Rasch Analysis of Reliability and Validity of Scores From the Foot and Ankle Ability Measure (FAAM)

2019 ◽  
Vol 41 (2) ◽  
pp. 229-236 ◽  
Author(s):  
Lauren M. Matheny ◽  
Thomas O. Clanton
Keyword(s):  
Rating Scale ◽  
Reliability And Validity ◽  
Measurement Model ◽  
Good Evidence ◽  
Ankle Injuries ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Acceptable Range ◽  
Ability Measure ◽  
Item Reliability

Background: The purpose of this study was to determine the reliability and validity of scores from the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports scales in patients who have a variety of ankle injuries. Methods: All patients who underwent surgical treatment for an ankle injury and completed the FAAM ADL and Sport scales were included in this study ( n = 456; 192 females, 264 males). The average age was 47.6 years (range, 18-79 years). The average time to follow-up was 3.8 years (range, 2.0-7.7 years). All data were collected prospectively and reviewed retrospectively. A reliability and validity analysis, utilizing the Rasch measurement model, a special case of item response theory (IRT), was conducted. Results: Reliability was very good. For FAAM ADL, person reliability was 0.87 and item reliability was 0.99. For FAAM Sport, person reliability was 0.89 and item reliability was 1.0. Infit mean square (MNSQ) values, which assess internal scale validity, were examined. For FAAM ADL, items 11 (coming up on your toes) and 10 (squatting) were high (2.27 and 2.08, respectively). All other infit values were within the acceptable range of 0.5 to 1.7. For FAAM Sport, all infit values were within the acceptable range. Outfit MNSQ values, which assess the FAAM ADL and Sport rating scale function, were examined. Three items from FAAM ADL were beyond the acceptable range. Items 10 and 11 from FAAM ADL had high outfit MNSQ values (2.15 and 1.98, respectively). Item 19 (light to moderate work) item had a marginally low outfit MNSQ of 0.48. For FAAM Sport, all outfit values were within the acceptable range. Conclusion: There was very good evidence of the reliability and validity of FAAM ADL and FAAM Sport scores. Two FAAM ADL items may indicate the need for further scale development for use in a diverse surgical ankle population. Level of Evidence: Level III, comparative series.

scholarly journals Reliability and Validity of Scores from the Foot and Ankle Ability Measure

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Lauren Matheny ◽  
Thomas Clanton
Keyword(s):  
Item Difficulty ◽  
Reliability And Validity ◽  
Good Evidence ◽  
Small Sample ◽  
Test Theory ◽  
Foot And Ankle ◽  
Scale Validity ◽  
Acceptable Range ◽  
Ability Measure ◽  
Internal Scale

Category: Ankle Introduction/Purpose: A commonly used measure of ankle function is the Foot and Ankle Ability Measure (FAAM). To support interpretation of the FAAM, evidence of reliability and validity must be established. Some studies have assessed FAAM scores; however, these studies had small sample sizes, sample characteristics that may limit generalizability, and did not report reliability estimates. These studies were also unable to account for person ability and item difficulty, a unique feature Rasch modeling offers, which is key when attempting to generalize to other populations. The purpose of this study was to determine whether there is evidence of reliability and validity for the FAAM ADL and Sport scales, utilizing the Rasch model, in patients who have undergone surgical intervention for the treatment of an ankle injury. Methods: Evidence of reliability and validity were determined utilizing the Rasch measurement model, a special case of item response theory, which has been used to develop new patient reported outcome measures and improve existing measures. This is a widely used technique that may be used as an alternative to classical test theory due to advantages including generalizability across samples, accounting for response options not equally spaced in terms of ability, and identifying poorly functioning items. The scale of interest is measured in terms of item difficulty and generates estimates of locations of individual items (item difficulty) and ability level along a common interval-level scale (log-odds). To identify misfit items, outfit mean-square (MNSQ) and infit MNSQ statistics were assessed. Infit and outfit MNSQ range from 0 to positive infinity (ideal value of 1.0 means observed variance = expected variance; acceptable value range 0.5 -1.7). Person reliability was also reported (analogous to Cronbach’s a). Results: There were 456 patients included in the study(192 females, 264 males)(average age=47.6 years(18-79). Rasch analysis showed good evidence of reliability for FAAM ADL and FAAM Sport scores (Figure 1). Person reliability was 0.87 for FAAM ADL and 0.89 for FAAM Sport. Outfit MNSQ values for FAAM ADL items 11 (Coming Up On Toes) and 10 (Squatting) were high (2.17, 1.96). Item 19 “Light/Moderate Work” was low(0.48), indicating item redundancy. For FAAM Sport, all outfit values (range 0.67 -1.64) were within the acceptable range. For internal scale validity, infit MNSQ values for FAAM ADL items 11 and 10 were high(2.30, 2.05). All other infit values (range 0.61 -1.48) were within the acceptable range. For FAAM Sport, all infit values (range 0.74 -1.65) were within the acceptable range. Conclusion: This study provides good evidence of reliability for FAAM ADL and Sport scores in a wide range of patients who underwent ankle surgery, which may demonstrate wide clinical applicability. Both scales demonstrated good internal scale validity; however, 3 FAAM ADL items may indicate the need for further scale development for use in a diverse ankle population.

