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36 Cards in this Set
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1. Landorf & Radford (2008)
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Validation Study:
Minimal Important Difference Level 5 - Own Paradigm Clinical Significance vs Statistical Significance (VAS, FPI, FHSQ to evaluate Pt based outcomes). INFERENCES: - large s/s (power) n=175, - global questionnaire (sensitivity) - reproducible RELIABILITY: Not tested VALIDITY: MID as indicator of FHSQ, FFI, VAS clinical validity CONCL: MID can be used to determine between clinical and statistical significance. |
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2. Root et al. (1966)
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STJ Axis of motion description - Triplanar (SP / FP / TP)
Confirms Manters 16SP & 42TP axis Forerunner to Ideal stance criteria Level 5 - Own Paradigm INFERENCES: - n=22 sample (small) - STJ Axis Varies btwn patients - External representation of internal position VALIDITY: No validation of aparatus constructed CONCL: STJ hinge movement in three planes (SP / FP / TP) |
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3. Bailey et al. (1984)
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Validation Study:
Testing validity of the Determined Neutral Position (DNP) measure of STJ Neutral using Tomography 2:1 - INV:EV, 33% ROM. HoE: Level 5 – non experimental descriptive case study Paradigm: Root INFERENCES: Conclude that STJN position - varies from pt to pt, from left to right and - location of STJN is variable in relation to total ROM - Small sample size n= 15 - subject recruitment unkwn - Variability of the STJN Validiation Criterion Validation of DNP calculation using tomograms Clinical relevance: - STJN position varies from patient to patient, from left to right - Location of STJN id variable in relation to total ROM - Criterion validation of DNP (STJN) 2:1 |
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4. Kirby (2001)
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STJ Axis Location & Rotational Equilibrium Theory
- New Paradigm based on Spatial Location + Forces involved - Related to clinical observations Level 6 Own Paradigm INFERENCES: - Own opinion - Face validity only - Can better explain clinical pathologies RELIABILITY: VALIDITY: Face validity – based on own observations CONCL: Consider the bony prominances and their effect on STJ Axis (thus magnitude of Pro / sup, and balance of pro / sup timings) ie: Rotation Equilibrium |
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5. Lewis et al. (2009)
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Reliability & Validation Study
Functionally locating STJ axis Level 5 Root Paradigm INFERENCES: - n = 4 (MRI + metronome method) - n = 24 (skin marker method) - not homogenised data - mathematical calc of ‘least square mean helical axis’ RELIABILITY: - two way ANOVA of testers & trials - more than 1 rater, - more than 1 test (for the 2nd test) - Inter-reliability OK VALIDITY of Invivo functional STJ location method: Criterion – Using MRI Convergent – Comparison against cadaver studies CONCL: - STJ more like a helical axis (refutes root 66) |
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6. Phillips (2000)
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What is Normal?
