Search Results
Reliability of Ankle Goniometric Measurements
A Literature Review
This article reviews the existing range-of-motion measurement literature related to ankle dorsiflexion and plantarflexion to determine whether the reliability of ankle range-of-motion measurements can be defined, how the characteristics of the study population or clinician affect reliability, and the level of responsiveness for these measures. A MEDLINE search was performed through February 2004, and 11 articles met the inclusion criteria established for this review. Ample evidence was found for intrarater reliability for ankle dorsiflexion and plantarflexion range of motion. Although some evidence for interrater reliability of dorsiflexion was found, little evidence for interrater reliability of plantarflexion range of motion was uncovered. On the basis of the current literature, the responsiveness of ankle joint range-of-motion measurements is uncertain and requires further studies using patient populations. (J Am Podiatr Med Assoc 95(6): 564–572, 2005)
Background: The Foot Posture Index (FPI) has been advocated as a simple and convenient tool to assess static foot posture in a clinical setting. Although published studies have indicated that the FPI has good intrarater reliability and moderate interrater reliability, these studies were conducted on a previous version of the tool that used eight criteria to score a patient’s foot posture. The revised tool has only six criteria (FPI-6). The purpose, therefore, of this study was to investigate the intrarater and interrater reliability of the revised version of the FPI.
Methods: Three different raters used the FPI-6 to twice evaluate 92 feet from 46 individuals.
Results: Intrarater reliability was high but interrater reliability was only moderate. In addition, using the raw score generated by the FPI-6 to classify feet into one of five categories did not improve agreement between raters.
Conclusions: The FPI-6 should be used with extreme caution and may actually have limited value, especially from a research perspective. (J Am Podiatr Med Assoc 98(1): 7–13, 2008)
Interrater Reliability of Spectral Doppler Waveform
Analysis Among Podiatric Clinicians
Background:
Spectral Doppler ultrasound examination of pedal arteries is one of the most frequently used noninvasive assessment methods by health-care professionals for the diagnosis and ongoing monitoring of people at risk for or living with peripheral arterial disease. The aim of this study was to determine the interrater reliability of the interpretation of spectral Doppler waveform analysis.
Methods:
An interrater reliability study was conducted among five experienced podiatric physicians at the University of Malta Research Laboratory (Msida, Malta). A researcher who was not a rater in this study randomly selected 229 printed spectral Doppler waveforms from a database held at the University of Malta. Each rater independently rated the qualitative spectral waveforms.
Results:
Interrater reliability of the spectral Doppler waveform interpretation was excellent among the five experienced podiatric physicians (α = 0.98). The intraclass correlation coefficient showed a high degree of correlation in waveform interpretation across raters (P < .001).
Conclusions:
This study demonstrates high interrater reliability in visual spectral Doppler interpretation among experienced clinicians. The current foot screening guidelines do not refer to spectral Doppler waveform analysis in their recommendations, which has been shown in studies to be an important modality for the diagnosis of peripheral arterial disease when ankle-brachial pressure indexes are falsely elevated in calcified arteries. If interpreted correctly, the information obtained can provide an indication of the presence of peripheral arterial disease and facilitate early management of this condition.
Background: Foot dimension information is important both for footwear design and clinical applications. In recent years, non-contact three-dimensional foot digitizers/scanners became popular as they are non-invasive and are both valid and reliable for the most of measures. Some of them also offer automated calculations of basic foot dimensions. The study aimed to determine test-retest reliability, objectivity, and concurrent validity of the Tiger full foot 3D scanner as well as the relationship between the manual measures of the medial longitudinal arch of the foot and its alternative parameters obtained automatically by the scanner. Methods: Intraclass correlation coefficients and the values of minimal detectable change were used to assess the reliability and objectivity of the scanner. Concurrent validity and the relationship between the arch height measures were determined by the Pearson's correlation coefficient and the limits of agreement between the scanner and the calliper method. Results: Both the relative and absolute agreement between the repeated measurements obtained by the scanner show excellent reliability and objectivity of linear measures and only good to nearly good test-retest reliability and objectivity of the arch height. Correlations between the values obtained by the scanner and the calliper were generally higher in linear measures (rp{greater than or equal to}0.929). The representativeness of state of bony architecture by the soft tissue margin of the medial foot arch demonstrate the lowest correlations among the all measurements (rp{less than or equal to}0.526). Conclusions: The Tiger full foot 3D scanner offers both excellent reliability and objectivity in linear measures, which correspond to those obtained by the calliper method. However, values obtained by the both methods shouldn't be used interchangeably. The arch height measure is less accurate, which could limit its use in some clinical applications. Orthotists and related professions probably appreciate scanner more than other specialists.
