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

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  #31  
Old 9th April 2012, 03:37 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Kenva
Please don't go away, defend your work or we will take it as a sign that you left the podium because you are not willing to soften your conclusions.

Quote:
Here is your original posting
"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!!!"
We are not discussing cars.
We are discussing your words and your results as I am actually trying to use them and yet you act as if I'm not keyboarding in English or believe that you can spin the facts to justify your conclusion.

Correct me once again.

According to your study
(this study and not some future one that you are presupposing will go through the roof to correct the problem findings with this study....that would only reflect a bias to your future outcomes which you claim doesn't exist:

Your examiners labeled the same foot differently as to the location of the subtalar axis.
Summarily, they could not determine RELIABLY whether or not the STJ Axis was medial, lateral or normal.
Then you concluded that this was a reliable test.

Are we on the same page yet?

I was taught right here by Dr Spooner (I think?) that researchers are supposed to work from the nil.
They test an hypothesis as if it was incorrect. In that way, bias is eliminated consciously and subliminally.
To justify the problems of this paper with statements that "This would be an easy one to solve, I THINK" and "the Kappas will go through the roof" reflect a new unproven hypothesis and nothing more.

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  #32  
Old 9th April 2012, 10:54 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
Correct me once again.
According to your study, your examiners labeled the same foot differently as to the location of the subtalar axis.
Summarily,they could not determine RELIABLY whether or not the STJ Axis was medial, lateral or normal.
OK drsha, once again,
The study published in JAPMA shows results of of an intratester reliability. The labeling of the axis, and thus the kappa statistics were done on a test, retest protocol. The results look at what a tester labeled the first, second and third time.

The intrarater reliability for the actual location of the STJA expressed with a Cronbach Alpha gives values around 0.9 - In my opinion, these are strong results underlining the fact that locating the axis for a tester in a test/retest setup is reliable.

When a tester has to label an axis, the results show less consistency with low kappa results, as discussed before...

damn, didn't I just say the same thing again as the postings before???

Answer a question for me...

Is the STJA location technique the technique where you look for the points of no rotation on the plantar surface of the foot, Marking those points and connecting them?

The possible added mechanical value behind this concept is that perpendicular pressure on one side or the other of the STJA creates pronatory or supinatory moments. The fact that one would name/label the location of the axis 'medial, lateral or normal' doesn't influence the mechanical effect.
translating this to the results of the study, the test itself can be determines as reliable on an intrarater level, the labeling is not.


Drsha, The fact that you've been naming me Kenya instead of Kenva didn't mean you weren't referring to me right?

I really still have the feeling that we're going in circles here.

Hope to have answered your question sufficiently.
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  #33  
Old 9th April 2012, 10:57 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Kenva
Please don't go away, defend your work or we will take it as a sign that you left the podium because you are not willing to soften your conclusions.
So i'm sticking to the conclusion of this research project, not 'willing to soften' on my conclusions if that's Okey.
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  #34  
Old 9th April 2012, 01:50 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
I was taught right here by Dr Spooner (I think?) that researchers are supposed to work from the nil.
Possibly the null...
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  #35  
Old 9th April 2012, 05:08 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Ken,

I've really enjoyed reading your comments and findings from the research.
I hope your weekend with the family was not too disrupted or irritated by this discussion.

Looking forward to reading more of you and your colleagues research in the future.

Tracy
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  #36  
Old 9th April 2012, 07:21 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Kenva,

thanks for your postings and your explination of your research! Fantastic.

Dennis,

You are such a pain in the neck. I have never ever personally met anyone on this forum face to face, but i have learned a lot and would love to meet these people if i had the chance.

You, however, are annoying and I wish you would go away. Your egotistical ramblings are such a frustrating diversion from many interesting discussions.

Sorry to be so negative, but I just had to let you know how you make me feel.

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  #37  
Old 9th April 2012, 07:50 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
OK drsha, once again,
The study published in JAPMA shows results of of an intratester reliability.

The intrarater reliability for the actual location of the STJA expressed with a Cronbach Alpha gives values around 0.9 - In my opinion, these are strong results underlining the fact that locating the axis for a tester in a test/retest setup is reliable.

When a tester has to label an axis, the results show less consistency with low kappa results, as discussed before...

.

Hope to have answered your question sufficiently.
Kenva:
So sorry. Kenva is not a typical name for me and I got lost in my passion for responding to your great posts.

I think I finally understand what you are stating about your article and am more capable of summing up your finding as to the presence of the intrapersonal reliability of The Kirby test and a lack of an Interpersonal Reliability of The Kirby Test.