Normal vs Pathological vs Ideal stance? Normal vs Abnormal? 11 x Criteria to consider when determining 'normal' foot Level 6 – Respectable Opinion Root Paradigm INFERENCES: - Qualitative look at a quantitative measure - Refer to ‘Ideal’ rather than ‘Normal’ RELIABILITY: N/A VALIDITY: N/A CONCL: Clinically evaluate foot ‘function’ – Not appearance |
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7. Pierrynowski et al. (1996)
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Reliability Study
Test reliability of technique Podiatrists use in placing foot in STJ Neutral Level 5 – Non exp Comparative Root Paradigm INFERENCES: - good reliability study size (n = 9 + 9 raters) - small subject pool (n = 6 subjects) - Only one foot used (menz 03 satisfied) - STJN position not definitive / accurate - Mean values of measures compared as baseline RELIABILITY: - Two data acquisition systems used to measure proficiency - Blinding, skill acquisition accounted for - Reliability of experienced pods shown VALIDITY: - Face validity only - Radiographs not compared (criterion validation) - Non Weight Bearing measures used CONCL: Continual training and technique improvement increases reliability of placing foot in STJN |
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8. Robinson et al. (2001)
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Reliability study
Reliability of RCSP & NCSP skin calliper technique Approx Level 5 (not exactly) Root Paradigm INFERENCES: - Small tester pool (one tester, two sessions) - Small Sample size (n= 8) - No subject Randomization or allocation RELIABILITY: ANOVA = NCSP Reliable, = RCSP has problems with x-ray positioning VALIDITY: - Criterion Validation of Skin Marking Procedure - Indirectly validates Mas & Ack skin errors - Indirect validation of the use of NCSP & RCSP measures as reliable CONCL: - Reliable calliper method suggested (but high risk that this is not the right picture) - Found 50% to 40% position of calc - Low sample (8) and rater size (1) and Testing (2) = Poor applicability / usefulness |
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9. Ganley (1985) + Weed (1986)
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Ganley: Two unit Tarsus - NCC as single unit
Weed: Separate triplanar motion required - OKC and CKC, - importance of weight bearing - Planar dominance in STJ & MTJ (TP > SP > FP) Level 6 - Opinions Paradigm – Own INFERENCES: - Many variations of OKC & CKC in clinic RELIABILITY: N/A VALIDITY: Face validity CONCL: - TP > SP > FP in MTJ & STJ motion - OKC motion important to the understanding of CKC movement in STJ & MTJ motion |
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10. Nester et al. (2001)
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Single axis of MTJ
MTJ - Discussion and setup for 2002 axis determination, Level 5 – Discussion paper (almost opinion) Own Paradigm INFERENCES: - difficulties of 3D motion analysis (small segments) - not tested under walking conditions (NWB) - not reproducible - Improves on Manters cadaver study which removed ligaments + musculature. RELIABILITY: N/A VALIDITY: - Motion produced manually by an unspecified method - Unkwn sample size (Unknown validity) - Face validity CONCL: - Single axis of MTJ 29.0 SP and 37.9 TP (from van Langelaan, Benick & Lundberg & Svensson) - Refutes Manter (two axis) - Nester supports Findlow study |
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11. Nester et al. (2002)
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MTJ axis Kinematic characteristics using WB
Level 5 Own 'Kinematic' Paradigm INFERENCES: - Influences of movement on markers...? - n = 25 subjects (Paired!) - Live subjects (vs manter cadavic studies) RELIABILITY: New method not tested VALIDITY: New method not validated Convergence Validity (in the ball park with other measures) CONCL: Single axis of MTJ 29.0 SP and 37.9 TP |
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12. Tweed et al. (2008)
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Systematic Review of MTJ
Level 1 Root vs Nester Paradigms INFERENCES: - Large pool of authors - Referenced Studies methods / sample sizes may not be valid for a systematic review RELIABILITY: As above VALIDITY: As above CONCL: - Supports Single axis 29.0SP / 37.9TP - all studies use small sample sizes |
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13. Lundberg et al. (Pro & Sup) (1989)
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Live Patient Kinematics of AJ & Foot in Pronation & Supination
