Is a Three-component Video-based Version of the Foot Posture Index Valid for Assessing Pediatric Patients With Orthopaedic and Neurologic Foot Conditions?

IF 4.2 2区 医学 Q1 ORTHOPEDICS Clinical Orthopaedics and Related Research® Pub Date : 2024-11-01 Epub Date: 2024-05-09 DOI:10.1097/CORR.0000000000003110
Susan A Rethlefsen, Sylvia Ounpuu, Jennifer Rodriguez-MacClintic, Alison Hanson, Eva M Ciccodicola, Kristan A Pierz, Tishya A L Wren
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Abstract

Background: The Foot Posture Index-6 (FPI6) is an assessment of foot position that can be useful for patients with orthopaedic complaints. The FPI6 rates six components of foot position from -2 to +2, resulting in a total score on a continuum between -12 (severe cavus or supination) to +12 (severe planus or pronation). The subscores are ratings made by the examiner and are subjective assessments of deformity severity. The FPI6 requires palpation of bony structures around the foot and therefore must be administered live during physical examination. Because it is sometimes impractical to perform these assessments live, such as for retrospective research, a valid and reliable video-based tool would be very useful.

Questions/purposes: This study examines a version of the FPI using three of the original six components to determine: (1) Are scores from the three-component version of the FPI (FPI3) associated with those from the original six-component version (FPI6)? (2) Is the three-component FPI3 as reliable as the original six-component FPI6? (3) Are FPI3 assessments done retrospectively from video as reliable as those done live?

Methods: A retrospective group of 155 participants (106 males; mean age 13 ± 4 years) was studied. All had undergone gait analysis including videotaping and in-person assessment using the FPI6. Ratings for three components (calcaneus inversion/eversion, medial arch congruence, and forefoot abduction/adduction) were extracted yielding an FPI3 score ranging from -6 to +6. The other three components of the FPI6 (talar head palpation, curves above and below the lateral malleolus, talonavicular joint bulge) were excluded from the FPI3. FPI6 and FPI3 scores and side-to-side asymmetry were compared for all participants and for diagnosis subgroups (cerebral palsy and Charcot-Marie-Tooth disease) using a Pearson correlation. Agreement for foot posture categorization between the FPI6 and FPI3 was assessed using weighted kappa. Intra- and interrater reliability of live and video-based assessments for the FPI3 and its components were examined using intraclass correlation coefficients (ICCs) and Bland-Altman analysis.

Results: Scores from the FPI3 and FPI6 are highly associated with each other, suggesting the FPI3 is an adequate substitute for the FPI6. FPI6 and FPI3 scores (r = 0.98) and asymmetry (r = 0.96) were highly correlated overall and within the cerebral palsy (r = 0.98 for scores; r = 0.98 for asymmetry) and Charcot-Marie-Tooth (r = 0.96 for scores; r = 0.90 for asymmetry) subgroups (all p < 0.001). Agreement between the FPI6 and FPI3 was high for foot posture categorization (weighted agreement = 95%, weighted κ = 0.88; p < 0.001). Interrater reliability for live ratings was similar for FPI3 and FPI6 and high for both measures (ICC = 0.95 for FPI6 and 0.94 for FPI3; both p < 0.001). High reliability was seen in video versus live ratings for the FPI3 total score and each of its components regardless of whether they were performed by the same (ICC = 0.98) or different (ICC = 0.97) raters (both p < 0.001), and interrater reliability remained high when the FPI3 was scored from video recordings (ICC = 0.96; p < 0.001).

Conclusion: The FPI3 is valid and reliable when done live or from video or by the same or different examiners. It is suitable for retrospective and multicenter research studies, provided videos are done using standardized protocols. Further research is recommended investigating possible ceiling and floor effects in patients with pathologic conditions.Level of Evidence Level III, diagnostic study.

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基于视频的三部分足部姿势指数版本是否适用于评估患有骨科和神经科足部疾病的儿科患者?
背景:足部姿势指数-6(FPI6)是一种足部姿势评估方法,对骨科疾病患者非常有用。FPI6 对足部位置的六个组成部分进行评分,从-2 到 +2,总分介于-12(严重穴位或上翻)到 +12(严重跖屈或前倾)之间。分值由检查者评定,是对畸形严重程度的主观评估。FPI6 需要对足部周围的骨骼结构进行触诊,因此必须在体格检查时进行现场操作。由于现场进行这些评估有时并不现实,例如在进行回顾性研究时,因此一种有效可靠的视频工具将非常有用:本研究对使用原有六项内容中的三项内容的 FPI 版本进行研究,以确定:(1)三项内容版本的 FPI(FPI3)得分与原有六项内容版本(FPI6)的得分是否相关?(2)三成分 FPI3 是否与原始六成分 FPI6 一样可靠? (3)通过视频进行的 FPI3 评估是否与现场评估一样可靠?我们对 155 名参与者(106 名男性,平均年龄为 13 ± 4 岁)进行了回顾性研究。所有参与者都接受了步态分析,包括录像和使用 FPI6 进行的现场评估。对三个部分(小腿内翻/外翻、内侧足弓同形和前足内收/外展)进行评分,得出 FPI3 分数,范围在 -6 到 +6 之间。FPI6 的其他三个组成部分(距骨头触诊、外侧踝上下弯曲、距骨关节隆起)不包括在 FPI3 中。利用皮尔逊相关性比较了所有参与者和诊断亚组(脑瘫和夏科-玛丽-牙病)的 FPI6 和 FPI3 分数以及两侧不对称情况。采用加权卡帕法评估了 FPI6 和 FPI3 对足部姿势分类的一致性。使用类内相关系数(ICC)和布兰德-阿尔特曼分析法对 FPI3 及其组成部分的现场和视频评估的内部和相互之间的可靠性进行了检查:结果:FPI3 和 FPI6 的得分高度相关,表明 FPI3 足以替代 FPI6。FPI6 和 FPI3 的得分(r = 0.98)和不对称性(r = 0.96)在总体上高度相关,在脑性麻痹(得分 r = 0.98;不对称性 r = 0.98)和夏科-玛丽-牙(得分 r = 0.96;不对称性 r = 0.90)亚组中也高度相关(所有 p 均小于 0.001)。在足部姿势分类方面,FPI6 和 FPI3 的一致性很高(加权一致性 = 95%,加权 κ = 0.88;p < 0.001)。FPI3 和 FPI6 的现场评分的互测可靠性相似,且两项测量的互测可靠性都很高(FPI6 的 ICC = 0.95,FPI3 的 ICC = 0.94;均 p < 0.001)。FPI3总分及其各组成部分的视频评分与现场评分的可靠性很高,无论评分者是相同(ICC = 0.98)还是不同(ICC = 0.97)(均为p < 0.001),当通过视频记录对FPI3进行评分时,评分者之间的可靠性仍然很高(ICC = 0.96;p < 0.001):结论:无论是现场还是录像,无论是由同一检查者还是由不同检查者进行评分,FPI3 都是有效和可靠的。只要使用标准化方案进行录像,它就适用于回顾性研究和多中心研究。建议进一步开展研究,调查有病理状况的患者可能出现的上限和下限效应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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