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Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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  #1  
Old 3rd April 2012, 04:23 AM
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Default Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Intratest Reliability in Determining the Subtalar Joint Axis Using the Palpation Technique Described by K. Kirby
J. De Schepper, K. Van Alsenoy, J. Rijckaert, S. De Mits, T. Lootens, P. Roosen
JAPMA, March/April 2012 Vol 2 #2, 122-129


This article concludes that "the low kappa values for the classification of the palpated axis location prevent the authors from defining the outcome of this technique as reliable and clinically useful"
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Old 3rd April 2012, 04:28 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Can you list the peer reviewed papers that demonstrate the reliablity or usefulness of the Foot Typing "theory" you promote?
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Old 3rd April 2012, 05:52 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

And indeed that same study stated in the abstract

Quote:
Conclusions: The clinical palpation technique itself is reliable;
More to the point, There is a difference between

"the low kappa values for the classification of the palpated axis location prevent the authors from defining the outcome of this technique as reliable and clinically useful"

And

"Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful""

I could say
"I have no evidence that Dennis has 5 fingers"

And this would be true. But not the same as

"There is evidence Dennis does not have 5 fingers. "

Good times.
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Old 3rd April 2012, 06:10 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by Robertisaacs View Post

Good times.
I am about to give up

Every thread is Barefoot this and that or Dennis being Dennis

driving me nuts
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Old 3rd April 2012, 06:23 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Originally Posted by mike weber View Post
I am about to give up

Every thread is Barefoot this and that or Dennis being Dennis

driving me nuts
Please don`t.
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Old 3rd April 2012, 06:27 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by Robertisaacs View Post
There is a difference between

"the low kappa values for the classification of the palpated axis location prevent the authors from defining the outcome of this technique as reliable and clinically useful"

And

"Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful""
Did the study conclude the Kirby test not reliable and clinically useful or not?

IMHO, it did.

If I'm understanding further what the authors research determines, it declared that you needed greater than 10 degrees of axis difference to have diagnostic and clinical import and where there is overlap or small degrees of difference the test becomes unreliable and clinically weak.

As one gets closer and closer to 10 degrees of variation (which is a huge amount) the clinical usefulness and applicability lacks power.

So if the STJ Axis of three patients, one zero deviated, the next 5 degrees deviated medially and the next 5 degrees laterally were presented, this paper concludes the Kirby Axis Measurement would not be sophisticated enough to pick up the deviations with accuracy or reliability.

I wish the authors could comment.

To use your five finger analogy, it's like saying that my fingertips cannot appreciate temperature gradients closer than 8 degrees. This means that for my fingers to discern one spot to be hotter or colder than another they would need to be separated by 9 degrees +.
That's why we have thermometers.

Robert:
Why don't we stop diverting about my fingers or straw men or some other psychobabble and start with the words that these authors wrote that I quoted verbatim.

Dennis
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Old 3rd April 2012, 08:10 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Old 3rd April 2012, 08:30 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Hi drSha
I don't think we've met in person or on the arena, but it looks about a good time for me to step in and try to explain - even though from the reactions above, i'm not sure any further explanations will help the situation.

There are levels of evidence, and up to now, no official research was performed on the clinical test to locate the STJA. This means that the highest level before the last edition of JAPMA was 'clinical expertise'. Doing a reliability study was a first step we took in trying to determine if it was sound to use a test, such as the one mentioned above.

Quote:
Originally Posted by drsha View Post
If I'm understanding further what the authors research determines, it declared that you needed greater than 10 degrees of axis difference to have diagnostic and clinical import and where there is overlap or small degrees of difference the test becomes unreliable and clinically weak.


Indeed, for non trained testers, the smallest detectable difference was about 10° for the angle and about 7 mm for the translation.
This result had much to do with a couple of points discussed later on in the article.
We only palpated under the calcaneum over a distance of about 5 to 8 cm. Also the thumb has a surface of about 1cm². these result in a low sensitivity of untrained testers.

We picked this one up in a second study, using a punchpin. Non trained testers went from 11° to 5° without any further training!

Trained testers had a SDD of about 3° to 5° not having a lot of influence by using the punchpin.

When we’re talking about clinical relevant, maybe you should try to draw an angle of 5° or 10° over a distance of 5 to 8 cm and place your thumb on that. Even on the widest point, your thumb is still going to cover the 10 degrees. Furthermore the population tested here had no real ‘extreme’ deviations. In my opinion it is not so important to discuss a difference of 5 degrees, but it is important to be able to see a difference in larger deviations as this could influence your treatment protocol

Quote:
Originally Posted by drsha View Post
So if the STJ Axis of three patients, one zero deviated, the next 5 degrees deviated medially and the next 5 degrees laterally were presented, this paper concludes the Kirby Axis Measurement would not be sophisticated enough to pick up the deviations with accuracy or reliability.


