Introduction
Materials and methods
Selection of clinicians as evaluators
Selection of patients as evaluators
Study design
Statistical methods
Results
Evaluating clinicians and patients
Results of statistical analysis
JSSF scale | JOA scale | ||||||||
---|---|---|---|---|---|---|---|---|---|
Institute | No. of patients | No. of clinicians | ICC |
P
| Institute | No. of patients | No. of clinicians | ICC |
P
|
Ankle-hindfoot | |||||||||
A
| 6 |
4
|
0.7246 (0.37882-0.9472)
| 0.03 | A | 5 | 5 |
0.8721 (0.642-0.98)
|
0.0004
|
B
| 3 |
4
| 0.8526 (0.452-1.0) | 0.016 | B | 3 | 4 | 0.4647 (−0.052-0.98) | 0.3406 |
C
| 3 | 3 |
0.9318 (0.52842-0.9982)
|
0.015
| C | 2 | 4 | 0.3018 (−0.312-1.0) | 0.4241 |
D | 3 | 2 | 0.2753 (−1.52-0.98) | 0.5508 | |||||
E | 2 | 4 | −0.6691 (−0.72482-0.6935) | 0.9009 | |||||
Midfoot | |||||||||
C | 2 | 3 | 0.6975 (−0.152-1.0) | 0.1896 | C | 2 | 3 |
0.9162 (0.32-1.0)
|
0.0467
|
E | 2 | 2 | 0.8324 (−0.022-1.0) | 0.1984 | |||||
Hallux | |||||||||
A | 6 | 6 | 0.5429 (0.212-0.89) | 0.1862 | A | 6 | 6 | 0.5840 (0.26582-0.9050) | 0.1235 |
C | 2 | 2 | 0.0 (−1.02-1.0) | 0.5904 | C | 2 | 3 | −0.5676 (−0.61522-0.3498) | 0.9011 |
D
|
7
|
2
|
0.971 (0.842-1.0)
|
0.0004
| |||||
Lesser toe | |||||||||
A | 2 | 6 | 0.7298 (0.222-1.0) | 0.0861 |
A
|
2
|
6
|
0.8586 (0.432-1.0)
|
0.0187
|
C | 2 | 3 | 0.569 (−0.182-1.0) | 0.2666 |
C
|
2
|
3
|
0.9461 (0.532-1.0)
|
0.0133
|
D | 4 | 2 | 0.441 (−0.852-0.95) | 0.4583 | |||||
RA | |||||||||
A | 2 | 4 | 0.08 (−0.0142-0.99) | 0.7107 | A | 2 | 4 | 0.3099 (−0.192-1.0) | 0.4188 |
B | 2 | 6 | 0.4162 (−0.042-1.0) | 0.3289 | B | 2 | 6 | 0.3513 (0.00472-1.0) | 0.3853 |
% Difference in range of ±1 to ±5 | ||||
---|---|---|---|---|
Site and scale | No. | ±1 | ±3 | ±5 |
Ankle-hindfoot | ||||
JSSF | 83 | 43.4 | 61.4 | 68.7 |
JOA | 83 | 42.3 | 56.6 | 75.9 |
Midfoot | ||||
JSSF | 10 | 50.0 | 50.0 | 70.0 |
JOA | 4 | 25.0 | 25.0 | 25.0 |
Hallux | ||||
JSSF | 45 | 31.1 | 40.0 | 55.6 |
JOA | 56 | 37.5 | 53.8 | 62.5 |
Lesser toe | ||||
JSSF | 6 | 33.3 | 66.7 | 83.3 |
JOA | 4 | 75.0 | 100 | 100 |
RA | ||||
JSSF | 21 | 19.5 | 47.6 | 61.9 |
JOA | 21 | 19.0 | 33.3 | 52.4 |
% Difference, by JSSF scale | % Difference, by JOA scale | |||||||
---|---|---|---|---|---|---|---|---|
Experience | level No. | ±1 | ±3 | ±5 | No. | ±1 | ±3 | ±5 |
Ankle-hindfoot | ||||||||
Specialist | 34 | 47.1 | 64.7 | 76.5 | 33 | 45.5 | 57.6 | 75.8 |
Generalist | 25 | 52.0 | 76.0 | 80.0 | 26 | 38.5 | 61.5 | 84.6 |
Resident | 24 | 29.2 | 41.7 | 45.8 | 24 | 41.7 | 50.0 | 66.7 |