Foot and Ankle Injections in Athletes

2021 ◽  
pp. 194173812110036
Author(s):  
Jonathan K. Ochoa ◽  
Christopher E. Gross ◽  
Robert B. Anderson ◽  
Andrew R. Hsu
Keyword(s):  
English Language ◽  
Platelet Rich Plasma ◽  
Empirical Studies ◽  
Autologous Blood ◽  
Case Series ◽  
Placental Tissue ◽  
Ankle Injuries ◽  
Extensive Literature ◽  
Foot And Ankle ◽  
Level Of Evidence

Context: Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. Evidence Acquisition: An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. Study Design: Clinical review. Level of Evidence: Level 4. Results: Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. Conclusions: Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.

scholarly journals Responsiveness of the PROMIS and FAAM Instruments in Foot and Ankle Orthopedic Population

2018 ◽  
Vol 40 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Jerry Bounsanga ◽  
Maren W. Voss ◽  
...  
Keyword(s):  
T Test ◽  
Measurement Information ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Level Ii ◽  
Patient Reported ◽  
Prospective Comparative Study ◽  
Ability Measure

Background: Investigating the responsiveness of an instrument is important in order to provide meaningful interpretation of clinical outcomes. This study examined the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), the PROMIS Pain Interference (PI), and the Foot and Ankle Ability Measure (FAAM) Sports subscale in an orthopedic sample with foot and ankle ailments. Methods: Patients presenting to an orthopedic foot and ankle clinic during the years 2014–2017 responded to the PROMIS and FAAM instruments prior to their clinical appointments. The responsiveness of the PROMIS PF v1.2, PROMIS PI v1.1, and FAAM Sports were assessed using paired samples t test, effect size (ES), and standardized response mean (SRM) at 4 different follow-up points. A total of 785 patients with an average age of 52 years (SD = 17) were included. Results: The PROMIS PF had ESs of 0.95 to 1.22 across the 4 time points (3, >3, 6, and <6 months) and SRMs of 1.04 to 1.43. The PROMIS PI had ESs of 1.04 to 1.63 and SRMs of 1.17 to 1.23. For the FAAM Sports, the ESs were 1.25 to 1.31 and SRMs were 1.07 to 1.20. The ability to detect changes via paired samples t test provided mixed results. But in general, the patients with improvement had statistically significant improved scores, and the worsening patients had statistically significant worse scores. Conclusion: The PROMIS PF, PROMIS PI, and FAAM Sports were sensitive and responsive to changes in patient-reported health. Level of Evidence: Level II, prospective comparative study.

