12 research outputs found
Inter-assessor reliability of practice based biomechanical assessment of the foot and ankle
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 (upto 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
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Welfare Receipt Trajectories of African-American Women Followed for 30Â Years
Although there has been much discussion about the persistence of poverty and welfare receipt among child-rearing women in the US, little is known about long-term patterns of poverty and welfare receipt or what differentiates those who remain on welfare from those who do not. Furthermore, are there distinctions between child-rearing women who are poor but not on welfare from those who do receive welfare? This study examined trajectories of welfare receipt and poverty among African-American women (n = 680) followed from 1966 to 1997. A semiparametric group-based approach revealed four trajectories of welfare receipt: no welfare (64.2%), early leavers (12.7%), late leavers (10.1%), and persistent welfare recipients (10.1%). The “no welfare” group was further divided into a poverty group and a not poverty group to distinguish predictors of welfare from predictors of poverty. Multivariate analyses revealed differences in predictors of trajectory groups in terms of education, physical and psychological health, and social integration. In addition, earlier chronic illness and social integration were important predictors to differentiate between long-term users (i.e., late leavers, persistent recipients) and short-term users (i.e., early leavers). Trajectories did not differ in teenage motherhood, substance use, or family history of welfare receipt. Implications for public policy are discussed