Midfoot | ||||||||
Specialist | 4 | 75.0 | 75.0 | 100 | 1 | – | – | – |
Generalist | 2 | 50.0 | 50.0 | 50.0 | 1 | – | – | – |
Resident | 4 | 25.0 | 25.0 | 50.0 | 2 | 0 | 0 | 0 |
Hallux | ||||||||
Specialist | 17 | 41.2 | 52.9 | 64.7 | 22 | 50.0 | 54.5 | 63.6 |
Generalist | 13 | 23.1 | 23.1 | 38.5 | 18 | 27.8 | 50.0 | 55.6 |
Resident | 15 | 26.7 | 40.0 | 60.0 | 16 | 31.3 | 56.3 | 68.9 |
Lesser toe | ||||||||
Specialist | 3 | 0 | 33.3 | 66.7 | 2 | 100 | 100 | 100 |
Generalist | 2 | 50.0 | 100 | 100 | 1 | – | – | – |
Resident | 1 | – | – | – | 1 | – | – | – |
RA | ||||||||
Specialist | 6 | 33.3 | 50.0 | 66.7 | 5 | 20.0 | 40.0 | 60.0 |
Generalist | 7 | 14.3 | 42.9 | 57.1 | 8 | 37.5 | 37.5 | 50.0 |
Resident | 8 | 12.5 | 50.0 | 62.5 | 8 | 0 | 25.0 | 50.0 |
JSSF scale | JOA scale | ||||
---|---|---|---|---|---|
Parameter | RC (%) | κ | Parameter | RC (%) | κ |
Ankle-hindfoot (n = 83) | Ankle-hindfoot (n = 83) | ||||
Pain | 79.5 |
0.672
| Pain | 77.1 |
0.639
|
Activity limitations | 71.1 |
0.568
| Deformity, forefoot | 89.2 |
0.574
|
Maximum walking distance | 85.5 |
0.604
| Deformity, hindfoot | 79.5 |
0.514
|
Walking surfaces | 83.1 |
0.711
| MTP/IP joint motion | 71.1 | 0.358 |
Gait abnormality | 83.1 |
0.582
| Hindfoot motion | 94 |
0.78
|
Sagittal motion | 85.5 |
0.625
| Stability | 63.9 | – |
Hindfoot motion | 80.7 |
0.573
| Walking ability | 77.1 | – |
Stability | 86.7 |
0.405
| Muscle strength | 86.7 | 0.286 |
Alignment | 79.5 | – | Sensory disturbance | 86.7 | 0.252 |
Climbing/descending stairs | 96.4 |
0.928
| |||
Sitting on heels | 88 |
0.81
| |||
Standing on toes | 79.5 |
0.548
| |||
Footwear | 88 |
0.522
| |||
Japanese-style toilet | 73.5 |
0.514
| |||
Midfoot (n = 10) | Midfoot (n = 4) | ||||
Pain | 60 |
0.492
| Pain | 50 | – |
Activity limitations | 60 | 0.31 | Deformity, forefoot | 50 | 0 |
Max. walking distance | 60 | – | Deformity, hindfoot | 25 | – |
Footwear requirements | 70 | – | MTP/IP joint motion | 75 | – |
Walking surfaces | 60 | – | Hindfoot motion | 50 | 0.333 |
Gait abnormality | 90 |
0.821
| Stability | 75 |
0.5
|
Alignment | 90 | – | Walking ability | 50 | 0.2 |
Muscle strength | 25 | – | |||
Sensory disturbance | 75 | – | |||
Climbing/descending stairs | 75 | – | |||
Sitting on heels | 75 | – | |||
Standing on toes | 100 | – | |||
Footwear | 25 | – | |||
Japanese-style toilet | 50 | – | |||
Hallux (n = 45) | Hallux (n = 56) | ||||
Pain | 66.6 | – | Pain | 57.1 | 0.357 |
Activity limitations | 64.4 | – | Deformity, forefoot | 64.3 |
0.474