Interdigital vs Transarticular Lateral Release With Scarf Osteotomy

2021 ◽  
pp. 107110072110353
Author(s):  
Florian Hartenbach ◽  
Brigitta Höger ◽  
Karl-Heinz Kristen ◽  
Hans-Jörg Trnka
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Rating Scale ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Radiographic Outcomes

Background: We compare the clinical and radiographic outcomes of the interdigital approach vs the medial transarticular approach for lateral release combined with scarf osteotomy. Methods: Seventy-seven feet with moderate to severe hallux valgus underwent scarf osteotomy and lateral soft tissue release, using an interdigital approach (n = 36) vs medial transarticular approach (n = 41). The clinical measurements (range of motion, American Orthopaedic Foot and Ankle Society [AOFAS] score) and radiographic data were evaluated preoperatively and at final follow-up (93-124 months postoperatively). Additionally, the numeric pain rating scale and Foot and Ankle Outcome score [FAOS] were assessed postoperatively. Results: The AOFAS score improved from 60 (q1 = 54, q3 = 70) to 93 (q1 = 85, q3 = 98) in the transarticular group, and from 59 (q1 = 50, q3 = 64) to 95 (q1 = 85, q3 = 100) in the interdigital group. The hallux valgus angle improved from 35.7±6.5 degrees to 15.5±7.6 degrees in the transarticular group, and from 36.0±6.8 degrees to 12.9±13.0 degrees in the interdigital group. The intermetatarsal angle improved from 16.5±2.5 degrees to 6.5±2.7 degrees within the transarticular group and from 17.2±2.5 degrees to 7.3±4.3 degrees in the interdigital group. None of the clinical or radiographic parameters showed any significant differences between the treatment groups. Conclusion: Comparison of outcomes between the interdigital approach and the transarticular approach for lateral soft-tissue release with scarf osteotomy are equally successful. The transarticular approach can thus be considered safe and effective, with the additional benefits of just one scar as opposed to 2. Level of Evidence: Level III, therapeutic.

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure

2020 ◽  
pp. 107110072097266
Author(s):  
Joseph T. O’Neil ◽  
Otho R. Plummer ◽  
Steven M. Raikin
Keyword(s):  
Computerized Adaptive Testing ◽  
Case Series ◽  
Adaptive Testing ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Ability Measure ◽  
The Impact

Background: Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level of Evidence: Level IV, case series.

Foot and Ankle Related Sex-Specific Analysis Within High-Impact Journals

2019 ◽  
Vol 41 (3) ◽  
pp. 356-363 ◽  
Author(s):  
Arianna L. Gianakos ◽  
Nicole George ◽  
Meghan Merklein ◽  
Lori Chambers ◽  
Richard Ferkel ◽  
...  
Keyword(s):  
Statistical Model ◽  
Sports Medicine ◽  
High Impact ◽  
Ankle Injuries ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Time Period ◽  
Specific Analysis ◽  
Significant Difference ◽  
The Impact

Background: The impact of patient sex on the prevalence of foot and ankle injuries has been established. Reporting of differences on treatment outcomes is lacking. The purpose of this study was to identify trends in sex-specific outcomes across high-impact journals over a 5-year time period. Methods: Two independent investigators reviewed journal issues published during 2 calendar years (2011 and 2016) in the 5 highest-impact orthopedic foot and ankle/sports subspecialty journals ( Foot & Ankle International [ FAI], Foot and Ankle Surgery [ FAS], American Journal of Sports Medicine [ AJSM], Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy [ KSSTA]). Studies were stratified into those that involved sex-specific analysis (SSA), where sex was a variable in a multifactorial statistical model, and those that only reported sex as a demographic characteristic or utilized sex-matched cohorts. Results: A total of 473 studies evaluating a total of 273 128 patients met criteria. An average of 43.9% (119 967 patients) of the population were female. Only 16.7% (79/473) of studies included sex as variable in a statistical model. Thirteen percent (25/193) and 19.3% (54/280) of studies reported SSA in 2011 and 2016, respectively. FAI was the only journal demonstrating a significant improvement of reporting SSA from 2011 to 2016 ( P < .002). Thirty percent (24/79) of studies that performed SSA demonstrated significant differences between male and female outcomes. Conclusion: Reporting of SSA in the orthopedic literature continued to be lacking. Only 16.7% of all articles evaluated in 2011 and 2016 performed SSA, with 30% of this subset reporting a statistically significant difference in outcomes. Level of Evidence: Level III, comparative study.

