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Another bl....y outcome measure for the foot

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  #1  
Old 30th September 2005, 07:01 PM
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Default Another bl....y outcome measure for the foot

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Does anyone share my frustraton at the plethora of outcome tools that have been developed for the foot :( . When will it stop? When will people actually stop developing them and start doing research that actually uses them

Now we have this one:
Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders I: development of standard rating system.
J Orthop Sci. 2005 Sep;10(5):457-65
Quote:
BACKGROUND: The aim of this study was to report the five scales comprising the rating system that the Japanese Society for Surgery of the Foot (JSSF) devised (JSSF standard rating system) and the newly offered interpretations and criteria for determinations of each assessment item. METHODS: We produced the new scales for the JSSF standard system by modifying the clinical rating systems established by the American Orthopaedic Foot and Ankle Society (AOFAS scales) and the Japanese Orthopaedic Association's foot rating scale (JOA scale). We also provided interpretations of each assessment item and the criteria of determinations in the new standard system. RESULTS: We improved the ambiguous expressions and content in the conventional standard rating systems so they would be easily understood by Japanese people. The result was five scales in total. Four were designed for use specifically for ankle-hindfoot, midfoot, hallux metatarsophalangeal-interphalangeal, and lesser metatarsophalangeal-ineterphalangeal sites; and the fifth was for the foot and ankle with rheumatoid arthritis. Furthermore, we described interpretations and criteria for determinations with regard to evaluation items in each scale. CONCLUSIONS: Conventionally, the AOFAS scales or the JOA scale have been separately applied depending on the sites or disorders concerned, but it was often difficult to decide on scores during practical evaluations because of differing expressions in different languages and also because of ambiguity in the interpretation of each evaluation item and in scoring standards as well. JSSF improved these scales and added definite interpretations of evaluation items as well as criteria for the rating (to be reported here in part I). Because these steps were expected to improve the reliability of outcomes assessed by each scale, we examined the reliability in scores of the newly developed scales, which are reported in part II (in this issue).
Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders II: interclinician and intraclinician reliability and validity of the newly established standard rating scales and Japanese Orthopaedic Association rating scale.
J Orthop Sci. 2005 Sep;10(5):466-74.
Quote:
BACKGROUND: This study evaluated the validity and inter- and intraclinician reliability of (1) the Japanese Society of Surgery of the Foot (JSSF) standard rating system for four sites [ankle-hindfoot (AH), midfoot (MF), hallux (HL), and lesser toe (LT)] and the rheumatoid arthritis (RA) foot and ankle scale and (2) the Japanese Orthopaedic Association's foot rating scale (JOA scale). METHODS: Clinicians from the same institute independently evaluated participating patients from their institute by two evaluations at a 1- to 4-week interval. Statistical evaluation was as follows. (1) The intraclass correlation coefficient (ICC) was calculated from data collected from at least two examinations of each patient by at least two evaluating clinicians (Data A). (2) Total scores for the two evaluations were determined from the distribution of differences in data between the two evaluations (Data B); each item was evaluated by determining Cohen's coefficient of agreement. (3) The relation between patient satisfaction and total score was investigated only for patients who underwent surgery (Data C). Spearman's rank correlation coefficient was obtained. RESULTS: Participants were 65 clinicians and 610 patients, including those with disorders of the AH (313), MF (47), HL (153), and LT (50) and those with RA (47). From Data A, the ICC was high for AH and HL by JSSF scales and for AH, MF, and LT by the JOA scale. From Data B, the coefficient showed high validity for both scales for AH, with almost no difference between the two scales; the validity for HL was higher with the JOA scale than with the JSSF scale. From Data C, correlations were significant between patient satisfaction and outcome for AH and HL by the JSSF scales and for AH, HL, and LT by the JOA scale. CONCLUSIONS: The validity of both scales was high. Clinical evaluation of the therapeutic results using these scales would be highly reliable.
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  #2  
Old 30th September 2005, 07:35 PM
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Young Craig , would I be right in detecting a note of frustration here?

All I can say is thank 'crunchie', peeps are beinging to realise the state is measurable, and maybe when they do get round to the research bit, we can have some decent base line data.


How are you anyway?

Cheers
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  #3  
Old 30th September 2005, 07:40 PM
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It just seems as though people are more keen to develop yet another outcome tool, rather than spend that time using the ones we have. .... why waste resources reinventing the wheel? We should be getting on with doing research on, for eg, diferences in outcomes between 2 interventions using outcome tools we now have, rather than develop new tools to measure the outcomes!!
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  #4  
Old 29th November 2005, 08:02 PM
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Here ia another ...aggggghhhhhh:

