions > Science & Engineering Faculty
Copyright Owner: Copyright 2014 Journal of Orthopaedic & Sports Physical Therapy
Deposited On: 06 Oct 2014 23:39
Last Modified: 22 Jun 2017 15:01

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