Cargando…
Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists
BACKGROUND: Identification of locations with elevated plantar pressures is important in daily foot care for patients with rheumatoid arthritis, metatarsalgia and diabetes. The purpose of the present study was to evaluate the proficiency of podiatrists, pedorthists and orthotists, to distinguish loca...
Autores principales: | , , , , , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2006
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698918/ https://www.ncbi.nlm.nih.gov/pubmed/17140435 http://dx.doi.org/10.1186/1471-2474-7-93 |
_version_ | 1782131242411491328 |
---|---|
author | Guldemond, Nick A Leffers, Pieter Nieman, Fred HM Sanders, Antal P Schaper, Nicolaas C Walenkamp, Geert HIM |
author_facet | Guldemond, Nick A Leffers, Pieter Nieman, Fred HM Sanders, Antal P Schaper, Nicolaas C Walenkamp, Geert HIM |
author_sort | Guldemond, Nick A |
collection | PubMed |
description | BACKGROUND: Identification of locations with elevated plantar pressures is important in daily foot care for patients with rheumatoid arthritis, metatarsalgia and diabetes. The purpose of the present study was to evaluate the proficiency of podiatrists, pedorthists and orthotists, to distinguish locations with elevated plantar pressure in patients with metatarsalgia. METHODS: Ten podiatrists, ten pedorthists and ten orthotists working in The Netherlands were asked to identify locations with excessively high plantar pressure in three patients with forefoot complaints. Therapists were instructed to examine the patients according to the methods used in their everyday clinical practice. Regions could be marked through hatching an illustration of a plantar aspect. A pressure sensitive platform was used to quantify the dynamic bare foot plantar pressures and was considered as 'Gold Standard' (GS). A pressure higher than 700 kPa was used as cut-off criterion for categorizing peak pressure into elevated or non-elevated pressure. This was done for both patient's feet and six separate forefoot regions: big toe and metatarsal one to five. Data were analysed by a mixed-model ANOVA and Generalizability Theory. RESULTS: The proportions elevated/non-elevated pressure regions, based on clinical ratings of the therapists, show important discrepancies with the criterion values obtained through quantitative plantar pressure measurement. In general, plantar pressures in the big toe region were underrated and those in the metatarsal regions were overrated. The estimated method agreement on clinical judgement of plantar pressures with the GS was below an acceptable level: i.e. all intraclass correlation coefficient's equal or smaller than .60. The inter-observer agreement for each discipline demonstrated worrisome results: all below .18. The estimated mutual agreements showed that there was virtually no mutual agreement between the professional groups studied. CONCLUSION: Identification of elevated plantar pressure through clinical evaluation is difficult, insufficient and may be potentially harmful. The process of clinical plantar pressure screening has to be re-evaluated. The results of this study point towards the merit of quantitative plantar pressure measurement for clinical practice. |
format | Text |
id | pubmed-1698918 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2006 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-16989182006-12-19 Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists Guldemond, Nick A Leffers, Pieter Nieman, Fred HM Sanders, Antal P Schaper, Nicolaas C Walenkamp, Geert HIM BMC Musculoskelet Disord Research Article BACKGROUND: Identification of locations with elevated plantar pressures is important in daily foot care for patients with rheumatoid arthritis, metatarsalgia and diabetes. The purpose of the present study was to evaluate the proficiency of podiatrists, pedorthists and orthotists, to distinguish locations with elevated plantar pressure in patients with metatarsalgia. METHODS: Ten podiatrists, ten pedorthists and ten orthotists working in The Netherlands were asked to identify locations with excessively high plantar pressure in three patients with forefoot complaints. Therapists were instructed to examine the patients according to the methods used in their everyday clinical practice. Regions could be marked through hatching an illustration of a plantar aspect. A pressure sensitive platform was used to quantify the dynamic bare foot plantar pressures and was considered as 'Gold Standard' (GS). A pressure higher than 700 kPa was used as cut-off criterion for categorizing peak pressure into elevated or non-elevated pressure. This was done for both patient's feet and six separate forefoot regions: big toe and metatarsal one to five. Data were analysed by a mixed-model ANOVA and Generalizability Theory. RESULTS: The proportions elevated/non-elevated pressure regions, based on clinical ratings of the therapists, show important discrepancies with the criterion values obtained through quantitative plantar pressure measurement. In general, plantar pressures in the big toe region were underrated and those in the metatarsal regions were overrated. The estimated method agreement on clinical judgement of plantar pressures with the GS was below an acceptable level: i.e. all intraclass correlation coefficient's equal or smaller than .60. The inter-observer agreement for each discipline demonstrated worrisome results: all below .18. The estimated mutual agreements showed that there was virtually no mutual agreement between the professional groups studied. CONCLUSION: Identification of elevated plantar pressure through clinical evaluation is difficult, insufficient and may be potentially harmful. The process of clinical plantar pressure screening has to be re-evaluated. The results of this study point towards the merit of quantitative plantar pressure measurement for clinical practice. BioMed Central 2006-12-01 /pmc/articles/PMC1698918/ /pubmed/17140435 http://dx.doi.org/10.1186/1471-2474-7-93 Text en Copyright © 2006 Guldemond et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Guldemond, Nick A Leffers, Pieter Nieman, Fred HM Sanders, Antal P Schaper, Nicolaas C Walenkamp, Geert HIM Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists |
title | Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists |
title_full | Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists |
title_fullStr | Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists |
title_full_unstemmed | Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists |
title_short | Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists |
title_sort | testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698918/ https://www.ncbi.nlm.nih.gov/pubmed/17140435 http://dx.doi.org/10.1186/1471-2474-7-93 |
work_keys_str_mv | AT guldemondnicka testingtheproficiencytodistinguishlocationswithelevatedplantarpressurewithinandbetweenprofessionalgroupsoffoottherapists AT lefferspieter testingtheproficiencytodistinguishlocationswithelevatedplantarpressurewithinandbetweenprofessionalgroupsoffoottherapists AT niemanfredhm testingtheproficiencytodistinguishlocationswithelevatedplantarpressurewithinandbetweenprofessionalgroupsoffoottherapists AT sandersantalp testingtheproficiencytodistinguishlocationswithelevatedplantarpressurewithinandbetweenprofessionalgroupsoffoottherapists AT schapernicolaasc testingtheproficiencytodistinguishlocationswithelevatedplantarpressurewithinandbetweenprofessionalgroupsoffoottherapists AT walenkampgeerthim testingtheproficiencytodistinguishlocationswithelevatedplantarpressurewithinandbetweenprofessionalgroupsoffoottherapists |