Evidence of Validity for the Foot and Ankle Ability Measure (FAAM).
Foot Ankle Int. 2005 Nov;26(11):968-83.
Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM.
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BACKGROUND: There is no universally accepted instrument that can be used to evaluate changes in self-reported physical function for individuals with leg, ankle, and foot musculoskeletal disorders. The objective of this study was to develop an instrument to meet this need: the Foot and Ankle Ability Measure (FAAM). Additionally, this study was designed to provide validity evidence for interpretation of FAAM scores. METHODS: Final item reduction was completed using item response theory with 1027 subjects. Validity evidence was provided by 164 subjects that were expected to change and 79 subjects that were expected to remain stable. These subjects were given the FAAM and SF-36 to complete on two occasions 4 weeks apart. RESULTS: The final version of the FAAM consists of the 21-item activities of daily living (ADL) and 8-item Sports subscales, which together produced information across the spectrum ability. Validity evidence was provided for test content, internal structure, score stability, and responsiveness. Test retest reliability was 0.89 and 0.87 for the ADL and Sports subscales, respectively. The minimal detectable change based on a 95% confidence interval was +/-5.7 and +/--12.3 points for the ADL and Sports subscales, respectively. Two-way repeated measures ANOVA and ROC analysis found both the ADL and Sports subscales were responsive to changes in status (p < 0.05). The minimal clinically important differences were 8 and 9 points for the ADL and Sports subscales, respectively. Guyatt responsive index and ROC analysis found the ADL subscale was more responsive than general measures of physical function while the Sports subscale was not. The ADL and Sport subscales demonstrated strong relationships with the SF-36 physical function subscale (r = 0.84, 0.78) and physical component summary score (r = 0.78, 0.80) and weak relationships with the SF-36 mental function subscale (r = 0.18, 0.11) and mental component summary score (r = 0.05, -0.02). CONCLUSIONS: The FAAM is a reliable, responsive, and valid measure of physical function for individuals with a broad range of musculoskeletal disorders of the lower leg, foot, and ankle.
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  #5  
Old 30th November 2005, 03:11 AM
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Hi Craig,

Irrespective of the validity of carrying out these pieces of research, I would like to believe that diurnal variation figured at least somewhere in each of the studies you mention - but I suspect not.

If scientific method is being used to gather data and correlate differences, then diurnal or circadian variation would really have to be part of that scientific method. Without it the results are going to be skewed, to say the least.

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Old 12th August 2006, 04:57 PM
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Proposal of a questionnaire to evaluate the foot in the rheumatic diseases.
Clin Ter. 2006 May-Jun;157(3):199-205
Coaccioli S, Pinoca F, Puxeddu A
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OBJECTIVE: To compile a simple questionnaire, named 'Foot Health Questionnaire-1' (FHQ1), which would evaluate the state of the foot in rheumatic diseases, such as osteoarthritis (OA) and rheumatoid arthritis (RA).

MATERIALS AND METHODS: Sixty-three consecutive subjects entered the study: 25 with RA; 14 with OA; 10 with CTD and 14 healthy control subjects.

RESULTS: It was possible to establish that the highest mean value of FHQ1 refers to RA patients (median FHQ1 value, 41) and OA patients (median FHQ1 value, 37) whereas for CTD patients the mean value was 14 and for healthy subjects was = 0, as expected. It results that 72% of RA patients and 65% of OA patients enter classes III and IV of FHQ1, whereas 70% of CTD patients were in class I.

CONCLUSIONS: An evaluation questionnaire regarding the algo-functioning of the foot could be a useful tool in routine rheumatologic clinical practice.
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Old 12th August 2006, 07:15 PM
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Thumbs down Foot Outcome measures studies:

Craig and others
I am looking to use a foot outcome tool for clinical audit process.
The NZ Ministry of health has good information on how this should be done but i was wondering what is the best ,user friendly outcome tool to serve this purpose?
Any ideas,suggestions

andrew jones :)
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Old 17th August 2006, 06:29 PM
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Default ...they just keep on coming...

A new foot and ankle outcome score: Questionnaire based, subjective, Visual-Analogue-Scale, validated and computerized
Foot and Ankle Surgery Article in Press
Quote:
Abstract
Our purpose was to construct and validate a new score taking into consideration the flaws of existing scores.

Methods
A new score named Visual-Analogue-Scale Foot and Ankle (VAS FA) with the following features was constructed: questionnaire based on 20 subjective questions, Visual-Analogue-Scale (VAS) based rating, computerized evaluation. The score was validated in 121 subjects. For validation, SF-36® and Hannover Questionnaire (Q) were obtained and correlated with VAS FA.

Results
The correlation VAS FA versus SF-36® and Q (Pearson, all p-values <0.001, r ≥ 0.5) was sufficient for the total score and all score categories (pain, function, other complaints).

The time needed for evaluating the scores was significantly lower for VAS FA than for SF-36® and Q (Oneway-ANOVA, p < 0.001).

Conclusions
The introduced score is the first validated (on SF-36®), subjective, VAS based outcome score for foot and ankle. The VAS FA is computerized which enables faster evaluation than SF-36® or Q.
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Old 18th August 2006, 12:15 AM
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THEY'RE COMING OUT OF THE WALLS MAN!!!!!

