In this study, the Arabic adaptation of the WeeFIM questionnaire was performed following a systematic standardized approach to provide population-based information from a parental perspective about the functional skills of children with healed burns. The study was conducted in two main steps. The first was the translation process from the original English version of the questionnaire into an Arabic one according to published guidelines, and the second was the determination of its psychometric characteristics. In the current study, the researchers chose to assess the feasibility and reliability of the WeeFIM instrument as the time-consuming factor was too important in terms of clinical basis, especially for patients with burn injuries, aiming to have a simple, reliable instrument for measuring the functions of children with burns. The time of filling out the questionnaire and the number of missing answers were the measurements of the assessment of feasibility, and the 1st and 2nd scores were the indicators of intra-rater reliability. Interviewing a child and the parents is considered feasible and takes approximately 5.5 to 7.5 minutes; this range of time is considered less than the average of most researchers (about 10 to 15 min.), which can be attributed to the feasibility of the Arabic version of the WeeFIM instrument, in addition to some limitations that have obligated the researcher to ask the questions in a too simple way, which leads consequently to less time of filling. The mean administration time of the second assessment (5.57 min.) was less than that of the first assessment (7.45 min.), which can be attributed to the time elapsed since the beginning of the study, which showed that more experience administering the WeeFIM instrument resulted in less time needed to complete the test and more understanding of the items of the questionnaire by the parents. The administration time was not influenced by the age of the child nor the gender, which can be attributed to the method of filling, as it is a parent-filled questionnaire, and to the domains assessed as the WeeFIM is used to assess general function. Another aspect of feasibility is the number of missing answers. In this study, a high answer rate was expected as the WeeFIM is a 7-rank scale that nearly includes most of the varieties of functional independence and also assesses general functional activities that are used daily by every child. The results have shown a low percent of questionnaires that had missing answers (16.03%), indicating that WeeFIM is a highly feasible instrument in measuring functional independence in Egyptian children with burns (Table 15). The number of missing answers per each measurement decreased from the first to the second tests (Table 4), which can be attributed to improvement in the patients' function or a better understanding of the items of the questionnaire. Moreover, the reliability of the WeeFIM scores was good. In terms of reliability, the current study has established that the WeeFIM was reliable with excellent test-retest reliability as there was a strong direct correlation between the first score and the second one. It was evaluated by calculating the Pearson Correlation Coefficient (r = 0.986).
The average interval between both measures was one week. Compared with the original English WeeFIM, the Arabic version showed a stronger correlation coefficient than the English one. Ottenbacher et al.,  used PCC to assess test-retest reliability and they found that (r = 0.67), in the Chinese one (r = 0.8 approximately) , and also in the Dutch one (r = 0.8 approximately) . When the WeeFIM instrument was administered over a one-week period, the researchers noticed some minor test effects. In other circumstances, for example, the interview caused parents to have a different opinion of their child's talents, which resulted in different responses within a few days (memory of the previous interview leading to additions or a more realistic view of the child's performances). The Arabic WeeFIM had worse internal consistency than the original English one. It was assessed using the Cronbach alpha coefficient (alpha = 0.619), indicating acceptable internal consistency, whereas in the original English version, alpha = 0.9 , in the adapted version for Turkish children with C.P., alpha = 0.93 approximately , and in the adapted version for Dutch children with burns, alpha = 0.984 , all suggesting high internal consistency in these studies. Low Cronbach alpha values can be linked to 1-a small number of variables (only 4 items were included in the test). Two-internal consistency is lower with basic questions than with more specific ones, and the questions in this questionnaire are designed to assess general function .
Other studies have used a 0.6 Cronbach's alpha for other instruments, including the Pediatric Evaluation of Disability Inventory (PEDI) , the Instrument to Assess Knowledge Sharing Quality , the General Health Questionnaire (GHQ-12) , and the Adult Learning Inventory (AL-i) among first-year medical students in a Malaysian medical school . This study examined the effects of two independent variables on the measured scores and times: Gender: There were no significant differences in the mean scores (and mean times) of the eighteen items, so there was no gender effect on both the 1st and 2nd scores (and times). Age: There were no significant differences in the mean scores (and mean times) of the eighteen items, so there was no age effect on both the 1st and 2nd scores (times).
