Inter-assessor reliability of practice based biomechanical assessment of the foot and ankle

Inter-assessor reliability of practice based biomechanical assessment of the foot and ankle

Hannah L Jarvis1

Christopher J Nester

Richard K Jones

Anita Williams

Peter D Bowden

Abstract

Background

There is no consensus on which protocols should be used to assess foot and lower limb

biomechanics in clinical practice. The reliability of many assessments has been questioned by

previous research. The aim of this investigation was to (i) identify (through consensus) what

biomechanical examinations are used in clinical practice and (ii) evaluate the inter-assessor

reliability of some of these examinations.

Methods

Part1: Using a modified Delphi technique 12 podiatrists derived consensus on the

biomechanical examinations used in clinical practice. Part 2: Eleven podiatrists assessed 6

participants using a subset of the assessment protocol derived in Part 1. Examinations were

compared between assessors.

Results

Clinicians choose to estimate rather than quantitatively measure foot position and motion.

Poor inter-assessor reliability was recorded for all examinations. Intra-class correlation

coefficient values (ICC) for relaxed calcaneal stance position were less than 0.23 and were

less than 0.14 for neutral calcaneal stance position. For the examination of ankle joint

dorsiflexion, ICC values suggest moderate reliability (less than 0.61). The results of a random

effects ANOVA highlight that participant (up to 5.7°), assessor (up to 5.8°) and random (up

to 5.7°) error all contribute to the total error (up to 9.5° for relaxed calcaneal stance position,

up to 10.7° for the examination of ankle joint dorsiflexion). Kappa Fleiss values for

categorisation of first ray position and mobility were less than 0.05 and for limb length

assessment less than 0.02, indicating slight agreement.

Conclusion

Static biomechanical assessment of the foot, leg and lower limb is an important protocol in

clinical practice, but the key examinations used to make inferences about dynamic foot

function and to determine orthotic prescription are unreliable.

http://www.jfootankleres.com/content/pdf/1757-1146-5-14.pdf

NICE Venous Thromboembolic Diseases Clinical Guideline

NICE have published and update on the Venous thromboembolic diseases (144) clinical guideline on

27/06/12 and is now available at the NICE website at:

http://guidance.nice.org.uk/CG144

Guidance aims to improve procurement across healthcare system

Guidance aimed at improving procurement across the healthcare system has been published by the Department of Health.

'NHS procurement: raising our game' sets out proposed actions for NHS trusts and the Department and focuses on taking immediate action to start tackling six key areas for improvements:

• levers for change
• transparency and data management
• NHS standards of procurement
• leadership, clinical engagement and reducing variation
• collaboration and use of procurement partners
• suppliers, innovation and growth

Read NHS Procurement: raising our game

This guidance is launched in advance of a procurement strategy planned for later in 2012 that will be developed following a wider call for evidence. It aims to start the journey to world class procurement by identifying those issues and actions that require immediate attention in order to lay the foundations for a fuller and further-reaching strategy later in the year.

In support, we are also publishing NHS Standards of Procurement, which will support trusts in understanding what good procurement looks like and in planning their improvements at a local level.

The standards can be used to identify what a trust's areas of strengths and weakness are in their procurement and suggest ways in which they can start to monitor and measure improvements.

Read NHS Standards of Procurement

Racial differences in foot disorders and foot type: The Johnston County Osteoarthritis Project

Golightly, Yvonne M, Hannan, Marian T, Dufour, Alyssa B, Jordan, Joanne M (2012); Racial differences in foot disorders and foot type: The Johnston County Osteoarthritis Project'; Arthritis Care & Research; Arthritis Care Res; John Wiley & Sons, Inc.; 2151-4658; http://dx.doi.org/10.1002/acr.21752

Objective.

To describe racial differences in the frequency of structural foot disorders and pes planus, and cavus foot types in a large cohort of African American and Caucasian men and women 50+ years old. 

Methods.

