Quality of Life Research

, Volume 23, Issue 2, pp 571–579 | Cite as

Cross-cultural adaptation and validation of the Manchester Foot Pain and Disability Index into Spanish

  • Gabriel Gijon-Nogueron
  • Mwidimi Ndosi
  • Alejandro Luque-Suarez
  • Begonya Alcacer-Pitarch
  • Pedro Vicente Munuera
  • Adam Garrow
  • Anthony C. Redmond



The Manchester Foot Pain and Disability Index (MFPDI) is a self-assessment 19-item questionnaire developed in the UK to measure foot pain and disability. This study aimed at conducting cross-cultural adaptation and validation of the MFPDI for use in Spain.


Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes measures were followed in the MFPDI adaptation into Spanish. The cross-cultural validation involved Rasch analysis of pooled data sets from Spain and the UK.


Spanish data set comprised 338 patients, five used in the adaptation phase and 333 in the cross-cultural validation phase, mean age (SD) = 55.2 (16.7) and 248 (74.5 %) were female. A UK data set (n = 682) added in the cross-cultural validation phase; mean age (SD) = 51.6 (15.2 %) and 416 (61.0 %) were female. A preliminary analysis of the 17-item MFPDI revealed significant local dependency of items causing significant deviation from the Rasch model. Grouping all items into testlets and re-analysing the MFPDI as a 3-testlet scale resulted in an adequate fit to the Rasch model, χ 2 (df) = 15.945 (12), p = 0.194, excellent reliability and unidimensionality. Lack of cross-cultural invariance was evident on the functional and personal appearance testlets. Splitting the affected testlets discounted the cross-cultural bias and satisfied requirements of the Rasch model. Subsequently, the MFPDI was calibrated into interval-level scales, fully adjusted to allow parametric analyses and cross-cultural data comparisons when required.


Rasch analysis has confirmed that the MFPDI is a robust 3-subscale measure of foot pain, function and appearance in both its English and Spanish versions.


Cross-cultural validation Patient outcome measures Foot pain Rasch analysis 



Firstly, the authors acknowledge the assistance of Isis Outcomes (Isis Innovation Ltd, Oxford UK) for granting permission to use the MFPDI in this study. Permissions to use the MFPDI in all translations can be sought directly from Isis Outcomes ( Secondly, we would also like to acknowledge the assistance of the University of Manchester for access to the original MFPDI UK data set. Thirdly, we would like to thank our colleagues who helped with data collection: Javier Ramos, Bárbara Pineda, María Reina, Cristina Algaba, Raquel Cintado, Encarnacion Cortes Jeronimo, Irene Garcia Paya and Guillermo Lafuente. Lastly, we would like to thank all patients that took part in this study.

Conflict of interest

All authors have completed the Unified Competing Interest form at (available from the corresponding author) and declared no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Gabriel Gijon-Nogueron
    • 1
  • Mwidimi Ndosi
    • 2
  • Alejandro Luque-Suarez
    • 3
  • Begonya Alcacer-Pitarch
    • 2
  • Pedro Vicente Munuera
    • 4
  • Adam Garrow
    • 5
  • Anthony C. Redmond
    • 2
  1. 1.Department of Nursing and PodiatryUniversity of MálagaMálagaSpain
  2. 2.Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
  3. 3.Department of PhysiotherapyUniversity of MálagaMálagaSpain
  4. 4.Department of PodiatryUniversity of SevilleSevilleSpain
  5. 5.The School of Nursing, Midwifery & Social WorkUniversity of ManchesterManchesterUK

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