Intrarater and Interrater Reliability of First Metatarsophalangeal Joint Dorsiflexion
Goniometry versus Visual Estimation
Background:
Visual estimation (VE) and goniometric measurement (GM) are commonly used to assess first metatarsophalangeal joint dorsiflexion. The purposes of this study were to determine the intrarater and interrater reliability of VE and GM and to establish whether reliability was influenced by the experience of the examiner.
Methods:
Ten experienced and ten inexperienced examiners evaluated three real-size photographs of a first metatarsophalangeal joint positioned in various degrees of dorsiflexion on two separate occasions.
Results:
Experienced examiners demonstrated excellent intrarater and interrater reliability for GM (intraclass correlation coefficient [ICC], >0.953; standard error of measurement [SEM], 1.8°–2.5°) compared with inexperienced examiners, who showed fair-to-good intrarater and interrater reliability (ICC, 0.322–0.597; SEM, 2.0°–3.0°). For VE, inexperienced examiners demonstrated fair-to-good interrater and excellent intra-rater reliability (ICC, 0.666–0.808), which was higher compared with experienced examiners (ICC, 0.167–0.672). The SEM (2.8°–4.4°) was less varied than that of experienced examiners (SEM, 3.8°–6.4°) for VE, but neither group’s SEMs were clinically acceptable.
Conclusions:
Although minimal differences between intrarater and interrater reliability of GM and VE are noted, this study suggests that GM is more reliable than VE is when used by experienced examiners. These findings support the continued use of GM for first metatarsophalangeal joint dorsiflexion assessment. (J Am Podiatr Med Assoc 102(4): 290–298, 2012)
Background
Plantar pressure plate instruments are commonly used in clinical practice and biomechanical analysis and are useful to establish a relationship between gait disorders and foot pressure. The aim of this study was to verify the reliability and repeatability of the Footwork pressure plate system for static and dynamic conditions.
Methods
Forty healthy adults, without apparent gait pathology, were recruited. For the static condition, participants were asked to stand static on the Footwork pressure plate for 5 sec in natural position (arms on either side of the body, feet shoulder-width apart in a comfortable angle, and looking ahead). For the dynamic condition, subjects were told to step five times with each foot on the plate following the three-step protocol. Both conditions were performed in two testing sessions spaced by 1 week.
Results
Intrasession and intersession reliability for both conditions showed substantial to almost perfect intraclass correlation coefficient (ICC) values, and low coefficient of variation, low standard error measure, and low percentage error. Intrasession ICCs were 0.724 to 0.993 for static condition evaluation and 0.639 to 0.986 for dynamic condition evaluation. Intersession reliability ICCs ranged from 0.850 to 0.987 for the static condition and from 0.781 to 0.996 for the dynamic condition. Coefficient of variation values were below 8% in both cases and percentage error calculated from standard error measure were less than 10%.
Conclusions
The present work demonstrates that the Footwork plantar pressure plate system is a reliable instrument for collecting plantar pressures in static and dynamic conditions. Reliability data were higher for the static trials, probably because of the individual physiologic fluctuations, which are larger during dynamic gait. Reliability for intersession and average intrasession trials were higher than single-test reliability. The results from the present work can be used as a starting point for future research and to establish a basis for sample sizes for investigations that would use the Footwork platform.