This would depend on the person performing the test… so start practicing – the more you do it, the better you get at it. Or use a punch pin…
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Old 3rd April 2012, 08:51 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Furthermore, our conclusions actually were

Quote:
Taking into account the strength of the Cronbach a for slope and intersection of the STJ axis, being the two important parameters for defining a line in two dimensions, we conclude that the palpation technique itself can be defined as reliable.

Quote:
The low kappa values for the classification of the palpated axis location prevent the authors from defining the outcome of this technique as reliable and clinically useful.

here I have to explain that kappa statistics are done on a nominal data level and means that this is about being able to 'Label' the axis as medial, lateral or normal... but this would be an easy one to solve I think... if you can define a range, the kappa's will go through the roof!!!


Quote:


As SEM scores are directly related to the reliability of a test, the reported low values support the conviction of the researchers that the precision of

the measurements taken and scores obtained show the usefulness of this clinical test.




Take it or leave it... I would say


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Old 3rd April 2012, 10:16 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by Kenva View Post
Furthermore, our conclusions actually were

[font=AdvP7F86][size=2][font=AdvP7F86][size=2]



here I have to explain that kappa statistics are done on a nominal data level and means that this is about being able to 'Label' the axis as medial, lateral or normal... but this would be an easy one to solve I think... if you can define a range, the kappa's will go through the roof!!!
Thank you for your clear and precise posting.

In light of its power and your obvious skills as a researcher, I would hope that the editor (s) will be able to eradicate this thread ASAP so that my untrained conclusions can be eliminated from the internet.

This remains continued growth on my part as I am educated on EBM.

My overall opinion on the use and applicability of The STJ Axis remains in question as probably yours does for Functional Foot Typing but that's what happens when you are driving a Mercedes and someone pulls up to you in a BMW.

I hope your future research continues to show STJ Axis mearurement to be valid and clinically relevant as I think there are many ways to skin the biomechanical cat.

Respectfully,

Dennis
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Old 3rd April 2012, 10:18 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Did the study conclude the Kirby test not reliable and clinically useful or not?

IMHO, it did.
Well, we've heard from the author. That should do.

I don't want a scrap with you Dennis. I'm listening to bel's link, and looking forward to watching Episode 1 of series 2 of game of thrones later. I've had a shocking day but am now feeling mellow and well disposed to the world. I was merely pointing out the the difference between lack of evidence and evidence of lack. Thats hardly psychobabble. You got a bit excited and overstated your case, thats all.

Damn but this was a nice song.
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Old 3rd April 2012, 11:00 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by drsha View Post
Thank you for your clear and precise posting.
you're very welcome!


Quote:
Originally Posted by drsha View Post
I hope your future research continues to show STJ Axis mearurement to be valid and clinically relevant as I think there are many ways to skin the biomechanical cat.
My point exactly, and this is what my job as a lecturer and "researcher" is about. Only we have to accept that having 'an opinion' or 'an idea' isn't always good enough. A profound evidence based framework is what 's going to help us all move forward... how small the steps may be at any given time... So if I have to choose one way to skin that cat above another, I know what to choose.

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Old 3rd April 2012, 01:12 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by Kenva View Post
My point exactly, and this is what my job as a lecturer and "researcher" is about. Only we have to accept that having 'an opinion' or 'an idea' isn't always good enough. A profound evidence based framework is what 's going to help us all move forward... how small the steps may be at any given time... So if I have to choose one way to skin that cat above another, I know what to choose.
Ken and Joris:

Congratulations.....your paper made it into the MD-Orthopedics world!!

(see attached pdf)
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Old 4th April 2012, 04:02 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
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I would hope that the editor (s) will be able to eradicate this thread ASAP so that my untrained conclusions can be eliminated from the internet.
Dennis
Nah, let it stand please. Even P Diddy steps in it once in a while Denny boy:

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Old 4th April 2012, 11:03 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Nah, let it stand please. Even P Diddy steps in it once in a while Denny boy:

the Difference is Diddy would just by a new pair of Shoes

Dennis would take out a patent on it
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Old 5th April 2012, 05:10 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by mike weber View Post
the Difference is Diddy would just by a new pair of Shoes

Dennis would take out a patent on it
.....and trademark it.....