(AJ, TCal, TNJ, Prox & Dist Med Cune) Level 5 Root Paradigm INFERENCES: - All foot joints participate in some form of Pro / Sup movements (Rot Tfr Mech) - Small Sample size (n=8) - n = 1 x tested calc sideways roll (validity??) - No search criteria - Only right foot used menz (03) RELIABILITY: - Static WB xrays only VALIDITY: - Criterion validity (Roentgen Stereophotogrammetry) - Only right foot used – not representative of natural walking CONCL: Rotation Transfer Mechanism - Foot as Rigid Lever (torsion transmitter) & Mobile adapter (torsion dissipater) - TNJ – Greatest Motion - TNJ > TNJ > NCJ - Calc sideways roll - RTM more effective in Supination |
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14. Wolf et al. (2008)
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Trying to establish Baseline of Funct Foot Units
Pins & Opto-electric system to identify functional units of the mid-stance foot in running & walking Level 5 Forming Own 'Kinematic' Paradigm INFERENCES: - n = 6 (walking) - n = 4 (slow running) - invasive methods RELIABILITY: - High between subj variability (inter) VALIDITY: - Cannot be extrapolated to wider population CONCL: - Distal + Proximal Medial ray = Funct Unit, - Nav + Cub = Rigid Unit, - Cal + Cub + 5th = Funct Unit |
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15. Saxena & Kim (2003)
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Trying to establish a baseline for AJ Df in NWB in adolescent athletes
Level 5 (non-experimental comparative study) Own Paradigm INFERENCES: - Didn't gather correct stats - methods, subjects - High variability - Large conclusions - Poor design = methods not rigorous RELIABILITY: - No between or within rater reliability - Parallax errors (goniometer use) - Poor reproducibility = decreases reliability VALIDITY: - Not seen : poor construction of method - STDev > Mean = High variability in data CONCL: Conclusions about juvenile ankle equinus (< 10deg Df) not supported |
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16. Scharfbillig and Scutter (2004)
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Validation Study
Validate a measurement method for AJ dorsiflexion Level 5 Root Paradigm INFERENCES: - Well written & simple conclusions, - Inter hid Intra rater repeatability of measurement methods (high ICC resulted) - Small convenience sample size (n=14) Type II errors, - Both feet used RELIABILITY: Inter-rater reliability (between) Intra-rater reliability (within) ICC still relatively high when adjusted VALIDITY: Face validity highest form possible (many joints involved) Criterion validity not possible - between subject variability too high, - photographic/x-ray techniques not used CONCL: Modified Lidcombe template valid measure of AJ Df |
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17. Mun-tea-nu et al. (2009)
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Reliability Study
Reliability of AJ Dorsiflexion measure + WB + Knee extended Approx Level 5 (Reliability Study) Root Paradigm - (10 degree Df gait clearance) INFERENCES: - TESTED FOR NORMALITY! - n = 30 (n = 4 testers) - Blinding - AJ movement = AJ + STJ + MTJ + FF Joints... (NOT STJ alone) - Subjective ability of clinician RELIABILITY: - 4 different experienced pod raters tested - Intra & Inter rater reliability tested (ICC 2,2) VALIDITY: - n = 30 (good) - Not STJ alone - Face validity CONCL: Reliable technique (experienced and inexperienced) Consider subject applicability and what you want Df to represent |
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18. Hiller (2006)
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Reliability & Validity Study
Reliability & Validity of CAIT, Approx Level 5 (Reliability Study) Own Paradigm INFERENCES: - Celing of CAIT too low @ 30 - Homogeniety of subjects not tested, - CAIT questions (3x not suitable) RELIABILITY: - Test-retest reliability: (ICC 2,1) VALIDITY: - Concurrent validity: CAIT vs LEFS and VAS (using Spearman ρ) - Predictive Validity: has the potential to predict future sprain. Pt who have sprained AJ + low CAIT score = more likely to resprain - Construct validity: Rasch analysis - pt with greater ankle instability will be more likely to receive higher CAIT score - Discriminative validity: if the subjects have a functional ankle instability AT THE TIME the study was taken (predictive refers to future risk-of FAI) CONCL: CAIT Valid & Reliable way of measuring ankle instability Better measure of the severity of ankle instability |
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19. Roukis (2005)
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Retrospective Review
