## 4 Discussion  
The adapted ASPS for measuring stress factors among podiatry students showed good [PERSON]'s alpha coefficients and ICCs; for this reason and according to the guidelines for the process of cross-cultural adaptation of self-reported measures [22] and following the recommendations for evaluating [PERSON]'s alpha coefficients, the ASPS is a test retest reliable tool.  
The ASPS showed good reliability and repeatability with adequate internal consistency to evaluate stress in podiatry students, and the questionnaire also shows excellent reproducibility; all of the \(p\)-values from the [PERSON] paired test were not statistically significant in any dimension. In addition, the Bland and Altman method shows whether there are differences between the tests (pre and post-tests) in order to check the reproducibility of the test results and whether the differences are systematic or random. After analyzing our results, we can conclude that there are no differences between the pre and post-test total scores or domain scores.  
Our results are comparable to the original test retest reliability of [PERSON] and [PERSON]'s (2009) questionnaire due to higher Cronbach's alpha values being found according to total and domain scores and all domains, and also better ICCs by each domain and item [18]. Our sample was similar to that of [PERSON] and [PERSON] (2009) with respect to age, sex and number of participants [18].  
We were not able to compare our reliability data for the total items (\(\alpha\) = 0.8626) and domains (performance of practical activities: \(\alpha\) = 0.8684, professional communication domain: \(\alpha\) = 0.8765, time management domain: \(\alpha\) = 0.8832, environment domain: \(\alpha\) = 0.8974, professional education domain: \(\alpha\) = 0.873 and theoretical activity domain: \(\alpha\) = 0.8787) with other tools that are used to measure stress in podiatry students because there is no specific and directly-oriented instrument for these students at this time. For this reason, we compared our results with prior scientific studies in which general instruments were used to assess stress in podiatry or chiropody students.  
We found better values with the ASPS when compared with the USOS questionnaire. This tool was used in a study by [PERSON] et al. (2013) with podiatry students from the United Kingdom and Australia [14]. The USOS questionnaire has 18 items in three subscales (academic demands \(\alpha\) =0.85, financial issues \(\alpha\) = 0.8 and personal issues \(\alpha\) = 0.73) [11]. Similar values were found after using the 10-item perceived stress scale (\(\alpha\) = 0.84) [26; 27]. This scale was used in a study by [PERSON] et al. (2015) with first and second-year podiatry students that aimed to investigate the effects of coffee intake, energy  
Figure 2: [PERSON] and [PERSON] plots for six domain test retest scores for individual participants according to the ASPS.  
drink consumption and perceived stress on sleep quality in these students during their preclinical studies [28; 29].  
The Sisco Inventory of Academic Stress [29] is composed of 31 items with an \(\alpha\) coefficient of 0.90, and the academic stressors scale [7; 30; 31] is composed of a total of 54 items with a Cronbach's \(\alpha\) coefficient that oscillates between 0.79 and 0.96. The \(\alpha\) values of these instruments were very similar to those found for the ASPS, but the items and dimensions are not focused on the podiatry setting alone.  
One of the study's limitations was not considering age and sex due to the sample size and greater number of females compared to males. Additionally, a larger and more diverse (individuals from other universities) sample size would help to improve the strength of the study.  
Finally, a questionnaire can only gather agree/disagree data, but not the opinions behind the answers, and further investigation is needed in podiatry students to study this important problem.