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Open AccessArticle

Adaptation and Validation of the Diabetic Foot Ulcer Scale-Short Form in Spanish Subjects

Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain
Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Camí de les Escoles S/N, 08916 Badalona, Spain
Diabetic Foot Unit, University Hospital Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain
Systems Biology and Statistical Methods for Biomedical Research, IRBLleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain
Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Carretera de Sant Vicent del Raspeig s/n, 03080 Alicante, Spain
Grupo Nacional de Estudio y Asesoramiento de Úlceras por Presión (GNEAUPP) Steering Committee, 26004 Logroño, Spain
Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08041 Barcelona, Spain
Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, 08041 Barcelona, Spain
Faculty of Medicine, University of Vic (UVIC/UCC), 08500 Vic, Spain
Authors to whom correspondence should be addressed.
These authors contributed equally to this study.
J. Clin. Med. 2020, 9(8), 2497;
Received: 18 June 2020 / Revised: 30 July 2020 / Accepted: 31 July 2020 / Published: 3 August 2020
(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects)
Diabetic foot ulcer (DFU) is a chronic complication that negatively affects the quality of life (QoL) of diabetic patients. In Spain, there is no specifically designed and validated instrument to assess the QoL of patients with DFU. Our aim was to adapt the Diabetic Foot Ulcer Scale-Short Form (DFS-SF) questionnaire to a Spanish population and validate it. A prospective, observational design was used. The DFS-SF was administered by personal interview. The validated SF-36 and EQ-5D generic instruments were used as reference tools. The reliability, validity, and sensitivity to changes were assessed using standard statistical methods. A sample of 141 patients with DFU was recruited. The content validity was 3.46 on average (maximum score of 4). The internal consistency of the DFS-SF subscales showed a standardized Cronbach’s α range between 0.720 and 0.948. The DFS-SF domains showed excellent reproducibility measures (intraclass correlation coefficient from 0.77–0.92). The criterion validity was good with significant correlations between each DFS-SF subscale and its corresponding SF-36 and EQ-5D subscales (p < 0.001). However, the questionnaire structure was not validated (comparative fit index = 0.844, root mean square error of approximation = 0.095, and standardized root mean square residual = 0.093). The instrument showed high sensitivity to ulcer changes over time (p < 0.001). The adapted and validated Spanish version of the DFS-SF questionnaire has good psychometric properties and shows good sensitivity to ulcer changes, although the construct validity was not optimal. The adapted questionnaire will be a useful tool specifically to assess the QoL in subjects with diabetic foot ulcers in the clinical and research settings in Spain. View Full-Text
Keywords: diabetic foot ulcer; type 2 diabetes; quality of life; psychometric validation; reliability; validity diabetic foot ulcer; type 2 diabetes; quality of life; psychometric validation; reliability; validity
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Martinez-Gonzalez, D.; Dòria, M.; Martínez-Alonso, M.; Alcubierre, N.; Valls, J.; Verdú-Soriano, J.; Granado-Casas, M.; Mauricio, D. Adaptation and Validation of the Diabetic Foot Ulcer Scale-Short Form in Spanish Subjects. J. Clin. Med. 2020, 9, 2497.

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