With you on this one Craig. Thing is its much easier to design systems than to use them. Thats why the NHS re cycles every few years rather than trying to make the current system work! Such is life.

Robert
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Old 18th August 2006, 01:13 PM
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Bloody hell, LOL, think u hve given me ample to work with there.. Am new to both the site and my new found own deep rooted belief in the enormity of the possibilities of our profession, thanks for enhancing it further.
D
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Old 19th August 2006, 12:47 AM
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A number of factors may account for the growing library of tools. The first references listed here highlight the perceived need to develop population specific tools. Or, the lack of applicability of a tool developed for use in one "population" to meet the needs of another. If tools have questions/ factors which are somewhat parochial then their use is limited to that "parish". Similarly, many of these tools are condition specific and thus applicable to a limited target, for example patients with rheumatoid arthritis. Another limiting factor is that these tools are usually designed to answer a specific question and may not provide the answer to all questions.

Perhaps (as ever) an even stronger driver is that of potential financial gains. Developers tend to copyright the tools and sell them on, rather than allowing free use. Thus, it is less expensive to develop a new tool and /or the developer gains financially from its development.

David's point re: diurnal variation is debatable. All of the outcome tools capture a specific response at a specific instant in time, so too do all clinical measurements. Researchers realise this and take account of it. By evaluating the within-day and between-day error as part of the development process, these variations can be quantified. If large within / between day error is observed the tool could be deemed to have poor repeatability. Thus, if one wished to study diurnal variation you would need to partition the measurement error from the "real" variation- this is not as simple as it first appears. I should be interested to learn of podiatric methodologies that have achieved this.
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Old 27th September 2006, 03:45 PM
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Default another one

A patient-based questionnaire to assess outcomes of foot surgery: Validation in the context of surgery for hallux valgus.
Qual Life Res. 2006 Sep 25;
Dawson J, Coffey J, Doll H, Lavis G, Cooke P, Herron M, Jenkinson C
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Background: A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery.

Methods: We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional.

Conclusions: The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions
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Old 6th December 2006, 01:55 PM
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Responsiveness of the Foot Function Index, AOFAS Clinical Rating Systems, and SF-36 after Foot and Ankle Surgery.
Foot Ankle Int. 2006 Nov;27(11):930-4
Soohoo NF, Vyas R, Samimi D
Quote:
BACKGROUND: There is uncertainty regarding which outcomes tools should be used to report the results of treatment for patients with foot and ankle disorders. This study compared the responsiveness of the Foot Function Index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Systems, and Medical Outcomes Study Short Form-36 (SF-36) in patients with foot and ankle surgery.

METHODS: Twenty-five patients were recruited at a tertiary referral foot and ankle practice. The mean age of the patient sample was 40 years (range 21 to 69) and 19 were women (76%). Thirteen patients (52%) had conditions affecting the ankle, hindfoot, or midfoot, while 12 patients (48%) had conditions affecting the forefoot. Patients completed packets preoperatively and 6-months postoperatively which included informed consent forms, the FFI, the AOFAS, and the SF-36 questionnaires. Standardized response means (SRM) and effect sizes (ES) were used as the measures of responsiveness and were calculated for the AOFAS scores, the three domains of the FFI, the eight SF-36 sub-scales, and the two SF-36 summary scales.

RESULTS: The standardized response mean (SRM) for the AOFAS scores was 1.10 and the effect size (ES) was 1.12. The SRM for the three FFI domains ranged from -0.39 to -0.83, while the ES ranged from -0.55 to -0.86. The SRM for the SF-36 ranged from 0.09 to 0.72 (ES ranged from 0.09 to 0.77) with the highest values occurring with the Bodily Pain sub-scale (SRM 0.72, ES 0.77) and Physical Component Summary scale (SRM 0.76, ES 0.68).

CONCLUSIONS: This study demonstrated increased responsiveness of foot and ankle specific outcomes tools compared to the SF-36. However, the Bodily Pain sub-scale and Physical Component Summary scale of the SF-36 had levels of responsiveness approaching those of the FFI and AOFAS Systems after foot and ankle surgery. This suggests that the SF-36 may be used alone to monitor the outcomes in these patients without sacrificing adequate sensitivity to clinical change.
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Old 14th December 2006, 01:04 AM
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The Achilles Tendon Total Rupture Score (ATRS): Development and Validation.
Am J Sports Med. 2006 Dec 7;
Nilsson-Helander K, Thomeé R, Grävare-Silbernagel K, Thomeé P, Faxén E, Eriksson BI, Karlsson J
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BACKGROUND: There is a need for a patient-relevant instrument to evaluate outcome after treatment in patients with a total Achilles tendon rupture.

PURPOSE: To develop and validate a new patient-reported instrument for measuring outcome after treatment for total Achilles tendon rupture.

STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1.