As per your findings, we can draw the following conclusions:
1. Kirby's Subtalar Joint Axis Test Has Intrapersonal Reliability

2. Kirby's Subtalar Joint Axis Test Lacks Interpersonal Reliability


No need to reply further if I am correct.

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  #38  
Old 10th April 2012, 01:02 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
No need to reply further if I am correct.
That's also a way to keep me going

Quote:
Originally Posted by drsha View Post
2. Kirby's Subtalar Joint Axis Test Lacks Interpersonal Reliability
Here I have to refer to the presentation I gave at the Belgian Podiatry Conference on March 23rd. Cadaver specimens were used to locate the STJA location and again 3 examiners performed a similar setup as the first research project. We also looked at the interrater reliability. Cronbach alpha's above 0.8 and 0.9 for the slope and intersection using the thumb would be considered as good to excellent. However, these results are not published in a peer reviewed journal yet.

Your statement above, if you would rely on a conference presentation, would be wrong. it doesn't lack of reliability. Not inter nor intra.
Furthermore, a vicon was used to locate the STJ axis of rotation and there wasn't a significant difference between the vicon results and the testers... so it's even a valid technique...

Hope you're convinced, probably not I presume...
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  #39  
Old 10th April 2012, 02:10 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Ken, I should like to summarise your research findings for those struggling with their interpretation and to ensure we are all understanding correctly:

1) Both intra and inter-rater quantification of STJ axial position were found to have good-excellent reliability for the palpation technique.

2) When the palpation technique was compared to the "gold standard" using 3D kinematics and bone pin markers, there was no significant difference between the palpation technique and the gold standard. Thus, the palpation technique is valid.

3) When several raters try to assign a qualitative label of axial position: medial, normal, or lateral, then the inter-observer reliability is poor as indicated by the low Kappa values.

Right?
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Old 10th April 2012, 02:14 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

I just got back from Austria for a ski vacation with my family. As I had no internet available (on orders of my dear wife … ) So, I was not able to participate and was only able to read this thread today.

I must admit, for once I was happy to have no internet access on vacation …

@ Ken,

Thanks for taking up this discussion in my absence !!
I guess indeed, almost everything is said on this one….

Cheers,
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  #41  
Old 10th April 2012, 02:23 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by Simon Spooner View Post
Ken, I should like to summarise your research findings for those struggling with their interpretation and to ensure we are all understanding correctly:

1) Both intra and inter-rater quantification of STJ axial position were found to have good-excellent reliability for the palpation technique.

2) When the palpation technique was compared to the "gold standard" using 3D kinematics and bone pin markers, there was no significant difference between the palpation technique and the gold standard. Thus, the palpation technique is valid.

3) When several raters try to assign a qualitative label of axial position: medial, normal, or lateral, then the inter-observer reliability is poor as indicated by the low Kappa values.

Right?
I think that sums it up, thank you very much...
anybody fancy a beer????
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  #42  
Old 10th April 2012, 02:29 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
Originally Posted by Jorisds View Post
@ Ken,

Thanks for taking up this discussion in my absence !!
I guess indeed, almost everything is said on this one….

Cheers,
Joris
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My main man! - happy you're back (hopefully in 1 piece?)
CU next week
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Old 10th April 2012, 02:41 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 Kenva View Post
I think that sums it up, thank you very much...
anybody fancy a beer????
Usually.
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Old 10th April 2012, 02:42 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 Kenva View Post
I think that sums it up, thank you very much...
anybody fancy a beer????
Yep, I`ve often fancied a pint whilst reading some recent threads on the Arena....but not this one Ken. Great research
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  #45  
Old 10th April 2012, 02:42 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Yup, I'm back !!
And ..... in one piece !!!!!

CU next week.
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Old 10th April 2012, 02:54 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 blinda View Post
Yep, I`ve often fancied a pint whilst reading some recent threads on the Arena....but not this one Ken. Great research
But only a tiny amount
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Old 10th April 2012, 06:56 PM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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Here I have to refer to the presentation I gave at the Belgian Podiatry Conference on March 23rd. Cadaver specimens were used to locate the STJA location and again 3 examiners performed a similar setup as the first research project. We also looked at the interrater reliability. Cronbach alpha's above 0.8 and 0.9 for the slope and intersection using the thumb would be considered as good to excellent. However, these results are not published in a peer reviewed journal yet.
Kenva:
As your passion reflects a sense of honesty rather than a sense that you are trying to deceive us and owing to the fact that you have given me the same fraternal courtesy, I accept your conference reference as factual until proven otherwise.

