Cross-cultural adaptation, translation, and validation of the functional assessment scale for acute hamstring injuries (FASH) questionnaire for French-speaking patients

Study design: This consisted of a translation and validation study.
Background: Acute hamstring injury is a frequent muscle strain in sports that require high explosive
strength, impulsion or running phases. Therefore, the Functional Assessment Scale for Hamstring Injury
questionnaire was developed to assess pain, physical activity level and ability to perform various exercises
in patients with hamstring injuries. The Functional Assessment Scale for Hamstring Injury questionnaire is
currently available in English, German, and Greek.
Objectives: The goal of this study was to provide a cross-culturally adapted French-translation of the
FASH questionnaire and to assess its psychometric performance.
Methods: The French-translation and cross-cultural adaptation process were based on international
recommendations, following six rigorous steps: (a) two initial translations from English to French; (b)
synthesis of the two translations; (c) back-translations; (d) comparisons between the back-translations and
the original questionnaire by an expert committee; (e) pretest; and (f) approval of the final French version
of the Functional Assessment Scale for Hamstring Injury questionnaire. To validate this French version, 116
subjects (17 pathological patients, 19 patients with other muscle injury, 40 athletes at risk, and 40 healthy
control athletes) were recruited to complete the Functional Assessment Scale for Hamstring Injury questionnaire.
The Short Form Health Survey (SF-36) was used as a comparative questionnaire. The psychometric
properties of the questionnaire were evaluated by determining the test-retest reliability after a 48–60-h
interval, internal consistency, construct validity, and floor/ceiling effects.
Results: All of the items of the Functional Assessment Scale for Hamstring Injury questionnaire were
translated without any major difficulties. The questionnaire showed excellent discriminative power by
obtaining significantly different scores from the four groups (p¼0.01). Regarding psychometric performances,
the test–retest reliability was excellent (IntraClass Coefficient Correlation of 0.997). Very high
internal consistency was also observed (Cronbach’s alpha of 0.969). Correlations with the physical health
subscales of the SF-36 were significant and considered to be strong, indicating an excellent convergent
validity. The other subscales of the SF-36 (mental health) were weakly correlated with the FASH, reflecting
good divergent validity. No floor or ceiling effects were observed.
Conclusion: The French-translation of the Functional Assessment Scale for Hamstring Injury questionnaire
and its cross-cultural adaptation can be considered to be successful. Functional Assessment Scale for
Hamstring Injury-French questionnaire is now a reliable and valid tool for patients suffering from acute
hamstring injury, and its application in clinical practice is particularly relevant.
IMPLICATIONS FOR REHABILITATION
The FASH-F can be considered to be discriminant, reliable and valid for the evaluation of the severity
of symptoms and sports ability in individuals with hamstring injuries.
FASH-F is now a reliable and valid tool for French-speaking patients suffering from acute hamstring
injury, and its application in clinical practice is particularly relevant.
A limitation of our study could be that the distribution between the different study groups was not
homogeneous implying that our findings may not be fully representative of the general population.