Inter-rater reliability of the Foot Posture Index (FPI-6) in the assessment of the paediatric foot

Abstract Background Reliability is an integral component of clinical assessment and necessary for establishing baseline data, monitoring treatment outcomes and providing robust research findings. In the podiatric literature traditional measures of foot assessment have been shown to be largely unreliable. The Foot Posture Index (FPI-6) is a clinical tool used in the assessment of foot and to date, there is limited research published which evaluates the reliability of this tool in children and adolescents. Method Thirty participants aged 5 - 16 years were recruited for the research. Two raters independently recorded the FPI-6 score for each participant. Results Almost perfect agreement between the two raters was identified following weighted kappa analysis (Kw = 0.86). Conclusion The FPI-6 is a quick, simple and reliable clinical tool which has demonstrated excellent inter-rater reliability when used in the assessment of the paediatric foot.</p

Assessing the admissibility of a new generation of forensic voice comparison testimony

This article provides a primer on forensic voice comparison (aka forensic speaker recognition), a branch of forensic science in which the forensic practitioner analyzes a voice recording in order to provide an expert opinion that will help the trier-of-fact determine the identity of the speaker. The article begins with an explanation of ways in which human speech varies within and between speakers. It then discusses different technical approaches that forensic practitioners have used to compare voice recordings, and frameworks of reasoning that practitioners have used for evaluating the evidence and reporting its strength. It then discusses procedures for empirical validation of the performance of forensic voice comparison systems. It also discusses the potential influence of contextual bias and ways to reduce this. Building on this scientific foundation, the article then offers analysis, commentary, and recommendations on how courts evaluate the admissibility of forensic voice comparison testimony under the Daubert and Frye standards. It reviews past rulings such as U.S. v. Angleton, 269 F.Supp 2nd 892 (S.D. Tex. 2003) that found expert testimony based on the spectrographic approach inadmissible under Daubert. The article also offers a detailed analysis of the evidence presented in the recent Daubert hearing in U.S. v. Ahmed, et al. 2015 EDNY 12-CR-661, which included testimony based on the newer automatic approach. The scientific testimony proffered in Ahmed is used to illustrate the issues courts are likely to face when considering the admissibility of forensic voice comparison testimony in the future. The article concludes with a discussion of how proponents of forensic voice comparison testimony might meet a reasonably rigorous application of the Daubert standard and thereby ensure that such testimony is sufficiently trustworthy to be used in court

Inter-rater reliability of the Foot Posture Index (FPI-6) in the assessment of the paediatric foot

BACKGROUND: Reliability is an integral component of clinical assessment and necessary for establishing baseline data, monitoring treatment outcomes and providing robust research findings. In the podiatric literature traditional measures of foot assessment have been shown to be largely unreliable. The Foot Posture Index (FPI-6) is a clinical tool used in the assessment of foot and to date, there is limited research published which evaluates the reliability of this tool in children and adolescents. METHOD: Thirty participants aged 5 - 16 years were recruited for the research. Two raters independently recorded the FPI-6 score for each participant. RESULTS: Almost perfect agreement between the two raters was identified following weighted kappa analysis (Kw = 0.86). CONCLUSION: The FPI-6 is a quick, simple and reliable clinical tool which has demonstrated excellent inter-rater reliability when used in the assessment of the paediatric foot

Evaluating the Biomechanics of the Pediatric Foot in Turner Syndrome

Turner syndrome is a genetic disorder that can present clinically with multiple concurrent comorbidities. This case report describes a 12-year-old girl with Turner syndrome who was referred for podiatric medical assessment and explores the application of optoelectronic stereophotogrammetry in the biomechanical assessment of the foot and lower limb. A four-segment kinematic foot model using 14-mm reflective markers was applied to the foot and lower limb of the patient to track motion at the tibia, rearfoot, forefoot, and hallux. Kinematic results presented in this case study illustrate evidence of excessive foot pronation throughout the stance phase of gait. Whether excessive pronation is a general characteristic of foot function in Turner syndrome remains to be confirmed, but the findings presented suggest that a comprehensive evaluation of foot biomechanics in patients with Turner syndrome may be warranted

Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models

Background: Various foot models are used in the analysis of foot motion during gait and selection of the appropriate model can be difficult. The clinical utility of a model is dependent on the repeatability of the data as well as an understanding of the expected error in the process of data collection. Kinematic assessment of the paediatric foot is challenging and little is reported about multi-segment foot models in this population. The aim of this study was to examine three foot models and establish their concurrent test-retest repeatability in evaluation of paediatric foot motion during gait. Methods: 3DFoot, Kinfoot and the Oxford Foot Model (OFM) were applied concurrently to the right foot and lower limb of 14 children on two testing sessions. Angular data for foot segments were extracted at gait cycle events and peaks and compared between sessions by intraclass correlation coefficient (ICC) with 95% confidence intervals (95% CI) and standard error of measurement (SEM). Results: All foot models demonstrated moderate repeatability: OFM (ICC 0.55, 95% CI 0.16 to 0.77), 3DFoot (ICC 0.47, 95% CI 0.15 to 0.64) and Kinfoot (ICC 0.43, 95% CI −0.03 to 0.59). On the basis of a cut-off of 5°, acceptable mean error over repeated sessions was observed for OFM (SEM 4.61° ± 2.86°) and 3DFoot (SEM 3.88° ± 2.18°) but not for Kinfoot (SEM 5.08° ± 1.53°). Reliability of segmental kinematics varied, with low repeatability (ICC < 0.4) found for 14.3% of OFM angles, 22.7% of 3DFoot angles and 37.6% of Kinfoot angles. SEM greater than 5° was found in 26.2% of OFM, 15.2% of 3DFoot, and 43.8% of Kinfoot segmental angles. Conclusion: Findings from this work have demonstrated that segmental foot kinematics are repeatable in the paediatric foot but the level of repeatability and error varies across the segments of the different models. Information on repeatability and test-retest errors of three-dimensional foot models can better inform clinical assessment and advance understanding of foot motion during gait

Selected static foot assessments do not predict medial longitudinal arch motion during running

Background: Static assessments of the foot are commonly advocated within the running community to classify the foot with a view to recommending the appropriate type of running shoe. The aim of this work was to determine whether selected static foot assessment could predict medial longitudinal arch (MLA) motion during running. Methods: Fifteen physically active males (27 ± 5 years, 1.77 ± 0.04 m, 80 ± 10 kg) participated in the study. Foot Posture Index (FPI-6), MLA angle and rearfoot angle were measured in a relaxed standing position. MLA motion was calculated using the position of retro-reflective markers tracked by a VICON motion analysis system, while participants ran barefoot on a treadmill at a self-selected pace (2.8 ± 0.5 m.s−1). Bivariate linear regression was used to determine whether the static measures predicted MLA deformation and MLA angles at initial contact, midsupport and toe off. Results: All three foot classification measures were significant predictors of MLA angle at initial contact, midsupport and toe off (p < .05) explaining 41–90 % of the variance. None of the static foot classification measures were significant predictors of MLA deformation during the stance phase of running. Conclusion: Selected static foot measures did not predict dynamic MLA deformation during running. Given that MLA deformation has theoretically been linked to running injuries, the clinical relevance of predicting MLA angle at discrete time points during the stance phase of running is questioned. These findings also question the validity of the selected static foot classification measures when looking to characterise the foot during running. This indicates that alternative means of assessing the foot to inform footwear selection are required

Steps towards evidence-based foot-care for children:behaviour and opinions of health professionals

Allied health professionals (AHPs) working with children need the appropriate knowledge, skills and experiences to provide high-quality care. This includes using research to drive improvements in care and ensuring that knowledge and practices are consistent and build upon the best available evidence. The aim of this work was to understand more about the shared behaviours and opinions of health professionals supporting children's foot health care; how they find information that is both relevant to their clinical practice as well as informing the advice they share. A qualitative design using semi-structured, one-to-one, telephone interviews with AHPs was adopted. Thematic analysis was used to generate meaning, identify patterns and develop themes from the data. Eight interviews were conducted with physiotherapists, podiatrists and orthotists. Five themes were identified relating to health professionals: (a) Engaging with research; (b) Power of experience; (c) Influence of children's footwear companies; (d). Dr Google - the new expert and (e) Referral pathways for children's foot care. The findings indicate that the AHPs adopted a number of strategies to develop and inform their own professional knowledge and clinical practice. There could be barriers to accessing information, particularly in areas where there is limited understanding or gaps in research. The availability of online foot health information was inconsistent and could impact on how AHPs were able to engage with parents during consultations. [Abstract copyright: © 2020 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.