Is this a SERM or a PERM Shoe CenteringTM.?
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Old 5th April 2012, 05:22 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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.....and trademark it.....
as a ****ing foot shyting system
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Old 5th April 2012, 07:51 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by mike weber View Post
the Difference is Diddy would just by a new pair of Shoes

Dennis would take out a patent on it
Quote:
Originally Posted by Kevin Kirby View Post
.....and trademark it.....

Is this a SERM or a PERM Shoe CenteringTM.?
Quote:
Originally Posted by Mark Russell View Post
as a ****ing foot shyting system
Cracking up over here!
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Old 5th April 2012, 09:08 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Less so over here.

Perhaps I'm just tired but the whole "eye for an eye" thing is doing little for me.
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Old 5th April 2012, 09:29 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Cracking up over here!
David:

I'm with you. I'm loving this thread now.

People who live in glass houses shouldn't be throwing stones.
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Old 5th April 2012, 10:51 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Robert I have great respect for you and 99% of the people contributing on PA. Mike made the point that most of the threads lately have degenerated into "barefoot this and that and Dennis being Dennis". I have to agree with him, it is getting tiresome and I for one am frustrated. I'm sensing many others are as well?

I feel that at some point a decision needs to be made as to the value that these diversions add to the overall quality of the forum. I have purposely avoided the barefoot posts until very recently and then on only one post. Dennis is a whole other matter.

I for one will attempt to avoid Dennis and his ramblings. I recommend that Dennis be held accountable for a rational explanation of Eric's (and our) questions and a polite discussion and that he not be allowed to continue to try to persuade through attrition and straw man argument but by facts and proof. If he cannot provide such then there is really little else to say on the subject is there?
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Old 5th April 2012, 03:01 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Yeah, I share the frustration. I'm just suffering a little battle fatigue! The barefoot loonies are merely trolls and should be booted. Dennis, Whilst I agree his postings most often start the fight and often add little, is a slightly different matter. The whole dig / counter dig thing will just continue. Forever.

Ignore me mate . I'll probably agree with you in the morning.
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Old 6th April 2012, 06:25 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

"Don't be afraid in nature: one must be bold, at the risk of having been deceived and making mistakes".
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Old 8th April 2012, 01:20 AM
drsha drsha is offline
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Originally Posted by Kenva View Post
Furthermore, our conclusions actually were






here I have to explain that kappa statistics are done on a nominal data level and means that this is about being able to 'Label' the axis as medial, lateral or normal...
Take it or leave it... I would say


Now that I have been able to review the slides you were so kind to furnish, I can comment more intelligently on your paper.
We all know that evidence has a level and potentially contains bias upon the authors. It must be reviewed as to its level, validity and applicability.

Your study has three subjects, the examiners.
We can assume that a greater number of examiners would be more valuable when their results are tabulated as to the reliability factor of their findings as well as to their reproducibility.

It is unicentered and not blinded so I would consider it a Level 4 study.

As far as I can tell (see attachment), one examiner found the STJ Axis of the foot involved to be "normal", the next found the STJ Axis to be "somewhat medial' and the third examiner found the STJ Axis to be "more medial".

Your examiners had a ten degree deviation in their readings.
The known studies for STJ Axis ROM shows a transverse plane range of between 30 and 40 degrees*
*Tomaro J, Burdett R, Chadran A: Subtalar Joint Motion and The Relationship to Lower Extremity Overuse Injuries; JAPMA, Vol 86, #9, 1996, p 427-32

This means your deviation of 10 degrees among examiners reflected an error rate of between 25 and 33% which is quite high.

In a treatment sense, these three examiners, using the same foot or model would apply different care.
The first would apply no medial skive, the second a low medial skive, lets say 2 degrees and the third would apply a higher medial skive, lets say 4 degrees.

In summary, your three examiners came up with a different STJ Axis diagnosis that would lead to three different treatments.

I would consider that, IMHO, unreliable and poorly reproducible yet you conclude that your study finds the STJ Axis Test of Kirby reliable.

I would conclude "this low level study seems to reveal that with further refinement and education and practice of the examiners, The STJ Axis Test of Kirby may prove to be of clinical import but that it currently lacks reproducibility and clinical validity".

I'm not sure what gave you the confidence to draw the conclusion that you did?

Your continued research may harvest higher level, more valid and more applicable evidence but IMHO, your case is not proven from the nul as required.