METHODS: Development of this instrument consisted of item generation and test construction, item reduction, validation, evaluation of structure and internal consistency, test-retest, and test for responsiveness. The final version, the Achilles tendon Total Rupture Score (ATRS), was tested for validity, structure, and internal consistency (Cronbach's alpha) on 82 patients and 52 healthy persons. A correlation analysis was performed of the ATRS with the 2 validated foot/ankle/Achilles tendon scores, the Foot and Ankle Outcome Score (FAOS) and the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S). Structure was evaluated with factor analysis. Test-retest reliability was evaluated on 43 patients. The ATRS responsiveness was tested on 43 patients by calculating the effect size.

RESULTS: The total score for the patients ranged from 17 to 100 with a mean (median) of 77 (85) and a standard deviation (interquartile range) of 21.4 (23). A significantly (P < .0001) higher total score was found for the healthy subjects, ranging from 94 to 100 with a mean (median) of 99.8 (100) and a standard deviation (interquartile range) of 1.1 (0). The ATRS correlated significantly (P < .01) with all subscales of the FAOS (r = 0.60-0.84) and the VISA-A-S (r = 0.78). The factor analysis gave 1 factor of importance. The internal consistency was 0.96 as measured with Cronbach's alpha. The test-retest produced an intraclass correlation coefficient of 0.98. The tests for responsiveness showed an effect size between 0.87 and 2.21.

CONCLUSION: The ATRS is a patient-reported instrument with high reliability, validity, and sensitivity for measuring outcome after treatment in patients with a total Achilles tendon rupture.

CLINICAL RELEVANCE: The ATRS is a self-administered instrument with high clinical utility, and we suggest the score for measuring the outcome, related to symptoms and physical activity, after treatment in patients with a total Achilles tendon rupture.
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Old 9th January 2007, 05:36 PM
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Default Re: Another bl....y outcome measure for the foot

Reliability and validity of the american orthopaedic foot and ankle society clinical rating scale: a pilot study for the hallux and lesser toes.
Foot Ankle Int. 2006 Dec;27(12):1014-9
Baumhauer JF, Nawoczenski DA, Digiovanni BF, Wilding GE.
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BACKGROUND: The use of clinical outcomes instruments is essential for the effective interpretation of individual patient progress as well as the comparison of treatment groups. An outcomes instrument must be reliable and valid to obtain any meaningful data. The purpose of the present study was to examine the reliability and validity of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale for the hallux metatarsophalangeal-interphalangeal and lesser toes metatarsophalangeal-interphalangeal joints.

METHODS: Eleven patients (one man, 10 women) with an average age of 54 (range 40 to 72) years and with classic rheumatoid arthritis not currently treated for foot complaints were enrolled in the present study. The average duration of rheumatoid arthritis was 14 years. Each patient completed a set of two outcomes instruments and had a physical examination by a single clinician at the initial visit and returned at 1 week for completion of the same scales and examination. The outcomes scales used were the AOFAS clinical rating scale for the hallux, the AOFAS clinical rating scale for the lesser toes, and the previously validated Foot Function Index (FFI). Test-retest reliability was evaluated using intraclass correlation coefficients between week 1 and week 2 for the summary scores as well as for the subscales of pain and activity. Consistency between the two instruments was evaluated with Pearson correlation coefficients.

RESULTS: The AOFAS clinical rating scale for the hallux and lesser toes is repeatable between 1-week trials (ICC 0.95; p < 0.05; ICC 0.80; p < 0.05, respectively). Moderately strong correlations were found between the mean values for the AOFAS hallux and FFI (r = -0.81; p < 0.05). Weaker correlations were seen between the mean values for the AOFAS lesser toes and FFI scales (r = -0.69; p < 0.05).

CONCLUSIONS: The hallux subscale for pain correlates strongly with the FFI subscale for pain, suggesting high content validity (r = -0.94; p < 0.001). Ceiling effects were seen with the AOFAS lesser toe subscale for activity, limiting its usefulness in a general patient population. The AOFAS lesser toe subscale for pain and the AOFAS hallux subscale for activity correlated weakly with the FFI values (r = -0.31; r = -0.37; p > 0.05, respectively).

CONCLUSIONS: Although the AOFAS hallux and lesser toe scales were found to be reliable in a rheumatoid patient population, their validity remains in question. These findings must be confirmed with larger subject numbers, with the inclusion of symptomatic patients before recommended routine use of the hallux clinical rating and lesser toe clinical rating scales.
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Old 20th January 2007, 11:08 AM
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Default Re: Another bl....y outcome measure for the foot

The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review.
BMC Musculoskelet Disord. 2007 Jan 18;8(1):6
Eechaute CJ, Vaes PH, Van Aerschot L, Asman S, Duquet W
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BACKGROUND: The assessment of outcomes from the patients' perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability.

METHODS: A computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients.