|
Footwear requirements | 73.3 | – | Deformity, hindfoot | 91.1 |
0.51
|
MTP joint motion | 75.6 |
0.559
| MTP/IP joint motion | 94.6 | 0.024 |
IP joint motion | 97.8 | – | Hindfoot motion | 69.6 |
0.526
|
MTP-IP Stability | 88.9 | 0.237 | Stability | 78.6 | 0.361 |
Callus or clavus | 80 | 0.281 | Walking ability | 73.2 |
0.532
|
Alignment | 57.8 | 0.282 | Muscle strength | 80.4 | – |
Sensory disturbance | 87.5 | 0.162 | |||
Climbing/descending stairs | 91.1 |
0.707
| |||
Sitting on heels | 85.7 |
0.439
| |||
Standing on toes | 69.6 |
0.479
| |||
Footwear | 71.4 |
0.492
| |||
Japanese-style toilet | 75.7 | – | |||
Lesser toe (n = 6) | Lesser toe (n = 4) | ||||
Pain | 100 |
1
| Pain | 50 | – |
Activity limitations | 66.7 | 0.25 | Deformity, forefoot | 100 | – |
Footwear requirements | 66.7 | – | Deformity, hindfoot | 100 | – |
MTP joint motion | 66.7 | – | MTP/IP joint motion | 50 | – |
IP joint motion | 83.3 | – | Hindfoot motion | 100 | – |
MTP-IP Stability | 100 | – | Stability | 50 | – |
Callus or clavus | 100 | – | Walking ability | 75 | – |
Alignment | 83.3 |
0.667
| Muscle strength | 100 | – |
Sensory disturbance | 100 | – | |||
Climbing/descending stairs | 100 | – | |||
Sitting on heels | 100 | – | |||
Standing on toes | 75 |
0.5
| |||
Footwear | 50 | – | |||
Japanese-style toilet | 100 | – | |||
RA (n = 21) | RA (n = 21) | ||||
Pain | 0.762 | – | Pain | 61.9 |
0.408
|
Derormity, hallux | 0.762 |
0.608
| Deformity, forefoot | 66.7 | – |
Deformity, lesser toe |
0.571
| 0.016 | Deformity, hindfoot | 71.4 |
0.571
|
Deformity, midfoot | 0.714 |
0.475
| MTP/IP joint motion | 57.1 | 0.171 |
Deformity, hindfoot | 0.476 | – | Hindfoot motion | 71.4 | 0.571 |
MTP/IP joint motion | 0.712 |
0.632
| Stability | 71.4 | – |
Hindfoot motion | 0.762 |
0.578
| Walking ability | 66.7 | – |
Walking ability | 0.571 | – | Muscle strength | 76.2 | – |
Climbing/descending stairs | 0.952 | – | Sensory disturbance | 95.2 | – |
Sitting on heels | 1 – | Climbing/descending stairs | 95.2 | – | |
Standing on toes | 0.857 | – | Sitting on heels | 90.5 | – |
Footwear | 0.857 |
0.745
| Standing on toes | 81 | – |
Japanese-style toilet | 0.905 |
0.811
| Footwear | 85.7 |
0.725
|
Japanese-style toilet | 95.2 |
0.905
|
Spearman rank correlation (ρ) | ||
---|---|---|
Parameter | JSSF scale | JOA scale |
Ankle-hindfoot 0.373 | (P < 0.0001) | 0.341 (P < 0.0001) |
Midfoot | 0.104 | −0.007 |
Hallux | 0.399 (P < 0.0001) | 0.271 (P < 0.005) |
Lesser toe | 0.321 | 0.737 (P < 0.0001) |
RA | – | – |