Dennis
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Old 8th April 2012, 03:00 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Originally Posted by drsha View Post
Now that I have been able to review the slides you were so kind to furnish, I can comment more intelligently on your paper.
We all know that evidence has a level and potentially contains bias upon the authors. It must be reviewed as to its level, validity and applicability.
I was sitting at our family easter brunch, when I got the e-mail alert... I'm happy this is getting so much attention! Have to point out that the slides and the article are 2 different projects (but this just to make sure we're not mixing things up)
To talk about the bias upon the authors, what do you think the influence would be and how we could take this 'bias' out of the equasion?

Quote:
Originally Posted by drsha View Post
Your study has three subjects, the examiners.
We can assume that a greater number of examiners would be more valuable when their results are tabulated as to the reliability factor of their findings as well as to their reproducibility.
Very correct. It could be better if we could have a 50 podiatrists with a different level of expertise and perform a similar study. this would indeed give us a more valuable results.

Quote:
Originally Posted by drsha View Post
It is unicentered and not blinded so I would consider it a Level 4 study.
It was indeed unicentered, but is was was blinded. We found it difficult to send 52 participant from one centre to another to be tested by different raters. The choice here was rather practical.

Quote:
Originally Posted by drsha View Post
As far as I can tell (see attachment), one examiner found the STJ Axis of the foot involved to be "normal", the next found the STJ Axis to be "somewhat medial' and the third examiner found the STJ Axis to be "more medial".

Quote:
Originally Posted by drsha View Post
Your examiners had a ten degree deviation in their readings.
The known studies for STJ Axis ROM shows a transverse plane range of between 30 and 40 degrees*
*Tomaro J, Burdett R, Chadran A: Subtalar Joint Motion and The Relationship to Lower Extremity Overuse Injuries; JAPMA, Vol 86, #9, 1996, p 427-32

Quote:
Originally Posted by drsha View Post
In summary, your three examiners came up with a different STJ Axis diagnosis that would lead to three different treatments.
More correctly said 'could lead' to different treatment protocols - but this would be a complete different research project. Yes, this is possible and our conclusion is indeed that the labeling of the axis isn't reliable.

You could look at this in another way. If you have a range of 30 to 40 degrees and you would have 3 to 4 labels with a range of 10°, your treatment protocol wouldn't be so different.

Every research project I've read, gives again more questions in need of an answer. One could look at the results of this project and draw conclusions from it, deciding that the test isn't of any value, and that's OK, I think.
I learned, teaching podiatry (biomechanics and OT), that we can get further with an critical 'open mind' then not.
Discussing the use of bisections and the 'neutral' paradigm is one of my favourite topics. To me, it's all about the 4th position of the Perry Model:Complex Dualism and Advanced Multiplicity.
If I may take a quote here from Wankat & Oreovicz in their chapter on teaching engeneering
Quote:
The student tries to retain a dualistic right-versus-wrong position but realizes that there are areas of legitimate uncertainty and diversity of opinion. Students react to position 4 in one of two ways. They may conform to what authority seems to want and learn the forms of independent intellectual thought. These students learn that independent-like thought will earn them good grades.
Genuinely independent thought has not yet been achieved or even considered as an issue. Most of the students Perry studied took this route. However, learning the forms is not enough, and these students may be tempted to escape.
The second reaction is that the student may oppose what authority wants in areas where multiplicity is important. The student may raise this multiplicity of opinions to a pervasive viewpoint that “anyone has a right to their own opinion.” This raises areas of multiplicity and uncertainty to equal status with areas of dualism. “Everyone has a right to their own opinion”
is obviously a wonderful position from which to fight authority. The danger of this position is that a bland “anything goes” attitude may prevail. The student may refuse to think since he or she believes everything can be solved by intuition. Men in this position fight authority openly, while women fight authority internally as “hidden multiplists” (Belenky et al., 1986).
These women may be silently alienated from college. Since engineering does not affect their interior life, engineering may appear irrelevant and they may quit engineering even though they can do the work. This position was taken by fewer students and is probably rare for engineering students.
An engineer in position 4 can solve problems cleverly and creatively. The task of solving the problems becomes a game. Unfortunately, he or she cannot see that some problems are much more important than others. This person lacks vision and may solve problems considered unimportant or even immoral by others. Many engineering graduates with both baccalaureate and advanced degrees seem to be in positions 3 and 4.
So again, personally, this is one step closed to a more EBM approach in the biomechanical understanding of the lower limb and foot. This doesn't mean that it all should stop just here. This doesn't mean that there aren't other, maybe better clinical tests out there with a higher reliability and validity. The difficulty is to get the results out there.
Personally, I didn't do this project because I wanted the STJA palpation technique to be bang on so I could stop teaching all the other stuff. I did it to be able to tell my students how this test stands next to other clinical tests in helping them to decide how to treat.