The results of the study showed that the majority of the sample had achieved high scores, which can be attributed to the fact that the study was limited to patients with healed burns. Furthermore, the mean of the 2nd score (94.04) was slightly greater than the mean of the 1st score (92.96), which can be attributed to some improvement in some patients' functions (Table 1). The low mean of time for filling can be attributed to the feasibility of filling, and the mean of the second time (5.57) was less than that of the first time (7.45), which can be attributed to a better understanding of questions by parents (Table 1). A high SD indicated non-homogeneity, which could be attributed to a wide age range (Table 1). The minimum scores were for 3-year-old boys (a low score may be attributed to their small age) and 15-year-old girls with burns to the lower jaw, chest, abdomen, and both upper limbs (a low score may be attributed to a high extent). The maximum score was achieved by a 15-year-old girl with a chronic burn in her thigh that had no effect on her functions (Table 1). The minimum time was for the older children, the smart and agile parents, and the cases with excellent functional independence levels. The maximum time was for the younger children, the highly educated parents, the parents with slow comprehension or less concentration, and the cases with poor functional independence levels.
The Wilcoxon-signed-rank test showed that score _2 was statistically significant with respect to score _1 with a p-value of 0.92 at level alpha = 0.1, which can be attributed to the improvement of the patients' functions (Table 2). Time_2 was statistically significant with respect to time _1 with a p-value of 0.000, which can be attributed to more understanding of the items in the questionnaire by the parents (Table 3).
The Mann-Whitney test showed that all of score_1, score_2, time_1 and time_2 were not statistically significant with respect to both gender and age.
It was predicted that age would be statistically significant to scores, but the results showed no statistical significance, which can be attributed to the unequal frequency distribution of children in both age groups and the severity of the cases, as the score of a 15-year-old child with a high extent may be less than the score of a 3-year-old child with a small burn area or away from joints, which has no effect on function. Correlations showed a very strong direct relationship between scores _1 and score_2 as r (Pearson correlation coefficient) = 0.986, which can be attributed to the improvement of the patients' functions (Table 5). There was also a weak inverse relationship with r = -0.233 between score_1 and time_1, which can be attributed to the feasibility of completing the questionnaire by patients with good functions who scored high (Table 5).score_2 and time_1 as r = -0.340, which can be explained by the fact that the less time in the 1st test refers to cases with good function, which in turn would have good scores in the 2nd time (Table 5). Score_2 and time_2 had a weak inverse relationship with r = -0.239, which had no statistical significance (Table 5). There was a weak inverse relationship between score_1 and time_2 with r = -0.233 and no statistical significance (Table 5). Time_1 and time_2 as r = 0.516, which can be attributed to more understanding of the items in the questionnaire by the parents (Table 5).
This study was limited by the high percentage of illiteracy of parents and children, the small sample size, the bad psychological status of some parents and children, some distracted parents who had filled out the questionnaire randomly, and some patients who had not continued in the study. From the properties of the WeeFIM instrument that the researchers experienced throughout the study, it nearly had no ceiling or floor effects, as it starts with complete independence and complete dependence, and any function of an ordinal individual will not have more or less of a score. So, it can perfectly assess improvement and deterioration throughout the rehabilitation program. The researchers made these final adaptations to overcome the limitations that they experienced in the practical application of the study, hoping to do better research in the future and to provide the researchers with good data for further research. The findings of the present study have indicated the need to consider the following recommendations: Studying the psychometric properties of the WeeFIM in relation to certain body parts. For more extensive studies in the validation process of the Arabic version of the original WeeFIM questionnaires in Egypt, different countries, and other Arabic countries are needed for results to be generalized. Other psychometric properties of the WeeFIM questionnaire (construct validity, criterion validity, responsiveness to change, agreement, and inter-rater reliability) should also be evaluated in future research. The design of future studies should include the division of the children into groups according to age for more accurate results of the effect of age on scores. Further studies should be undertaken with a larger sample size to provide a better statistical analysis of the data. Future studies should validate other questionnaires that measure function in children with burn injuries based on the results of the current study, and the researcher suggested replication of the current study for verification of results.