These are some of the more specific ways the OxAFQ-C is currently employed by our user community:

• Clinical investigation into the impact of foot anomalies for patients with Aperts Syndrome,
• A pilot study foot pain and shape in teenagers,
• Multi Centre, randomised controlled trial, Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever’s disease),
• Ankle joint sprains in children and evaluating the outcome of therapy,
• Prospective Comparison of Hind Foot Stabilization Procedures in Children,
• Study to assess the efficacy of orthotic therapy in treatment of patients with a range of musculoskeletal/Orthopaedic foot and ankle conditions.

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• Juvenile inflammatory arthritis
• Diagnoses
• Pes plano-valgus
• Benign joint hypermobility
• Congenital Talipes Equino Varus
• Tarsal coalitions
• Pes cavus
• Metatarsus varus
• Hallux abducto-varus (bunion)
• Toe deformity
• Osteochondrosis/apophysitis
• Idiopathic toe walking
• Hereditary Motor Sensory Neuropathy
• Cerebral Palsy
• Down syndrome
• Marfan Syndrome
• Fractures

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The OxAFQ-C was developed and tested in a 3 step process:

Phase 1 – Understanding the patient’s experience of their condition through qualified research.

Focus groups were convened with children affected by foot and ankle problems (along with their parent / caregiver) in three age groups, 5-7, 8-11 and 12-15. This research resulted in themes that children felt were important and affected them. Consistent themes identified by all groups were Physical Symptoms, activity limitations, reduced participation in certain contexts and self-consciousness due to appearance and other people’s attitudes. The results formed the basis of the PRO.

Phase 2 – Evaluation of test version in order to develop scales.

Initially 28 items were proposed (25 from Phase 1 and 3 extra from clinicians). Item responses were rated on a five-point scale indicating how frequently the issue affects the child, from never (score=4) to always (score=0). A survey of 158 children and their parents was carried out to determine the scaling, reliability and validity of the instrument. Exploratory factor analysis and Rasch analysis were used to devise the scales and refine the scaling.

Three domain scales were identified:

• Physical (6 items),
• Emotional (4 items), and
• School & Play (4 items)

As in classical approaches to measurement, domain scores are calculated as the total of the scale item scores and are transformed to a percentage scale (0-100), where a higher score represents better functioning. Although an item asking about ‘being able to wear the shoes you want’ did not fit with the scales, it was salient to many children and to most girls. The item has strong face validity and is included as a categorical descriptive variable but not allied to any domain scale. The remaining items were either redundant or did not improve the scaling and were dropped.

The three domain scales were shown to be internally consistent. The scales’ scores were also found to be stable at retest within two weeks, and to vary little whether reported by child or parent.

Phase 3 – Prospective study and further testing.

In the third phase, a prospective study was conducted with 80 children attending trauma and elective orthopaedic clinics to assess responsiveness and longitudinal validity of the domain scales. Children and parents completed PROs at an initial outpatient appointment (baseline) and again within two weeks (retest), and finally a third set of PROs to complete again after two months (follow-up).

The follow up PROs included an additional global rating of change ‘transition’ item asking respondents to indicate whether they thought, overall, the foot or ankle problem was about the same, better or worse, on a seven point scale, using increments of ‘slightly’, ‘quite a bit’ and ‘a lot’ better or worse. The global rating of change provided a patient-based anchor for comparing the magnitude of changes in domain scores.

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Details of the scoring system for the OxAFQ-C can be downloaded in Dossier Extracts section

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The OxAFQ-C is to date validated for pen and paper completion. Careful migration to a digital delivery format (for example screen based device) can be authorised. Please contact us for advice.

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