Back to the table now...
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Old 8th April 2012, 03:29 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Can I ask a silly question - why do you Dennis keep returning here to discuss your theory & argue against Kevin's? I'm genuinely interested in why you keep coming back here when in the main, people disagree with your theory. I know disagreement is not a reason to limit discussion but this seems a waste of your time & energy. Why not go to another site where your theories will be better accepted?
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Old 8th April 2012, 03:44 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Can I ask a silly question - why do you Dennis keep returning here to discuss your theory & argue against Kevin's? I'm genuinely interested in why you keep coming back here when in the main, people disagree with your theory. I know disagreement is not a reason to limit discussion but this seems a waste of your time & energy. Why not go to another site where your theories will be better accepted?
Simple - classic inferiority complex. End of.
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Old 8th April 2012, 04:23 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

I'm tired of the arguing. It's not achieving a thing as far as I can see.
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Old 8th April 2012, 03:28 PM
drsha drsha is offline
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Can I ask a silly question - why do you Dennis keep returning here to discuss your theory & argue against Kevin's? I'm genuinely interested in why you keep coming back here when in the main, people disagree with your theory. I know disagreement is not a reason to limit discussion but this seems a waste of your time & energy. Why not go to another site where your theories will be better accepted?
Markleigh (one of my daughters name is Leigh so I'm automatically fond of you):
If you look at this thread, I posted the results of an article published about the STJ Axis Test of Kirby.

Nothing to do with foot typing in any way shape or form.

In the very first posting, Mark Russell converted that to foot typing and me personally.

Robert Isaacs responded to the thread and I did likewise to him in kind.

Then Kenya stepped in and gave his own perspective of his paper and on his sayso, I immediately apologized for what at the time, seemed to be him educating me that his study did not overstep error in drawing the conclusions it did. I hope Kenya was not feeling a personal attack in my response.
Robert chimed in that the author spoke and I apologized with "that should do it".

Then Kevin, Wedemeyer, Mark Russell and Mike Weber (one of The Moderators) went upon a character assasination on yours truly.

I responded with quotes around learning by your mistakes and sticking up for what you believe in until PROVEN wrong. No personal attacks on my part.

Then, on another thread, Kenya was kind enough to share his slides and I got to see the one that related to the error rate between his three examiners.
I added my STJ Axis wording and the arrows and posted that in light of this new evidence, I once again had to claim that Dr Kirby's Test (Kenya's words in his article, not mine) seemed unreliable.

Then and this is my take, Kenya basically agreed with my presentation by stating "our conclusion is indeed that the labeling of the axis isn't reliable".
In Robert's words, once again "the author has spoken, we're done".
and I stopped posting.

Next you posted:
"Can I ask a silly question - why do you Dennis keep returning here to discuss your theory & argue against Kevin's? I'm genuinely interested in why you keep coming back here when in the main, people disagree with your theory. I know disagreement is not a reason to limit discussion but this seems a waste of your time & energy. Why not go to another site where your theories will be better accepted"?

I never discussed foot typing or foot centering, I never made a personal comment and tolerated that I was compared to the s*** on the sole of a shoe.

Please confirm your accusations or consider telling those who are displaying Chad behavior on The Arena to accept the message and not try to destroy the messenger and let's all live in peace but in answer to your request to leave The Arena, the reason I will never leave is that I love it here as it remains my main teaching tool for biomechanics.

Dennis
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Old 9th April 2012, 01:40 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

drsha, I just have the feeling i'm saying the same thing over and over again, and you're changing my words.

You may find that this is what you mean with me being biassed, but I would rather call it being correct...

LABELING
the subtalar joint shows not to be reliable... and you say:

Quote:
I once again had to claim that Dr Kirby's Test (Kenya's words in his article, not mine) seemed unreliable.
converting your conclusion into cars:
Its not because an Alpha Romeo has a bad reputation with it's electric components, that it's a bad car to drive in. but you would conclude:
don't drive those Alpha's, they are not reliable...

Just to make sure you get the grip

I said
Quote:
Originally Posted by Kenva View Post
here I have to explain that kappa statistics are done on a nominal data level and means that this is about being able to 'Label' the axis as medial, lateral or normal... but this would be an easy one to solve I think... if you can define a range, the kappa's will go through the roof!!!

You wrote:
Quote:
Kenya basically agreed with my presentation by stating "our conclusion is indeed that the labeling of the axis isn't reliable".
In Robert's words, once again "the author has spoken, we're done".
and I stopped posting.
So the title of the tread should actually be:
Study Finds labeling the Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

I think 'Kenya' has enough of this thread, have fun guys!
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