Of 1,695 Johnston County Osteoarthritis Project participants evaluated for foot disorders/type in 2006-2010, four with lower extremity amputation were excluded, leaving 1,691 available for analyses (mean age 69 years, mean body mass index [BMI] 31.5 kg/m2, 68% women, 31% African American). The most common foot disorders/types were identified using a validated foot examination. Each foot disorder/type was compared by race using logistic regression, controlling for age, BMI, and gender. Effect modification between race (African American versus Caucasian) and age, BMI (categorized as ≥30 [obese] or <30 kg/m2 [non-obese]), gender, and education were examined. 

Results.

Hallux valgus (64%), hammer toes (35%), overlapping toes (34%), and pes planus (23%) were common. Compared to Caucasians, African Americans were almost 3 times more likely to have pes planus and were nearly 5 times less likely to have Tailor's bunions or pes cavus. Among the non-obese, African Americans were more likely than Caucasians to have hallux valgus (adjusted odds ratio [aOR] =2.01, 95% confidence interval [CI] = 1.39-2.92), hammer toes (aOR=2.64, 95% CI=1.88-3.70), and overlapping toes (aOR=1.53, 95% CI=1.09-2.13). 

Conclusions.

Foot disorders are common among adults 50 years of age or older and differ by race. Future research is needed to determine the etiology of foot problems, especially those with racial differences, in order to inform prevention approaches.

New rules applicable to students for NHS Bursary Scheme from September

There are two different sets of rules applicable to students depending on when their course first started. These document published today sets out the new rules which will apply to students who started their course on or after 1 September 2012. The rules for students who started their course before 1 September 2012 are set out in the thirteenth edition of The NHS Bursary Scheme old rules. In each case the rules apply in relation to the academic year starting on or after 1 September 2012 but before 31 August 2013.

The NHS Bursary Scheme new rules first edition outlines the student support arrangements for students who start their course on or after 1 September 2012.

The NHS Bursary Scheme old rules thirteenth edition outlines the student support arrangements for students who started their courses before 1 September 2012.

Disclaimer

Students and prospective students should not rely on the current NHS Bursary rules and allowances when planning for subsequent academic years, these may be subject to review in the future and as a result may be liable to change. Further information about the NHS bursary will be posted on the NHS Student Bursaries website as and when it is made available. Students are advised to check the website on a regular basis. The Department of Health and NHS Student Bursaries will accept no responsibility for loss of any type however suffered by students who have relied on current rules and allowances in altering their circumstances (including but not limited to financial circumstances) whether for the current academic year, academic year to begin or indeed for subsequent academic years.

Equality Statement 2012

The NHS Bursary Scheme has been around since the early 1990s and is usually updated annually to take into account changes to policy. The Department of Health has worked with its key partners to undertake a review of the NHS Bursary Scheme. A number of options for the future of NHS student support were developed and assessed against a number of criteria one of which was equality. The Department of Health ran a public consultation on the options to seek the views of others with an interest, including people who were currently considering entering healthcare training. Respondents were asked to consider how far the options met a number of equality aims. The review concluded that, in the future, eligible students will all have access to the same package of financial support from September 2012 irrespective of their course. A report of the consultation, an impact assessment and an equalities impact assessment at the link below was published alongside the outcome of the consultation which is reported in supporting our future NHS workforce: consultation report.

These documents supersede the twelfth edition of the NHS Bursary Scheme. These documents are not distributed in hard copy

Third edition of Long Term Conditions Compendium published

The Department of Health has published the third edition of the Long Term Conditions Compendium of Information. It is aimed at commissioners as well as health and social care professionals, to provide the evidence for improving care and outcomes for people with long term conditions (LTCs).  It updates the second edition of the compendium published in January 2008.

This document contains the latest statistical data on long term conditions, links to the LTC QIPP (quality, innovation, productivity and prevention) workstream and provides data from the ongoing evaluation of the Whole System Demonstrator Programme on telehealth and telecare, which supports the delivery of 3 Million Lives. It also showcases examples of innovative projects across the country where organisations and communities are pushing the boundaries to deliver improvements in LTC care.

The information and evidence captured in this third edition of the compendium continues to reinforce why a focus on LTCs should be a priority.

Long Term Conditions Compendium of Information – third edition

Find out about the long term conditions strategy.