Manual for the Japanese Orthopaedic Association / Japanese Society for Surgeryof the Foot, Self-Administered Foot Evaluation Questionnaire (SAFE-Q)

The Japanese Orthopaedic Association / Japanese Society for Surgery of the Foot,
Self-Administered Foot Evaluation Questionnaire was created by The Clinical Outcomes Committeeof the Japanese Orthopaedic Association as well as The Clinical Outcomes Committee of theJapanese Society for Surgery of the Foot. The title of the questionnaire and the scoring method arespecified below. The Japanese Orthopaedic Association / Japanese Society for Surgery of the Foot,
Self-Administered Foot Evaluation Questionnaire cannot be changed without permission.
I.

Title of the Questionnaire
The title of this questionnaire, consisting of 34 mandatory items and 9 optional items (43items in total), is “Japanese Orthopaedic Association / Japanese Society for Surgery of the Foot,
Self-Administered Foot Evaluation Questionnaire.” The abbreviated form is SAFE-Q, and ispronounced “Seif-kju”.

II. Completion of the Questionnaire
1.

This questionnaire is composed of patient-centered questions for assessment and should be
filled out by the patients themselves or in cooperation with the caregiver. The healthcare
staff should not help the patient answer the questions, because this may potentially guide thepatient to give unintended answers. However, this does not apply in the following cases.
1) The patient asks about the content of the questions.
2) The patient is physically challenged and it is physically hard for him/her to write theanswers accurately.
3) The patient made a mistake when answering the questions (incorrect marking on VAS or
multiple answers).
4) Other cases in which a healthcare staff worker decides that it is necessary to help thepatient fill out the questionnaire.

2.

Healthcare staff workers must give consideration so that respondents do not learn thecomponent name and score of the questions.

III. Questionnaire Items
1.

Subscales of questions

The questions are comprised of the following subscales concerning the foot: [1] Pain andPain-Related, [2] Physical Functioning and Daily Living, [3] Social Functioning, [4]Shoe-Related, [5] General Health and Well-Being, and [6] Sports Activity (optional).
Question items of each component are as follows:[1] Question 1 to Question 7, Question 10, and Question 11 (9 items) are “Pain andPain-Related.”[2] Question 12 to Question 22 (11 items) concern “Physical Functioning and Daily
Living.”[3] Question 23 to Question 28 (6 items) concern “Social Functioning.”[4] Question 8, Question 9, and Question 34 (3 items) are “Shoe-Related.”[5] Question 29 to Question 33 (5 items) concern “General Health and Well-Being.”[6] Question 35 to Question 43 (9 items) concern “Sports Activity,” and are listed as
optional items.
2.

Score of question items1)

For questions other than Questions 3 and 43, give a score of 4, 3, 2, 1, or 0 in order,
from left to right.

2)

For Questions 3 and 43, which should be answered using the Visual Analog Scale(VAS), read the value (to one decimal place) on the scale with the right end (fullscale) as 10 cm. Calculate the score using the formula “(10 – the Value) × 0.4” forQuestion 3 and “the Value × 0.4” for Question 43.

3)

Calculate the score of each subscale using the formula “[score calculated for eachsubscale] × 25 / [number of question items for each subscale].” For each subscale,the minimum score is 0 and the maximum score is 100.

4)

The score of each subscale, and not the total score, is used for assessment.

5)

The score of each subscale can be calculated using the “Scoring Table for theJapanese Orthopaedic Association / Japanese Society for Surgery of the Foot,Self-Administered Foot Evaluation Questionnaire (SAFE-Q)”.

Scoring Table for the Japanese Orthopaedic Association /Japanese Society for Surgery of theFoot, Self-Administered Foot Evaluation Questionnaire (SAFE-Q)
Pain and Pain-Related (0 to 100 points)
Question 1
4, 3, 2, 1, 0
Question 2
4, 3, 2, 1, 0
Question 3(10 – value) × 0.4
Question 44, 3, 2, 1, 0Question 5
Question 6
Question 7
Question 10

4, 3, 2, 1, 04, 3, 2, 1, 04, 3, 2, 1, 0
4, 3, 2, 1, 0

Question 11

4, 3, 2, 1, 0

Calculated score

×=“Pain and Pain-Related”
score/100 points

Physical Functioning and Daily Living (0 to 100 points)
Question 12
4, 3, 2, 1, 0
Question 13
4, 3, 2, 1, 0
Question 14
4, 3, 2, 1, 0
Question 15
Question 16
Question 17
Question 18

4, 3, 2, 1, 04, 3, 2, 1, 04, 3, 2, 1, 04, 3, 2, 1, 0

Question 19
Question 20Question 21
Question 22

4, 3, 2, 1, 0
4, 3, 2, 1, 0
4, 3, 2, 1, 04, 3, 2, 1, 0

Calculated score

×=“Physical Functioning andDaily Living” score/100 points

Social Functioning (0 to 100 points)
Question 23
4, 3, 2, 1, 0
Question 24
4, 3, 2, 1, 0
Question 25
4, 3, 2, 1, 0
Question 26
Question 27
Question 28

4, 3, 2, 1, 0
4, 3, 2, 1, 04, 3, 2, 1, 0

Calculated score×= “Social Functioning” score/100 points

×= “Shoe-Related” score/100 points

Shoe-Related (0 to 100 points)
Question 84, 3, 2, 1, 0
Question 94, 3, 2, 1, 0
Question 34
4, 3, 2, 1, 0

Calculated score

General Health and Well-Being (0 to 100 points)
Question 29
4, 3, 2, 1, 0
Question 30
4, 3, 2, 1, 0
Question 31
4, 3, 2, 1, 0
Question 32
Question 33

4, 3, 2, 1, 0
4, 3, 2, 1, 0

Calculated score

×=“General Health andWell-Being” score/100 points

Optional Item: Sports Activity (0 to 100 points)
Question 35
4, 3, 2, 1, 0
Question 36
4, 3, 2, 1, 0
Question 37
Question 38Question 39
Question 40

4, 3, 2, 1, 0
4, 3, 2, 1, 0
4, 3, 2, 1, 0
4, 3, 2, 1, 0

Question 41
Question 42
Question 43

4, 3, 2, 1, 0
4, 3, 2, 1, 0
Value × 0.4

Calculated score

×= “Sports Activity” score/100 points