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Validity and Reliability of the Turkish Version of the Idiopathic Toe Walking Outcome (iTWO) Proforma
Esra Giray1, Munteha Ilkyaz Karadag2, Sude Gozukucuk Turkyilmaz1
1Department of Physical Medicine and Rehabilitation, University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye.
Introduction:
This study aims to evaluate the validity and reliability of the Turkish version of the Idiopathic Toe Walking Outcome proforma (iTWO proforma-T), a clinician- and parent-reported tool designed to assess symptoms, functional performance, and treatment outcomes in children with idiopathic toe walking (ITW).
Methods:
Thirty-five children aged 4-14 years with ITW were included. The translation procedure followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. Construct validity was examined through correlations between individual iTWO proforma-T items and the Toe Walking Severity Scale, the Oxford Ankle Foot Questionnaire (OxAFQ), and the Pediatric Outcomes Data Collection Instrument (PODCI). Test-retest reliability was assessed in 10 of the 35 participants using intraclass correlation coefficients (ICC).
Results:
Most items demonstrated excellent test-retest reliability (ICC > 0.90), including parent-reported toe-walking percentage, satisfaction, treatment adherence, pain-on-activity, and clinician-reported gait scale. Validity analyses showed significant and meaningful correlations between iTWO proforma-T items and established measures. The estimated toe-walking percentage correlated strongly with the Toe Walking Severity Scale (ρ = -0.549) and the OxAFQ emotional domain (ρ = -0.493). Functional performance items (gait scale, 2- and 6-minute walk tests) showed moderate positive correlations with toe-walking severity, whereas pain-related items correlated negatively with relevant PODCI and OxAFQ domains.
Conclusion:
The iTWO proforma-T is a valid and reliable instrument for evaluating symptoms, functional status, and treatment-related outcomes in children with idiopathic toe walking. The tool preserves the structure and measurement characteristics of the original proforma and can be confidently used by clinicians and researchers for evidence-based assessment and follow-up in Turkish-speaking pediatric populations.