The reliability of biomechanical measurements of the lower extremities, as they are commonly used in podiatric practice, was quantified by means of intraclass correlation coefficients (ICCs). This was done not only to evaluate interrater and intrarater reliability but also to provide an estimate for the accuracy of the measurements. The measurement protocol involved 30 asymptomatic subjects and five raters of varying experience. Each subject was measured twice by the same rater, with the retest immediately following the test. The study demonstrated that the interrater ICCs were quite low (≤0.51), except for the measurements of relaxed calcaneal stance position and forefoot varus (both 0.61 and 0.62 for left and right, respectively). However, the intrarater ICCs were relatively high (>0.8) for most raters and measurement variables. Measurement accuracy was moderate between raters. (J Am Podiatr Med Assoc 92(6): 317-326, 2002)
Dynamic Footprint Measurement Collection Technique and Intrarater Reliability
Ink Mat, Paper Pedography, and Electronic Pedography
Background:
Identifying the variability of footprint measurement collection techniques and the reliability of footprint measurements would assist with appropriate clinical foot posture appraisal. We sought to identify relationships between these measures in a healthy population.
Methods:
On 30 healthy participants, midgait dynamic footprint measurements were collected using an ink mat, paper pedography, and electronic pedography. The footprints were then digitized, and the following footprint indices were calculated with photo digital planimetry software: footprint index, arch index, truncated arch index, Chippaux-Smirak Index, and Staheli Index. Differences between techniques were identified with repeated-measures analysis of variance with post hoc test of Scheffe. In addition, to assess practical similarities between the different methods, intraclass correlation coefficients (ICCs) were calculated. To assess intrarater reliability, footprint indices were calculated twice on 10 randomly selected ink mat footprint measurements, and the ICC was calculated.
Results:
Dynamic footprint measurements collected with an ink mat significantly differed from those collected with paper pedography (ICC, 0.85–0.96) and electronic pedography (ICC, 0.29–0.79), regardless of the practical similarities noted with ICC values (P = .00). Intrarater reliability for dynamic ink mat footprint measurements was high for the footprint index, arch index, truncated arch index, Chippaux-Smirak Index, and Staheli Index (ICC, 0.74–0.99).
Conclusions:
Footprint measurements collected with various techniques demonstrate differences. Interchangeable use of exact values without adjustment is not advised. Intrarater reliability of a single method (ink mat) was found to be high. (J Am Podiatr Med Assoc 102(2): 130–138, 2012)
The purpose of this study was to determine the reliability and validity of two center-of-pressure quantification methods. One hundred five individuals (33 men and 72 women) with a mean age of 26.7 years participated in phase 1 of the study. Two measures of the center-of-pressure pattern, the lateral-medial area index and the lateral-medial force index, were calculated from plantar pressure data collected on all subjects. Between-trial reliability of the two measurements was assessed using intraclass correlation coefficients. In phase 2, frontal plane motion of the rearfoot was recorded in 30 individuals. Pearson correlation coefficients were then calculated between the two center-of-pressure indices and the magnitude of rearfoot eversion obtained from each subject during walking. Intraclass correlation coefficient values ranged from 0.374 to 0.889 for the lateral-medial area index and from 0.215 to 0.905 for the lateral-medial force index. Pearson correlation coefficients between the two center-of-pressure indices and the rearfoot kinematic variables ranged from 0.050 to 0.165. The lateral-medial area index and the lateral-medial force index may have adequate between-trial reliability but are not related to the magnitude of frontal plane rearfoot eversion during the stance phase of walking. (J Am Podiatr Med Assoc 93(2): 142-149, 2003)
Several decisions need to be made when prescribing foot orthoses for abnormal foot pronation. One of these decisions is how much force is needed from orthoses to supinate the foot. The supination resistance test has been described as one technique to help determine the amount of force needed. The aim of this project was to determine the reliability of the manual supination resistance test. Four clinicians of differing levels of experience performed the test on 44 subjects (88 feet) on 2 separate days. The test had good reliability overall, with an intertester intraclass correlation coefficient of 0.89. For the two more experienced clinicians, the intratester intraclass correlation coefficients were good (0.82 and 0.78), but for the two inexperienced clinicians they were poor (0.56 and 0.62). The supination resistance test may be clinically useful in the prescription of foot orthoses, but more work is needed to determine its validity and its relationship to clinical outcomes. (J Am Podiatr Med Assoc 93(3): 185-189, 2003)
