Kolcaba, K and R Steiner. :Empirical evidence for the nature of holistic comfort. .J Holist Nurs 18::46. ,2000. .
Dillard, J and S Knapp. :Complementary and alternative pain therapy in the emergency department. .Emerg Med Clin North Am 23::529. ,2005. .
Karoly, P and M Jensen. :Multimethod Assessment of Chronic Pain. ,Pergamon Press. ,Oxford, England. ,1987. .
Slater, K . :Human Comfort. ,Charles C Thomas Publisher. ,Springfield, IL. ,1985. .
Kolcaba, K and EA Fischer. :Holistic perspective on comfort care as an advance directive. .J Adv Nurs 18::66. ,1996. .
Kolcaba, K . :Holistic comfort: operationalizing the construct as a nurse-sensitive outcome. .ANS Adv Nurs Sci 15::1. ,1992. .
Hanspal, R, K Fisher, and R Nieveen. :Prosthetic socket fit comfort score. .Disabil Rehabil 25::1278. ,2003. .
Mundermann, A, R Humble, B Nigg, et al. :Development of a reliable method to assess footwear comfort during running. .Gait Posture 16::38. ,2002. .
Miller, J, B Nigg, W Liu, et al. :Influence of foot, shoe and leg characteristics on subjective comfort. .Foot Ankle 9::759. ,2000. .
Mundermann, A, R Humble, B Nigg, et al. :Orthotic comfort is related to kinematics, kinetics and EMG in recreational runners. .Med Sci Sports Exerc 35::1710. ,2003. .
Nigg, B . :The role of impact forces and foot pronation: a new paradigm. .Clin J Sport Med 11::2. ,2001. .
Nigg, B, M Nurse, and D Stefanyshyn. :Shore inserts and orthotics for sport and physical activity. .Med Sci Sports Exerc 31::421. ,1999. .
McPoil, T . :Athletic footwear: design, performance and selection issues. .J Sci Med Sport 3::260. ,2000. .
Nigg, B and B Segesser. :Biomechanical and orthopedic concepts in sport shoe construction. .Med Sci Sports Exerc 24::595. ,1992. .
Collinge, R and J Simmonds. :Hypermobility, injury rate and rehabilitation in a professional football squad: a preliminary study. .Phys Ther Sport 3::91. ,2009. .
Taunton, J, M Ryan, D Clement, et al. :A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics. .Br J Sports Med 37::239. ,2003. .
Guten, G . :Running Injuries. ,WB Saunders Co. ,Philadelphia. ,1997. .
Kinchington, M . :Lower limb injury implications for taekwondo. .Paper presented at the 2nd International Symposium for Taekwonddo Studies,October 12–13,Copenhagen, Denmark,2009. .
Orchard, JW and CF Finch. :Australia needs to follow New Zealand’s lead on sports injuries. .Med J Aust 177::38. ,2002. .
Orchard, J and H Seward. :Injury Report 2008: Australian Football League .Available at: http://www.injuryupdate.com.au/images/research/AFL_Injury_Report_2008.pdf. .Accessed February 10, 2010.
King, P and A Orlando. :Relationship of demographic variables on perception of fatigue and discomfort following prolonged standing under various flooring conditions. .J Occup Rehabil 14::63. ,2004. .
Williams, A and C Nester. :Patient perceptions of stock footwear design features. .Prosthet Orthot Int 30::61. ,2006. .
Impellizzeri, F and N Maffiuletti. :Convergent evidence for construct validity of a 7-point Likert scale of lower limb muscle soreness. .Clin J Sport Med 6::494. ,2007. .
Chiu, MC and MJ Wang. :Professional footwear evaluation for clinical nurses. .Appl Ergon 38::133. ,2007. .
Hong, W, Y Lee, H Chen, et al. :Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking. .Foot Ankle Int 26::1042. ,2005. .
Boonstra, A, H Schiphorst Preuper, MF Reneman, et al. :Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. .Int J Rehabil Res 31::165. ,2008. .
Eich, E, J Reeves, B Jaeger, et al. :Memory for pain: relations between past and present pain intensity. .Pain 5::23. ,1985. .
Downie, W, P Leatham, V Rhind, et al. :Studies with pain rating scales. .Ann Rheum Dis 37::378. ,1978. .
Lozano, L, E García-Cueto, and J Muniz. :Effect of the number of response categories on the reliability and validity of rating scales. .Eur J Res Methods Behav Social Sci 2::73. ,2008. .
Dijkers, M, G Kropp, R Espers, et al. :Reporting on reliability and validity of outcome measures in medical rehabilitation research. .Disabil Rehabil 24::819. ,2002. .
Goldstein, G, S Beers, and M Hersen. :Comprehensive Handbook of Psychological Assessment, Vol. 1: Intellectual and Neuropsychological Assessment. ,John Wiley & Sons. ,Hoboken, NJ. ,2004. .
Gaunt, R and G O’Neill. :Seven point Likert scale .Available at: http://intelligentmeasurement.wordpress.com/?s=SEVEN+POINT+LIKERT+SCALE. .Accessed February 10, 2010.
Bennett, PJ, C Patterson, and MP Dunne. :Health-related quality of life following podiatric surgery. .JAPMA 91::164. ,2001. .
Mundermann, A, D Stefanshyn, and B Nigg. :Relationship between footwear comfort of shoe inserts and anthropometric and sensory factors. .Med Sci Sport Exerc 33.:1939. ,2001. .
Bland, J and D Altman. :Measurement error. .BMJ 313::744. ,1996. .
American Academy of Podiatric Sports Medicine Web site .Available at: http://www.aapsm.org. .Accessed February 20, 2010.
American College of Sports Medicine Web site .Available at: http://www.acsm.org. .Accessed February 20, 2010.