Quote:
Your statement above, if you would rely on a conference presentation, would be wrong. it doesn't lack of reliability. Not inter nor intra.
So be it.

Kenva:
I was fine until Simon interjected:
"When several raters try to assign a qualitative label of axial position: medial, normal, or lateral, then the inter-observer reliability is poor as indicated by the low Kappa values".

I don't see any double negatives in the statement and previously on The Arena, I admitted that I didn't fully understand Kappa Value so does this statement say "the inter-observer reliability is poor"?

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Old 11th April 2012, 03:16 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

Quote:
does this statement say "the inter-observer reliability is poor"?
No. It says

Quote:
When several raters try to assign a qualitative label of axial position: medial, normal, or lateral, then the inter-observer reliability is poor
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Old 11th April 2012, 06:11 AM
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Smile Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

The work by Dr. Kirby is so useful to clinically diagnosing structural imbalances in the foot and ankle that cause deviations through the rest of the musculoskeletal system. The inability to accurately palpate and diagnose is always subject to examiner and patient variability. There are a lot of flaws in that study, and I find that there is many times a process of healing that will follow a flow based on the kinetic chain of an individual. To totally dismiss a useful system of classification to help promote a balanced structure is stupid. The porblem with the study is that the examiners probably have not used the sstem long enoudh to find it usefu
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Old 11th April 2012, 08:18 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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The work by Dr. Kirby is so useful to clinically diagnosing structural imbalances in the foot and ankle that cause deviations through the rest of the musculoskeletal system. The inability to accurately palpate and diagnose is always subject to examiner and patient variability. There are a lot of flaws in that study, and I find that there is many times a process of healing that will follow a flow based on the kinetic chain of an individual. To totally dismiss a useful system of classification to help promote a balanced structure is stupid. The porblem with the study is that the examiners probably have not used the sstem long enoudh to find it usefu
I understand your point thsat you believe in Dr Kirby;s work and its merit but there are those who have chosen other paths.
So why don't those very same rules hold for the work of others like Dr Root.

"One of the reasons why many podiatrists have moved away from the SJN Theory is due to some of the inherent problems and inconsistencies with this theory of mechanical foot therapy. One large problem with the SJN Theory relates to the reliability of the measurement procedures used within the standard biomechanical examination techniques proposed by Root.

These examination techniques have been found to have only fair to poor intertester reliability and, therefore, can not be considered reliable from one examiner to another."

Is this much different than the intertester reliability and the flaws you mention in Kenya's paper.

and

dare I say it, in mine or Dananberg's or MASS or ???.




Please let's end this here as I'm gooing to post my own threads and try not to disagree or give different insight or question the appropriateness of any other threads for awhile.

Dennis

PS: I don't know if that's Kappa or not.
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Old 11th April 2012, 10:27 AM
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Default Re: Study Finds Kirby's Subtalar Joint Axis Measurement "Not Reliable or Clinically Useful"

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I don't know if that's Kappa or not.
No. Try Kafka instead - without the conspiracy. This is becoming embarrassingly painful to read.
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Old 11th April 2012, 02:20 PM
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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
"One of the reasons why many podiatrists have moved away from the SJN Theory is due to some of the inherent problems and inconsistencies with this theory of mechanical foot therapy. One large problem with the SJN Theory relates to the reliability of the measurement procedures used within the standard biomechanical examination techniques proposed by Root.
The measurement error is just one problem with STJ neutral. Another problem is the idea of capturing the forefoot to rearfoot relationship in neutral position of the STJ and then treating the foot in the position in which the STJ stands. This position is the vast majority of the time withing 2 degrees of the end of range of motion in the direction of pronation. (unpublished data of mine) So, there is some inconsistancy within the theory of supporting the deformity and the actual treatment. However, there is at least a theory that connects the treatment and the measurement.



Quote:
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These examination techniques have been found to have only fair to poor intertester reliability and, therefore, can not be considered reliable from one examiner to another."

Is this much different than the intertester reliability and the flaws you mention in Kenya's paper.

Yes it is different.

The other data that was reported found that finding the location of the axis was repeatable and the unpublished data found that it was accurate. The inter rater error was found in describing whether the position that was found was to one side of the average or the other. Obviously, if they can find the axis accurately, a little more experience would allow them to estimate whether the location was on one side of the average or the other. The testers, problably just didn't yet have a good sense of what was average.

Eric
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