RESULTS: The inter-observer reliability of the selection procedure was excellent (k= .86). Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT), the Functional Ankle Outcome Score (FAOS), the Foot and Ankle Disability Index (FADI) and the Functional Ankle Ability Measure (FAAM). The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88). Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. Internal consistency was only demonstrated for the FAAM. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all subscales. Responsiveness was demonstrated for the AJFAT, FADI and the FAAM. Only for the FAAM, a minimal clinical important difference (MCID) was presented.

CONCLUSION: The FADI and the FAAM can be considered as the most appropriate, patient-assessed tools to quantify functional disabilities in patients with chronic ankle instability. The clinimetric qualities of the FAAM need to be further demonstrated in a specific population of patients with chronic ankle instability.
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Old 23rd January 2007, 08:44 PM
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Default Re: Another bl....y outcome measure for the foot

Craig,

As you suggest, there'se a never ending stream of instruments. Its what you do with them thats important. The "research question being answered" is more relevant than the tool, providing the tool works properly.

PB
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Old 5th February 2007, 11:58 PM
Paul B Paul B is offline
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Default Re: Another bl....y outcome measure for the foot

Quote:
Originally Posted by Craig Payne
Does anyone share my frustraton at the plethora of outcome tools that have been developed for the foot :( . When will it stop? When will people actually stop developing them and start doing research that actually uses them
Craig, I've just come across The AO Handbook of "Musculoskeletal Outcomes Measures and Instruments (published by AO and Thieme, 2005), authors Suk, Hanson, Norvell & Helfet.

The Foot Health Status Questionnaire ( FHSQ ) is ranked independently by the AO as the sign most valid measure of foot health (out of 30 instruments evaluated to date). Can you pass that onto Karl for his information?

Regards

Paul

Last edited by Admin : 8th February 2007 at 12:55 PM. Reason: fixed quote
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Old 8th February 2007, 07:40 AM
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Default Re: Another bl....y outcome measure for the foot

[2006] [FRI0573-AHP] FOOT HEALTH STATUS QUESTIONNAIRE: TRANSLATION AND VALIDATION OF THE BRAZILIAN VERSION (FHSQ-BR)

C. Tanaka1,A.F.B. Ferreira 1 , M.B. Ferraz 2 , I.M.M. Laurindo 1 , P.T. Rodrigues 1 1Rheumatology, University of São Paulo, 2Rheumatology, Federal University of São Paulo, São Paulo, Brazil

The purpose of this study was to conduct a cross-cultural adaptation and validation of the Foot Health Status Questionnaire (FHSQ) evaluating its measurement properties. All ten domains of the FHSQ were translated into Portuguese by two Brazilian translators creating Version 1. This version was back-translated by two native English-speaking teachers who made suggestions for Version 1, creating Version 2. A multidisciplinary committee was formed to test the instrument's semantic, idiomatic, experiential and conceptual equivalences. After being reformulated and approved by the committee, Version 3 was pre-tested on a group of patients from the Rheumatology Service of the Hospital das Cl?*nicas. They answered this version and made suggestions for the better understanding of the instructions, questions and response option. The FHSQ-Br was then created. The translated and adapted version was submitted to field test on a study group composed of sixty-five Rheumatoid Arthritis (RA) patients to evaluate test-retest reliability, internal consistency and construct validity. The construct validity of the FHSQ-Br was tested correlating the scores to clinical and laboratory parameters commonly used to assess RA (Health Assessment Questionnaire; Numbered Rating Scale for foot pain; foot X-rays; erythrocyte sedimentation rate and C-reactive protein). The cultural adaptation of the FHSQ was successfully accomplished, since patients suggested changes in only three items of the instrument during the pre-test phase. In the field test, the intra-class correlation coefficients showed high reliability for both intra- and inter-observer correlations. Internal consistency coefficients were statistically significant (p<0.05) for all domains. As for the evaluation of the construct validity, each domain revealed correlations with a specific group of parameters, according to what the domains were intended to measure. The FHSQ was cross-culturally adapted generating a reliable, consistent and valid instrument. This study has proven the FHSQ-Br to be a useful tool to evaluate foot health in systemic diseases and is easily adaptable to different cultures.

Miscellaneous forms of clinical care

Citation: Ann Rheum Dis 2006;65(Suppl II):669

FYI

http://www.fhsq.homestead.com/
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Old 3rd March 2007, 11:25 AM
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Default Re: Another bl....y outcome measure for the foot