Sports Physical Therapy Section Web site .Available at: http://www.spts.org. .Accessed February 20, 2010.
International Federation of Sports Medicine Web site .Available at: http://www.fims.org. .Accessed February 20, 2010.
The Medical Commission: International Olympic Committee Web site .Available at: http://www.olympic.org/en/content/The-IOC/Commissions/Medical. .Accessed February 20, 2010.
Medibank Private: The cost of physical inactivity: what is the lack of participation in physical activity costing Australia? Available at: http://www.medibank.com.au/Client/Documents/Pdfs/pyhsical_inactivity.pdf. .Accessed February 10, 2010.
Sports Medicine Australia: Olympic gold and Australia’s economy harmed by injuries, media release ,2008. .Available at: http://sma.org.au/2008/08/olympic-gold-%e2%80%93-and-australia%e2%80%99s-economy-%e2%80%93-harmed-by-injuries/. .Accessed July 26, 2011.
Brooks, J, C Fuller, S Kemp, et al. :A prospective study of injuries and training amongst the England 2003 Rugby World Cup Squad. .Br J Sports Med 39::288. ,2005. .
Walden, M, M Hagglund, and J Ekstrand. :UEFA Champions League Study: a prospective study of injuries in professional football during the 2001–2002 Season. .Br J J Sports Med 39::542. ,2005. .
Junge, A, J Dvorak, and T Gra-Baumann. :Football injuries during the World Cup 2002. .Am J Sports Med 32 ( Suppl 1:) :23S. ,2004. .
Kinchington, M . :Podiatric management at the Olympic and Paralympic Games Sydney. .Australian J Podiatr Med 35::9. ,2001. .
Orchard, J . :Missed time through injury and injury management at an NRL club. .Sports Health 22::11. ,2004. .
Babic, Z, M Misigoj-Durakovic, and H Matasic. :Croatian rugby project: part II. Injuries. .J Sports Med Phys Fitness 41::392. ,2001. .
Hagglund, M, M Walden, and J Ekstrand. :Lower limb re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: a randomized controlled trial. .Am J Sports Med 9::1433. ,2007. .
Orchard, J and H Seward. :Epidemiology of injuries in the Australian Football League, seasons 1997–2000. .Br J Sports Med 36::39. ,2002. .
Milani, T, E Hennig, and M LaFotune. :Perceptual and biomechanical variables for running in identical shoe constructions with varying midsole hardness. .Clin Biomech 12::294. ,2007. .
Lee, E and R Goonetilleke. :A qualitative study on the comfort and fit of ladies’ dress shoes. .Appl Ergon 38::687. ,2005. .
Mundermann, A, D Stefanshyn, and B Nigg. :Relationship between footwear comfort of shoe inserts and anthropometric and sensory factors. .Med Sci Sport Exerc 33.:1939. ,2001. .
Charm, R and M Redfern. :Effect of flooring on standing comfort and fatigue. .Hum Factors 43::381. ,2001. .
Orendurff, M, E Rohr, A Segal, et al. :Regional foot pressure during running, cutting, jumping, and landing. .Am J Sports Med 3::566. ,2008. .
Chen, H, B Nigg, and J de Koning. :Relationship between plantar pressure distribution under the foot and insole comfort. .Clin Biomech 9::335. ,1994. .
Wakeling, J, S Pascual, and B Nigg. :Altering muscle activity in the lower extremities by running with different shoes. .Med Sci Sports Exerc 34::1529. ,2002. .
Stefanyshyn, D and B Nigg. :Influence of midsole bending stiffness on joint energy and jump height performance. .Med Sci Sports Exerc 32::471. ,2000. .
Lake, M and M Lafortune. :Mechanical inputs related to perception of lower extremity impact loading severity. .Med Sci Sports Exerc 30::136. ,1998. .
Lake, M . :Determining the protective function of sports footwear. .Ergonomics 43::1610. ,2000. .
Yeung, E and S Yeung. :Interventions for preventing lower limb soft-tissue injuries in runners. .Cochrane Database Syst Rev 3::CD001256. ,2001. .
Collie, A, P Maruff, M Makdissi, et al. :CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. .Clin J Sport Med 13::28. ,2003. .
Redmond, A, J Crosbie, and R Ouvrier. :Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. .Clin Biomech 21::89. ,2006. .
Benner, P . :From novice to expert. .Am J Nurs 82::402. ,1982. .
English, I . :Intuition as a function of the expert nurse: a critique of Benner’s novice to expert model. .J Adv Nurs 18::387. ,2002. .
Comfort evaluation techniques are commonplace in medicine. However, measures of lower-limb comfort are infrequently used in the sporting environment. The purpose of this study was to develop an instrument for measuring lower-limb comfort, which will extend previous work in the field of injury awareness.
A lower-limb comfort index (LLCI) was developed for use in the environment of elite sport. Forty professional footballers participated in development of the index. The study had three components. A critical appraisal of the literature established the need for an LLCI. The second phase involved 20 professional footballers establishing and testing the components of the comfort index as an instrument for measuring comfort.
Nonparametric statistics (the McNemar test) in phase 2 indicated that the LLCI demonstrated good responsiveness to suitability (P = .019) and ease of use (P < .01). After a high level of agreement for responses, the third stage required 20 players to pilot test the reliability of the LLCI in a controlled environment. Repeated measures of difference between two periods for sum comfort (intraclass correlation coefficient = 0.99) and individual anatomical segments (κ = 0.72–1) provided confidence that the comfort index was reliable.
The LLCI showed good trait construct to provide confidence to conduct a future study to investigate interrater consistency in a wider cohort of professional footballers under different conditions, such as match-day and training-week environments. (J Am Podiatr Med Assoc 101(5): 371–384, 2011)