Development of the Oxford ankle foot questionnaire: finding out how children are affected by foot and ankle problems

Background A large number of children are affected by foot and ankle problems owing to congenital deformities, clinical syndromes, neuromuscular conditions or trauma. This study aimed to identify how children's lives are affected by foot and ankle problems from the child's perspective as the first stage in developing a family- assessed instrument. Methods This was a qualitative study using focus groups involving children with a variety of foot and ankle problems aged 5 - 7, 8 - 11 and 12 - 15 years, and separate concurrent groups for their parents. The focus groups were child- centred and involved creative activities; there were two main exercises. The first activity involved agreeing or disagreeing with several statements about children with foot and ankle problems; the second activity explored a typical ` day in the life' of a child with a foot or ankle problem. All the groups were audio- recorded and transcribed; grounded theory and comparative content analysis were used to identify and code themes participants reported as important. Results The groups ran successfully with children in all ages. Consistent themes identified by all groups were; ( i) specific activities that were more difficult; ( ii) physical symptoms; ( iii) reduced participation in certain life situations; and ( iv) self- consciousness. There were few differences in the issues raised by each age group although the life situations children encounter tend to become more complex as they get older; there is also the difficulty of negotiating a larger school campus at senior compared with junior school. There were no differences in the issues raised by children and their parents. Conclusions Focus groups involving creative child- centred activities were used successfully to elicit children's experience of their health problems. In addition to expected activity limitations and physical symptoms some children with foot or ankle problems endure participation restrictions and self- consciousness that are exacerbated by the behaviour of other people or their environment, particularly at school. The findings of this study informed the development of a questionnaire to measure how severely children are affected by foot or ankle problems from the child's perspective.