To determine whether if metatarsus primus elevatus (MPE) exists in hallux rigidus (HR) Level 5 - comparative study Root Paradigm INFERENCES: - Bias sample selection - Many studies fail to show differences btwn x-ray of HR to HV, MN or nil 1MPJ pathologies - N = 275 RELIABILITY: - Poor: one sample taken randomly by one rater - WB stance position in X-ray decr reliability - Pf during TO not able to be determined VALIDITY: Face validity Incorrect stats CONCL: - MPE in HR more than HL, HV, PF and Mort Neur - HR pop differences (II vs I or III) - True role of MPE in HR is still unknown |
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20. Scherer et al. (2006)
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Effect of Functional Foot Orthoses (Pf 1 RAY) can increase 1st MPJ Df
Level 4 – Quazi Experimental (intervention included) Root Paradigm INFERENCES: - 27 feet used (48 double dipped) - No rigid validation testing RELIABILITY: None Tested VALIDITY: None Tested Face Validity only CONCL: FFO: - Increases Df by 90%, - Decreases pressure by 15%, - Promotes orthoses use, - How orthotics effect change is unknown - Orthotics can be used to improve surgical prognosis |
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21. Paton (2006)
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Whether Pronation (Navic Drop) is assoc with 1MPJ motion in WB
Level 5 Root Paradigm INFERENCES: - Digital Calliper (nav Drop) + Df board Not validated - Normality Assumed (Pearsons), - Association investigated (preliminary study) - Bias attempted to be removed (shielding measures) - RF only used - n = 24 (convenience sample) - Problems with non-invivo study of an in-vivo movement (Df felt vs Pf seen) RELIABILITY: Not Tested VALIDITY: Not Tested CONCL: Incr nav drop = Decr Df 1MPJ Orthoses potential Rx option – inverse relationship of Nav drop to 1MPJ Df |
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22. Calvo et al. (2009)
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Importance of 1MET & Prox phalanx in hallux rigidus
Level 5 Root Paradigm INFERENCES: - Large Sample Size (n = 132 + 132) - Double dipping - New method of measuring Met length (not validated) - Normality not tested (non-para used) RELIABILITY: - One Rater used (not tested) VALIDITY: - Needs to be tested - New method of measuring Met length (not validated) CONCL: - 1st Met length : Incr incidence (not magnitude) of Hallux Rigidus - Phallanx Length not important |
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23. Beeson et al (2009)
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Cross sectional Study
Hallux Rigidus Risk Factors (Clinical Parameters & Demographics) Level 5 (Snapshot Study) Root Paradigm INFERENCES: - 1 rater, 1 session - Not all factors can be measured reliably - Qulitative & Quantitative Data Snapshot - Large population from adult clinic n= 132 + 132 - doubble dipped - Methodological errors (goiniometer) RELIABILITY: - FPI (Intra Rater reliability) An issue for clinical physical measurements of HR (esp angular measures) VALIDITY: Content Validity of Measures of H Rigidus CONCL: - Risk Factors : Gender, Age, Bilateral Condition, 2nd Phal => Hallux, HIPJ Hyperext, MTPJ Pain, Flat Foot, Gait Changes - Footwear aggravates but not cause |
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24. Kernozek et al (2003)
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To Identify Loading & Clinical Risk Factors associated with HAV Level 5 (No intervention)
Root Paradigm INFERENCES: - n = 40 HAV, 51 controls - Convenience Sample of Older subjects - Comparison group not homogenized - Subjective + Objective data evaluated RELIABILITY: - Visual Screening of subject’s feet? - Assumed from others procedures - Innate in Pressure Platform procedures VALIDITY: - All factors not considered - Pressure does not equal biomechanical CONCL: - Increased force duration at hallux region primary risk of HAV - Decrease in Peak force inversely related to HAV Pressure - Combinations surrounding Hallux to Ff regions significant in HAV pathology |
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25. Munuera et al. (2006)
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PRELIMINARY REPORT on Whether Orthotic treatment for STJ Pronation restores Df of the Hallux
Level 4 - Positive moulding Intervention Paradigm: Root + Nestor / Kirby (muscle involvement) INFERENCES: - Time is a factor in HL (dec Df Hallux to Stuctural) - Small Sample size (gives idea only) (n=8, Paired to 16) - Lots of Limitations - acknowledged (Size, Time, Reliability, Validity, Skin Markings, Unique individuals) - Compliance not controllable - No blinding - Assumed uniform FF / RF relationships RELIABILITY: - Poor reliability of methods (however acknowledged) - Not tested VALIDITY: - Prompts for further research - Face validity only CONCL: - Peroneus Longus will help Pf of 1 Ray - PL requires time to change its position, thus usefulness of orthoses Rx - Control Pf 1 Ray = Control Hallux Df Limitus |