Reliability and validity of the subjective component of the american orthopaedic foot and ankle society clinical rating scales.
J Foot Ankle Surg. 2007 Mar-Apr;46(2):65-74
Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK
Quote:
This study evaluates the criterion validity of the subjective component of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scales by correlating scores obtained with these rating scales to scores obtained with the Foot Function Index (FFI) in patients with foot and ankle conditions. To date, the AOFAS scoring scales have not been shown to provide valid information despite their popularity. The FFI, on the other hand, has previously been shown to provide valid information in regard to conditions affecting the foot and ankle. A moderately strong inverse criterion validity correlation (Pearson correlation coefficient = -0.68) was shown when preoperative patients were administered both the AOFAS and FFI questionnaires, and the resultant scores were compared. Test-retest reliability measurements showed no significant difference (P = .27) between preoperative AOFAS scale scores measured at least 2 weeks apart. Construct validity was shown (P = .006) when dependent preoperative and postoperative (at least 3 months) AOFAS scale scores were compared, indicative of the clinical rating scales' ability to discriminate and predict quality of life related to foot and ankle conditions. The moderate level of correlation, satisfactory degree of reliability, and responsiveness (ability to distinguish differences between preoperative and postoperative conditions in the same patient) observed in this study suggest that the subjective component of the AOFAS clinical rating scales provides quality-of-life information that conveys acceptable validity regarding conditions affecting the foot and ankle.
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Old 23rd March 2007, 12:35 AM
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Default Re: Another bl....y outcome measure for the foot

A survey of self-reported outcome instruments for the foot and ankle.
J Orthop Sports Phys Ther. 2007 Feb;37(2):72-84
Quote:
The information acquired from self-reported outcome instruments is useful only if there is evidence to support the interpretation of obtained scores. To properly interpret scores, there should be evidence for content validity, construct validity, reliability, and responsiveness. Evidence regarding score interpretation must also contain a description of the applicable test conditions, including information about the characteristics of subjects, timing of data collection, and construct of change. The objective of this review was to identify self-reported outcome instruments that have evidence to support their usefulness for assessingthe effect of treatment directed at individuals with foot and ankle-related pathologic conditions in an orthopaedic physical therapy setting. In addition, we provide specific information that will allow clinicians and researchers to select an appropriate instrument and properly interpret the obtained scores. Fourteen self-reported outcome instruments that met the objective of this review were identified. Five instruments, the Foot and Ankle Ability Measure, Foot Function index, Foot Health Status Questionnaire, Lower Extremity Function Scale, and Sports Ankle Rating System quality of life measure, satisfied all 4 categories of evidence (content validity, construct validity, reliability, and responsiveness) outlined herein
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Old 28th March 2007, 05:23 AM
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Default Re: Another bl....y outcome measure for the foot

Validation of a self-report instrument for assessment of hallux valgus.
Osteoarthritis Cartilage. 2007 Mar 24
Quote:
OBJECTIVES: To validate an instrument for self-reported hallux valgus (HV).

METHODS: The self-report instrument consists of five line drawings for each foot depicting a sequential increase in HV angle of 15 degrees developed from a photograph of a normal foot. Participants were asked to select the picture which best represented their left and right feet in turn. Four hundred and fifty-nine subjects completed the self-report instrument: 100 attending a hospital rheumatology clinic and 359 who participated in a community questionnaire study. Three hundred and eighty-four completed it on two occasions (1-2 months apart in 71 subjects and 3-6 months apart in 313) and were assessed once by a blinded observer. Twenty-five subjects were assessed by the blinded observer on two occasions. Validity of the instrument was assessed by the weighted kappa statistic for subject-observer agreement and reliability by the weighted kappa statistics for subject repeatability and observer repeatability. These analyses were repeated for HV dichotomised as present or absent.

RESULTS: For the five-grade HV scale, weighted kappa scores (left and right feet combined) were 0.45 for subject-observer agreement, 0.53 at 1-2 months and 0.51 at 3-6 months for subject repeatability, and 0.82 for observer repeatability. For the dichotomised scale (left and right feet combined), sensitivity was 75% and specificity was 82%: kappa scores were 0.55 for subject-observer agreement, 0.63 at 1-2 months and 0.61 at 3-6 months for subject repeatability and 0.83 for observer repeatability.

CONCLUSIONS: The HV self-report instrument provides a valid and reliable assessment of the presence and severity of HV and appears suitable for use in epidemiological studies.
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Old 18th April 2007, 02:12 AM
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Default Re: Another bl....y outcome measure for the foot

Dear All

Thse Kappa scores are about the same as the weather bureau.

They look good if you work there but useless if you rely upon them

Musmed

www.musmed.com.au
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Old 4th May 2007, 02:18 PM
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Default Re: Another bl....y outcome measure for the foot

Correlation of the AOFAS Scores with a Generic Health Qualy Score in Foot and Ankle Surgery.
Foot Ankle Int. 2007 Apr;28(4):494-8
Quote:
BACKGROUND: The American Orthopaedic Foot and Ankle Score (AOFAS) is one scoring system used to assess and monitor the progress of patients after foot and ankle surgery. The aim of this study was to evaluate the trend of the AOFAS score over a period of time and correlate it with the QUALY score, which is a valid and reliable scoring system.

METHODS: All patients undergoing surgery by one foot and ankle surgeon between January, 2001, and July, 2003, were reviewed. The preoperative AOFAS and QUALY and postoperative scores at 3, 6 and 12 months, and yearly were collected prospectively.

