Adaptation and clinimetric properties of Persian version of Inlow’s 60-s diabetic foot screen: update 2022

Early identification of foot-related complications in individuals with diabetes is essential for preventing ulcers and amputations. The Inlow’s 60-Second Diabetic Foot Screen: Update 2022 is a concise and practical tool for risk assessment. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of this tool. A methodological study was conducted in two phases. In Phase 1, the tool was translated and culturally adapted following Beaton’s guidelines. Face and content validity were evaluated through expert feedback. In Phase 2, clinimetric properties included construct validity (known-groups comparison), criterion validity (correlation with Ankle-Brachial Index [ABI] as concurrent validity and incidence rate of complications as predictive validity), and reliability (inter-rater and intra-rater). Furthermore, the sensitivity and specificity of the tool alongside of Area Under Curve (AUC) were assessed. A total of 180 diabetic patients and 35 health care providers participated in the study. Face validity was confirmed. Content validity was also established, with item-level Content Validity Index (I-CVI) values ranging from 0.80 to 1.00, and a scale-level Content Validity Index average (S-CVI/Ave) of 0.95. Known-groups comparison revealed significant differences in risk distribution across the three patient groups ( p < 0.001). A strong inverse correlation was found between the Persian version of the Inlow’s risk levels and ABI values (Spearman’s ρ = –0.88, p < 0.001), supporting criterion validity. Complication incidence was 33.3% (4/12) in the High Risk group and 87.5% (14/16) in the Urgent Risk group, whereas no complications occurred in the Very Low-, Low-, or Moderate-Risk groups ( p < 0.001). Additionally, inter-rater and intra-rater reliability were excellent, with weighted kappa coefficients of 0.89 (95% CI: 0.65–1.00) and 0.87 (95% CI: 0.64–1.00), respectively. The AUC was 0.965 (95% CI: 0.933–0.998; SE = 0.017). Using a cut-off point of ≥ 4 (i.e., classifying patients at 'High' or 'Urgent' risk as positive), the tool demonstrated 100% sensitivity and 83.6% specificity. The Persian version of Inlow’s 60-Second Diabetic Foot Screen demonstrated strong validity and reliability and can be recommended for routine screening of diabetic foot risk in Iran. Its use in clinical settings may enhance early detection and prevention strategies for foot complications among diabetic patients.