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      Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders I: development of standard rating system

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          Abstract

          Background

          The aim of this study was to report the five scales comprising the rating system that the Japanese Society for Surgery of the Foot (JSSF) devised (JSSF standard rating system) and the newly offered interpretations and criteria for determinations of each assessment item.

          Methods

          We produced the new scales for the JSSF standard system by modifying the clinical rating systems established by the American Orthopaedic Foot and Ankle Society (AOFAS scales) and the Japanese Orthopaedic Association’s foot rating scale (JOA scale). We also provided interpretations of each assessment item and the criteria of determinations in the new standard system.

          Results

          We improved the ambiguous expressions and content in the conventional standard rating systems so they would be easily understood by Japanese people. The result was five scales in total. Four were designed for use specifically for ankle-hindfoot, midfoot, hallux metatarsophalangeal-interphalangeal, and lesser metatarsophalangeal-ineterphalangeal sites; and the fifth was for the foot and ankle with rheumatoid arthritis. Furthermore, we described interpretations and criteria for determinations with regard to evaluation items in each scale.

          Conclusions

          Conventionally, the AOFAS scales or the JOA scale have been separately applied depending on the sites or disorders concerned, but it was often difficult to decide on scores during practical evaluations because of differing expressions in different languages and also because of ambiguity in the interpretation of each evaluation item and in scoring standards as well. JSSF improved these scales and added definite interpretations of evaluation items as well as criteria for the rating (to be reported here in part I). Because these steps were expected to improve the reliability of outcomes assessed by each scale, we examined the reliability in scores of the newly developed scales, which are reported in part II (in this issue).

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          Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.

          Harold Kitaoka, Ian J. Alexander, Robert Adelaar … (1994)
          Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.
          Article 0 comments Cited 500 times – based on 0 reviews     Review now
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            Development of a patient-reported measure of function of the knee.

            Robert S Wainner, Nicole L. Snyder, F Fu … (1998)
            The purpose of the present study was to demonstrate the reliability, validity, and responsiveness of the Activities of Daily Living Scale of the Knee Outcome Survey, a patient-reported measure of functional limitations imposed by pathological disorders and impairments of the knee during activities of daily living. The study comprised 397 patients; 213 were male, 156 were female, and the gender was not recorded for the remaining twenty-eight. The mean age of the patients was 33.3 years (range, twelve to seventy-six years). The patients were referred to physical therapy because of a wide variety of disorders of the knee, including ligamentous and meniscal injuries, patellofemoral pain, and osteoarthrosis. The Activities of Daily Living Scale was administered four times during an eight-week period: at the time of the initial evaluation and after one, four, and eight weeks of therapy. Concurrent measures of function included the Lysholm Knee Scale and several global measures of function. The subjects also provided an assessment of the change in function, with responses ranging from greatly worse to greatly better, at one, four, and eight weeks. The Activities of Daily Living Scale was administered to an additional sample of fifty-two patients (thirty-two male and twenty female patients with a mean age of 31.6 years [range, fourteen to sixty-six years]) before and after treatment within a single day to establish test-retest reliability. Factor analysis revealed two dominant factors: one that reflected a combination of symptoms and functional limitations and the other, only symptoms. The internal consistency of the Activities of Daily Living Scale was substantially higher than that of the Lysholm Knee Scale (coefficient alpha, 0.92 to 0.93 compared with 0.60 to 0.73), resulting in a smaller standard error of measurement for the former scale. Validity was demonstrated by moderately strong correlations with concurrent measures of function, including the Lysholm Knee Scale (r = 0.78 to 0.86) and the global assessment of function as measured on a scale ranging from 0 to 100 points (r = 0.66 to 0.75). Analysis of variance with repeated measures revealed significant improvements in the score on the Activities of Daily Living Scale during the eight weeks of physical therapy (F2,236 = 108.13; p < 0.0001); post hoc testing indicated that the change in the score at eight weeks was significantly greater than the change at four weeks and that the change at four weeks was significantly greater than that at one week (p < 0.0001 for both). As had been hypothesized, the patients in whom the knee had somewhat improved had a significantly smaller change in the score, both at four weeks (F1,189 = 33.50; p < 0.001) and at eight weeks (F1,156 = 22.48; p < 0.001), compared with those in whom the knee had greatly improved. The test-retest reliability coefficient (intraclass correlation coefficient[2,1]) was 0.97. These results suggest that the Activities of Daily Living Scale is a reliable, valid, and responsive instrument for the assessment of functional limitations that result from a wide variety of pathological disorders and impairments of the knee.
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              The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility.

              F Cuomo, K Koval, N Schoenberg … (1993)
              The radiographs of fifty fractures of the proximal part of the humerus were used to assess the interobserver reliability and intraobserver reproducibility of the Neer classification system. A trauma series consisting of scapular anteroposterior, scapular lateral, and axillary radiographs was available for each fracture. The radiographs were reviewed by an orthopaedic shoulder specialist, an orthopaedic traumatologist, a skeletal radiologist, and two orthopaedic residents, in their fifth and second years of postgraduate training. The radiographs were reviewed on two different occasions, six months apart. Interobserver reliability was assessed by comparison of the fracture classifications determined by the five observers. Intraobserver reproducibility was evaluated by comparison of the classifications determined by each observer on the first and second viewings. Kappa (kappa) reliability coefficients were used. All five observers agreed on the final classification for 32 and 30 per cent of the fractures on the first and second viewings, respectively. Paired comparisons between the five observers showed a mean reliability coefficient of 0.48 (range, 0.43 to 0.58) for the first viewing and 0.52 (range, 0.37 to 0.62) for the second viewing. The attending physicians obtained a slightly higher kappa value than the orthopaedic residents (0.52 compared with 0.48). Reproducibility ranged from 0.83 (the shoulder specialist) to 0.50 (the skeletal radiologist), with a mean of 0.66. Simplification of the Neer classification system, from sixteen categories to six more general categories based on fracture type, did not significantly improve either interobserver reliability or intraobserver reproducibility.
              Article 0 comments Cited 42 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Orthop Sci
                Title: Journal of Orthopaedic Science
                Publisher: Springer-Verlag (Tokyo )
                ISSN (Print): 0949-2658
                ISSN (Electronic): 1436-2023
                Publication date (Print): September 2005
                Volume: 10
                Issue: 5
                Pages: 457-465
                Affiliations
                [ ]Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kanagawa, 216-8511 Japan
                [ ]Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
                [ ]Department of Orthopaedic Surgery, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan
                [ ]Department of Orthopaedic Surgery, Osaka Medical College, Osaka, Japan
                [ ]Department of Orthopaedic Surgery, Sapporo Medical University, Hokkaido, Japan
                [ ]Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
                [ ]Department of Orthopaedic Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
                [ ]Nomura Seikeigeka Ganka Clinic, Yamaguchi, Japan
                [ ]Department of Orthopaedic Surgery, Tohoku University, Miyagi, Japan
                [ ]Unit of Medical Statistics, Faculty of Education and Culture, St. Marianna University School of Medicine, Kanagawa, Japan
                Article
                Publisher ID: 936
                DOI: 10.1007/s00776-005-0936-2
                PMC ID: 2797841
                PubMed ID: 16193356
                SO-VID: 5f44d675-fa6a-409f-813b-a0f55718e94f
                Copyright © © The Japanese Orthopaedic Association 2005
                History
                Date received : 23 May 2005
                Date accepted : 28 June 2005
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The Japanese Orthopaedic Association 2005

                ScienceOpen disciplines: Orthopedics
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                ScienceOpen disciplines: Orthopedics

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