RESULTS: This study includes 204 operative procedures in 159 patients. The mean age of the patients was 51.9 (range 12 to 89) years. The AOFAS scores increased from a mean of 45.5 preoperatively to 76.5 at 3 months and reached a peak of 81.5 at 6 months and then started to decrease to 79.2 at 12 months. This fall, though seemingly marginal, was significant (p < 0. 01). This trend seems to be consistent for all the procedures. The 6-month AOFAS score was found to have a higher correlation with the final QUALY score (r(2) = 0.423) than the 12-month AOFAS score (r(2) = 0.326).

CONCLUSIONS: The AOFAS score has low levels of correlation with the validated generic health QUALY score. Our study suggests that scores collected preoperatively, at 6 and 12 months after surgery, and annually there after may be best. The 3-month score may not be necessary. We recommend that a generic health score such as the QUALY score be used in conjunction with the AOFAS score to reflect outcome
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Old 21st February 2008, 02:30 PM
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Default Re: Another bl....y outcome measure for the foot

The Foot Function Index now has a Chinese version:

Reliability and validity of the taiwan chinese version of the foot function index.
Wu SH, Liang HW, Hou WH.
J Formos Med Assoc. 2008 Feb;107(2):111-8.
Quote:
Background/Purpose: To test the reliability and validity of the Taiwan Chinese version of the Foot Function Index (FFI) among patients with plantar fasciitis and ankle/foot fracture.

Methods: Fifty plantar fasciitis patients and 29 ankle/foot fracture patients volunteered for the cross-sectional survey and 24 were re-retested later. The response distribution was compared between the two groups. The internal consistency and test-retest reliability were evaluated by using Cronbach's alpha and intraclass correlation coefficient (ICC). Criterion validity was examined for correlations with the Taiwan version of the Medical Outcomes Study Short Form-36 (SF-36) questionnaire. The influence of covariates (diagnosis, age, gender, employment) on the scores of total FFI and subscales was explored by multivariate general linear model analysis.

Results: Two items in the pain subscale had many answers in the non-applicable category and were removed from analysis. The internal consistency of the 21-item FFI was high (Cronbach's alpha = 0.94) and the test-retest reliability was satisfactory (ICC = 0.82). The activity limitation subscale had relatively lower Cronbach's alpha (0.75) and the items in this subscale had a high proportion of floor scores. There was a moderate correlation between the FFI total and subscale scores to the physical component summary scores rather than to the mental component summary scores of the SF-36. Multivariate general linear model analysis showed that the cases of plantar fasciitis had higher pain scores and lower activity limitation scores, although their FFI total scores were comparable.

Conclusion: The adapted Taiwan Chinese version of the FFI is reliable and valid and can be applied among traumatic and non-traumatic foot disorders. Nevertheless, its clinical application may be limited by a relatively high proportion of non-applicable answers and significant floor effect in some items.
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Old 3rd June 2008, 02:48 PM
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Default Re: Another bl....y outcome measure for the foot

Development and validation of a Greek language version of the Manchester Foot Pain and Disability Index.
Kaoulla P, Frescos N, Menz HB.
Health Qual Life Outcomes. 2008 Jun 1;6(1):39. [Epub ahead of print]
Quote:
BACKGROUND: The Manchester Foot Pain and Disability Index (MFPDI) is a 19 item questionnaire used to assess the severity and impact of foot pain. The aim of this study was to develop a Greek-language version of the MFPDI and to assess the instrument's psychometric properties.

METHODS: The MFPDI was translated into Greek by three bilingual content experts and two bilingual language experts, and then back-translated into English to assess for equivalence. The final Greek version was administered, along with a questionnaire consisting medical history and the Medical Outcomes Study Short Form 36 (SF-36), to 104 Greek-speaking, community-dwelling people (64 female, 40 male), aged between 64 and 90 years (mean 73.00, SD 5.26) with disabling foot pain.

RESULTS: The Greek translation of the MFPDI was found to have high internal consistency (Cronbach's 0.89, and item-total correlation coefficients from 0.33 to 0.72). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern with appearance and activity restriction, which explained 60.8% of the variance, with 38.9% of the variance explained by the first construct (functional limitation). Six items demonstrated different factor loadings to the original English version.

CONCLUSIONS: The Greek-language version of the MFPDI appears to be a valid tool in assessing foot pain in Greek-speaking older people. The total MFPDI scores are comparable between the Greek and English version, however due to differences in the factor loadings of some items, between-language comparisons of MFPDI should be undertaken with some caution.
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Old 19th August 2008, 03:01 PM
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Default Re: Another bl....y outcome measure for the foot

Computerized adaptive test for patients with foot or ankle impairments produced valid and responsive measures of function.
Hart DL, Wang YC, Stratford PW, Mioduski JE.
Qual Life Res. 2008 Aug 17. [Epub ahead of print]
Quote:
OBJECTIVE: We tested the item response theory (IRT) model assumptions of the original item bank, and evaluated the practical and psychometric adequacy, of a computerized adaptive test (CAT) for patients with foot or ankle impairments seeking rehabilitation in outpatient therapy clinics.