scholarly journals The Athletic Shoe in Football

2017 ◽  
Vol 9 (2) ◽  
pp. 126-131 ◽  
Author(s):  
James Jastifer ◽  
Richard Kent ◽  
Jeff Crandall ◽  
Chris Sherwood ◽  
David Lessley ◽  
...  
Keyword(s):  
Clinical Review ◽  
Literature Search ◽  
Mechanical Load ◽  
Health And Safety ◽  
Ankle Injuries ◽  
Protective Equipment ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Shoe Design ◽  
Primary Focus

Background: Foot and ankle injuries are common in sports, particularly in cleated athletes. Traditionally, the athletic shoe has not been regarded as a piece of protective equipment but rather as a part of the uniform, with a primary focus on performance and subjective feedback measures of comfort. Changes in turf and shoe design have poorly understood implications on the health and safety of players. Evidence Acquisition: A literature search of the MEDLINE and PubMed databases was conducted. Keywords included athletic shoewear, cleated shoe, football shoes, and shoewear, and search parameters were between the years 2000 and 2016. Study Design: Clinical review. Level of Evidence: Level 5. Results: The athletic shoe is an important piece of protective sports equipment. There are several important structural considerations of shoe design, including biomechanical compliance, cleat and turf interaction, and shoe sizing/fit, that affect the way an athlete engages with the playing surface and carry important potential implications regarding player safety if not understood and addressed. Conclusion: Athletic footwear should be considered an integral piece of protective equipment rather than simply an extension of the uniform apparel. More research is needed to define optimal shoe sizing, the effect that design has on mechanical load, and how cleat properties, including pattern and structure, interact with the variety of playing surfaces.

scholarly journals Efficacy of Instrument Assisted Soft-Tissue Mobilization in Patients with Heel Pain: An Experimental Study

2021 ◽  
pp. 292-301
Author(s):  
Shivani Bhurchandi ◽  
Pratik Phansopkar
Keyword(s):  
Rating Scale ◽  
Exercise Program ◽  
Heel Pain ◽  
Home Exercise ◽  
Pain Rating ◽  
Foot And Ankle ◽  
Home Exercise Program ◽  
Numerical Pain Rating Scale ◽  
Ability Measure ◽  
Pain Rating Scale

Aim: The purpose of this study was to evaluate and compare the effects of Instrument-Assisted Soft-Tissue Mobilisation (IASTM) and Therapeutic Ultrasound in patients with heel pain in terms of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. This was undertaken as even though Ultrasound is regularly used, heel pain still remains resistant to treatment in some patients. Hence, the need to compare a relatively newer technique with it. Study Design : Experimental study Place and Duration: Department of Musculoskeletal Physiotherapy Sciences, Ravi Nair Physiotherapy College, Sawangi (Meghe) , Wardha , duration of 12 months. Methods: Seventy people (n=70) with heel discomfort (lasting 6 weeks to 1 year) were chosen at random and placed into two groups, each getting eight therapy sessions. IASTM and Home Exercise Program was given to Group A, whereas Therapeutic Ultrasound and Home Exercise Program was given to Group Calf muscle stretches and Plantar fascia stretches were incorporated in the Home Exercise Programme. Outcome measures were recorded both at the beginning of treatment and after final treatment. The patients were assessed for Numerical Pain Rating Scale with first step in morning and at the beginning of first session and after end of last session and for Foot and Ankle Ability Measure scale at the beginning of first session and after end of last session. A follow up period of 90 days (after last session) was taken, the measurements of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale were taken again to see the long-term effects. Results: Group A which received IASTM + Home exercises showed great improvements than Ultrasound and Home exercise group, from baseline to week 4 after the pain intensity and foot function were assessed using Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. Statistically significant differences were found in both the groups. i.e. P=0.0001. But 7 people in Ultrasound group complained of pain and functional ability at follow-up session. Conclusion: In this study, it can be concluded that combining both the IASTM and Home Exercise Program have got beneficial effects in decreasing the pain intensity thus improving the foot and ankle function in patients with heel pain.

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