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26. Pique-Vidal & Vila (2009)
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Reliability & Mostly a Validity Study
Geometric analysis to identify Hallux Valgus Level 5 (Validation study) Own Paradigm INFERENCES: - TESTED FOR NORMALITY! - large sample size (n=176, 192 tested) - Testing not consistent - No randomisation of subjects RELIABILITY: - Measurements by 3 independent observers - VAS run through ANOVA, Tukeys et al VALIDITY: - Compared Angular Measurements, VAS, Centre of circle - Validated new measure - Convergent Validity of angular measurement to VAS - Face Validity - Positive correlation to HV levels - Criterion / Concurrent Validity – Manchester scale (as gold std?) CONCL: IP is valid measure – correlated with VAS & angular measurements VAS reliable |
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27. Kilmartin et al (1994)
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Controlled prospective trial of a foot orthosis for juvenile HV in Northampton
Level 4 Root Paradigm INFERENCES: - 6000 children surveyed – 120 loosely included, - Randomly assigned Control / no control - Little control over control group compliance - Baseline to Post lag time (3 years) - Non significant reduction in HV progression - Orthoses designed to prevent excessive STJ pronation RELIABILITY: - Single blinded observer - No effective way to control intervention… VALIDITY: - STJ pronation correlation to J-HV?? (lot more occurring between) = Face validity?? CONCL: Orthoses designed to prevent excessive STJ pronation do not significantly reduce J-HV. |
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28. Mündermann et al (2006)
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Foot orthoses affect frequency of muscle activity in the LL
Level 4 – Quazi Experimental (3 orthotic , 1 control) Own Paradigm – (mm activity in LL) INFERENCES: - Control Orthotic ≠ Molded or Post Orthotic - n = 20 (n=6 in each measure) (small sample size) - elite vs recreational runners - Single leg measure (menz) - Orthotic exposure only in experiment (rapid change, no accommodation occurring) RELIABILITY: - Randomised order of FO intervention - Only done in lab VALIDITY: - EMG wavelet previously validated CONCL: Foot orthoses can have an influence on mm function (leading to earlier fatigue, underlie certain injuries) |
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29. Murley et al (2009)
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Level 1 (systematic review)
Surrounds Argument around Root Paradigm (not root) INFERENCES: - From the 38 articles - Not enough research in EMG area to make sound conclusions - Too much heterogeneity between studies (large number of structural variations) = not much quality data, difference in methods of measuring RELIABILITY: - Inter-Rater (Kappa) – reporting of EMG variables 83% agreement VALIDITY: - External Validity (validity caused from factors outside the study) low for 25/38 studies - 56% score on modified quality index (lower end quality studies) CONCL: - Foot posture: Pronated feet - greater EM activation of inverter musculature and decreased activation of evertor musculature - Foot orthoses: Increased activation of TA and peroneaus longus. - Footwear: Elevated heels alter lower limb and back muscles. |
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30. Dixon (2006)
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Can centre of pressure data to indicate Rf inversion-eversion in shod running (looking at deviation of pressure, not amount of pressure)
Level 5 (non experimental descriptive study) Root Paradigm (pronation) INFERENCES: - Footwear not standardised - first of its kind in running - n = 33 (separated into pronators = small sample) - Outside measure of foot (not within foot pronation) - Lines guessed rather tan measured - Biomechanical terms overused… RELIABILITY: Post hoc Sheffe test to show reliability VALIDITY: Face validity? - measuring values, pressure plate measures COP CONCL: - High COP deviation for pronators - Caution using of COP to indicate ‘absolute rearfoot eversion’ - many variables effect this |
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31. Esenyel et al. (2003)
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Describe kinetic changes in LL associated with high heeled gait & insights into preventable problems that may arise from their daily use