METHODS: Data from 10,287 patients with foot or ankle impairments receiving outpatient physical therapy were analyzed. We first examined the unidimensionality, fit, and invariance IRT assumptions of the CAT item bank. Then we evaluated the efficiency of the CAT administration and construct validity and sensitivity of change of the foot/ankle CAT measure of lower-extremity functional status (FS).

RESULTS: Results supported unidimensionality, model fit, and invariance of item parameters and patient ability estimates. On average, the CAT used seven items to produce precise estimates of FS that adequately covered the content range with negligible floor and ceiling effects. Patients who were older, had more chronic symptoms, had more surgeries, had more comorbidities, and did not exercise prior to receiving rehabilitation reported worse discharge FS. Seventy-one percent of patients obtained statistically significant change at follow-up. Change of 8 FS units (scale 0-100) represented minimal clinically important improvement.

CONCLUSIONS: We concluded that the foot/ankle item bank met IRT assumptions and that the CAT FS measure was precise, valid, and responsive, supporting its use in routine clinical application.
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Old 14th January 2009, 04:58 PM
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Default Re: Another bl....y outcome measure for the foot

Cross-cultural adaptation and validation of the foot function index for use in german-speaking patients with foot complaints.
Naal FD, Impellizzeri FM, Huber M, Rippstein PF.
Foot Ankle Int. 2008 Dec;29(12):1222-8.
Department of Orthopaedic Surgery, Foot and Ankle Center, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland. florian.naal@gmail.com.

Quote:
BACKGROUND: The purpose of this study was to cross-culturally adapt the Foot Function Index (FFI) for use in German-speaking patients with foot complaints.

MATERIALS AND METHODS: The FFI was adapted for the German language according to the recommended forward/backward translation protocol. The following metric properties were assessed in 53 consecutive patients (mean age, 57.2 years; 39 women) undergoing foot surgery at our department: feasibility, reliability (intraclass correlation coefficient ICC), internal consistency (Cronbach's alpha, CA), and construct validity (correlation with the Short Form (SF-36), a VAS assessing pain, a VAS assessing function, and the University of California at Los Angeles (UCLA) activity scale.

RESULTS: The German FFI (FFI-D) comprised 18 items separated into a pain and a disability subscale. Completion of the FFI-D was feasible. The reliability and the internal consistency were both excellent with an ICC of 0.98 and a CA of 0.97 for the total score. We found moderate to high correlations between the FFI-D and the physical related SF-36 domains (r = -0.43 to -0.80), the VAS pain (r = 0.81), the VAS function (r = 0.77), and the UCLA (r = -0.52). Correlation coefficients between the FFI-D and the mental health related SF-36 domains were significantly lower (r = -0.08 to -0.32; p < 0.01), indicating divergent validity.

CONCLUSION: The German version of the FFI is a reliable and valid questionnaire for the self-assessment of pain and disability in German-speaking patients with foot complaints.
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Old 22nd January 2009, 12:07 AM
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Default Re: Another bl....y outcome measure for the foot

Quote:
Originally Posted by Craig Payne View Post
Does anyone share my frustraton at the plethora of outcome tools that have been developed for the foot :( . When will it stop? When will people actually stop developing them and start doing research that actually uses them

Sounds like the public service!

Last edited by Admin : 22nd January 2009 at 12:13 AM. Reason: fixed quote
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Old 17th April 2009, 05:08 AM
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Default Re: Another bl....y outcome measure for the foot

Validation of the Turkish version of the foot and ankle outcome score.
Göksel Karatepe A, Günaydın R, Kaya T, Karlıbaş U, Ozbek G.
Rheumatol Int. 2009 Apr 16. [Epub ahead of print]
Quote:
The objective is to develop a Turkish version of the foot and ankle outcome score (FAOS) and to investigate its validity and reliability. The Turkish version of FAOS was developed after the translation and back-translation. The translated version was pretested on 20 patients with rheumatoid arthritis. Then, the Turkish FAOS was administered to 55 patients having foot and ankle problems. They were also evaluated by using the four subscales of the Turkish version of AIMS2, and the Turkish version of SF-36 questionnaire to test validity. Fifty patients filled out the FAOS for second time to determine test-retest reliability. Construct validity was investigated with use of Spearman's rank correlation coefficient. Test-retest reliability was assessed with use of the intraclass correlation coefficient (ICC) and Cronbach's alpha score. The psychometric properties of the Turkish FAOS were generally similar to the original FAOS. The random ICC for the five subscales ranged from 0.70 to 0.96. The Cronbach's alpha coefficient ranged from 0.79 to 0.97. Construct validity of the FAOS was good. The Turkish FAOS correlated with the SF-36 and AIMS2 scales. The Turkish version of FAOS was valid and reliable instrument to assess the foot and ankle related problems. However, to assess its responsiveness further studies are needed.
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