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Validation of the Basic Foot Screening Checklist

A Population Screening Tool for Identifying Foot Ulcer Risk in People with Diabetes Mellitus

Virginia M. Bower Division of Clinical Services, Department of Podiatry, Royal Perth Hospital, Perth, Australia. Dr. Bower is now with Podiatric Medicine, Faculty of Medicine, Dentistry, and Health Sciences, University of Western Australia, Crawley, Western Australia.

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Michael Hobbs Department of Population Health, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Australia.

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Background: We sought to evaluate the validity, reliability, and predictive value of the Basic Foot Screening Checklist.

Methods: Five hundred patients with type 2 diabetes mellitus and impaired glucose tolerance were screened by a generalist foot screener and a specialist podiatric physician to determine the sensitivity and specificity of the Basic Foot Screening Checklist. One hundred twelve of the 500 participants had their feet screened by two foot screeners to determine reliability.

Results: The sensitivity of the screening tool was 0.54 (95% confidence interval, 0.50–0.58), and the specificity was 0.77 (95% confidence interval, 0.73–0.81), with a positive predictive value of 0.82 (95% confidence interval, 0.79–0.85). Overall, the reliability of the tool was poor (κ = 0.35; 95% confidence interval, 0.17–0.53).

Conclusions: The validity and reliability of the Basic Foot Screening Checklist was poor despite the finding that generalist foot screeners performed individual tests with good sensitivity and specificity. This inconsistency was likely attributable to the inability of screeners to adequately interpret the test findings and form accurate risk classification outcomes. (J Am Podiatr Med Assoc 99(4): 339–347, 2009)

Corresponding author: Virginia M. Bower, MPH, Podiatric Medicine, Faculty of Medicine, Dentistry, and Health Sciences, M422, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia 6009. (E-mail: virginia.bower@uwa.edu.au)