Level 5 (comparative study) Root Paradigm (changes from ‘ideal’ position) INFERENCES: - Sample size small (n=15), - No normality testing, - Non repeatable procedures, - non-significant data used - Shoes standardised RELIABILITY: - Highest three Between trial (inter) reliability scores were averaged and used - Shoes Standardized VALIDITY: - Face validity of mm activity CONCL: - Plantar Flexors: significant decrease in moment, work and power during stance phase of walking. - Hip Flexors: increase work during the transition from stance to swing phase. - Frontal plane motion: increase FP motion at hip & knee joint detected. - Increased Pathologies: Abnormal motions may lead to increased predisposition to back & proximal AJ pathologies |
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32. Ward et al. (2003)
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Fascia released from med to lat = incr in force in remaining fascia
Level 4 Invivo Paradigm INFERENCES: - n=4 (small sample size) - Intrinsic mm effects not included (but acknowledged) - Measure from hypothetical root positions (not validated) - Dynamic gait replicator RELIABILITY: Inter High - Dynamic Gate Replicator (DGR) Intra - Not easily achievable (rebuild DGR) VALIDITY: - Dynamic gait replicator: results reflect programming - Cadavic replication of gait…? Tested by Pressure & invivo data - Kinematics through stance = identical to invivo data… CONCL: - Resupination decreases after more than 66% fascia release - Thus: less than 66% release to maintain foot stability |
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33. Nester et al. (2007)
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To study the kinematic contributions the navicular, cuboid and metatarsal bones make to foot function using a dynamic walking cadaver model
Level 5 (non experimental study) Own Paradigm (no previous literature on navicular, cuboid and metatarsal kinematic during gait) INFERENCES: - small sample size (n=13) - the model showed what the feet were capable of rather than how they worked in-vivo - Not reproducible RELIABILITY: Not tested VALIDITY: Not Tested Face validity only Decreased applicability to other studies (Cadaver AJ SP kinematics did not correlate to other studies) CONCL: Low validity and reliability limit usefulness Foundations for further possible study |
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34. McGinley et al. (2009)
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Identify & evaluate the evidence describing the intra & inter reliability of 3D LL kinematic measures (3D gait analysis)
Level 1 - systematic review of reliability studies Own Paradigm - INFERENCES: - 15 full papers, 8 abstracts - Low homogeneity (Too much heterogeneity between studies (large number of structural variations in study design) - Populations used to develop need to be considered against those that they can be applied against (may not be the same) - Articles have different time frames, walking speeds, assessors RELIABILITY: Limited reliability studies surrounding gait measures VALIDITY: Face validity CONCL: Errors of < 2 deg regarded as OK in 3D Gait analysis Errors of > 5 deg regarded as large enough to mislead clinical interpretations Knowledge of errors reduces over-interpretation of results |
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35. Nester (2009)
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Lessons from dynamic cadaver & invasive bone pin studies: do we know how the foot really moves during gait
Level 6 (personal opinion) Own Paradigm - argues against root INFERENCES: - author opinion experiences, - Refers to 3 other authors - States its intention as opinion, not to cover all literature within the field RELIABILITY: N/A VALIDITY: N/A CONCL: - Clinicians should be aware of inter-patient variation (high) - Construct a model specific for the patient (rather than moulding a patient into a model) |
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36. Lundberg et al. (Df & Pf) (1989)
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Axis of rotation of the ankle joint
Level 5 (Non experimental descriptive summary) Root Paradigm INFERENCES: - small sample size (n=8) - Non-paired data (Right foot (Menz, 2003) - Not clear how 3D co-ordinates calculated or how kinematic analysis was performed RELIABILITY: VALIDITY: Roentgen stereophotogrammetry is a valid technique Criterion validity CONCL: - Df / Pf has a high variation between subjects (18 – 63 degrees) - Pf and Df, pro, sup, medial and lateral rotational axes run through one central point in the trochlea of the talus - This is slightly lateral to the midpoint of a line between the tips of the malleoli - The position of the axis of the talo-crural joint is important for the calculation of joints loads and torques - Considerable variation amongst individuals has implications for designing of models of the ankle |
