Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Rode Road, Chermside, Brisbane, QLD 4032, Australia.
J Foot Ankle Res. 2014 Jan 28;7(1):7. doi: 10.1186/1757-1146-7-7.
Foot disease complications, such as foot ulcers and infection, contribute to considerable morbidity and mortality. These complications are typically precipitated by "high-risk factors", such as peripheral neuropathy and peripheral arterial disease. High-risk factors are more prevalent in specific "at risk" populations such as diabetes, kidney disease and cardiovascular disease. To the best of the authors' knowledge a tool capturing multiple high-risk factors and foot disease complications in multiple at risk populations has yet to be tested. This study aimed to develop and test the validity and reliability of a Queensland High Risk Foot Form (QHRFF) tool.
The study was conducted in two phases. Phase one developed a QHRFF using an existing diabetes foot disease tool, literature searches, stakeholder groups and expert panel. Phase two tested the QHRFF for validity and reliability. Four clinicians, representing different levels of expertise, were recruited to test validity and reliability. Three cohorts of patients were recruited; one tested criterion measure reliability (n = 32), another tested criterion validity and inter-rater reliability (n = 43), and another tested intra-rater reliability (n = 19). Validity was determined using sensitivity, specificity and positive predictive values (PPV). Reliability was determined using Kappa, weighted Kappa and intra-class correlation (ICC) statistics.
A QHRFF tool containing 46 items across seven domains was developed. Criterion measure reliability of at least moderate categories of agreement (Kappa > 0.4; ICC > 0.75) was seen in 91% (29 of 32) tested items. Criterion validity of at least moderate categories (PPV > 0.7) was seen in 83% (60 of 72) tested items. Inter- and intra-rater reliability of at least moderate categories (Kappa > 0.4; ICC > 0.75) was seen in 88% (84 of 96) and 87% (20 of 23) tested items respectively.
The QHRFF had acceptable validity and reliability across the majority of items; particularly items identifying relevant co-morbidities, high-risk factors and foot disease complications. Recommendations have been made to improve or remove identified weaker items for future QHRFF versions. Overall, the QHRFF possesses suitable practicality, validity and reliability to assess and capture relevant foot disease items across multiple at risk populations.
足部疾病并发症，如足部溃疡和感染，会导致相当高的发病率和死亡率。这些并发症通常是由“高危因素”引起的，如周围神经病变和外周动脉疾病。高危因素在特定的“高危”人群中更为普遍，如糖尿病、肾病和心血管疾病。据作者所知，一种能够在多个高危人群中同时捕捉多种高危因素和足部疾病并发症的工具尚未经过测试。本研究旨在开发和测试昆士兰高危足部表格（QHRFF）工具的有效性和可靠性。
该研究分两个阶段进行。第一阶段使用现有的糖尿病足部疾病工具、文献检索、利益相关者团体和专家小组开发了 QHRFF。第二阶段测试了 QHRFF 的有效性和可靠性。招募了四名代表不同专业水平的临床医生来测试有效性和可靠性。招募了三组患者；一组测试了标准测量可靠性（n=32），另一组测试了标准有效性和组内可靠性（n=43），还有一组测试了组内可靠性（n=19）。有效性通过敏感性、特异性和阳性预测值（PPV）来确定。可靠性通过 Kappa、加权 Kappa 和组内相关系数（ICC）统计来确定。
开发了一种包含七个领域 46 个项目的 QHRFF 工具。在测试的 32 个项目中，至少有中等程度的一致性（Kappa>0.4；ICC>0.75）的项目达到了 91%（29 个）。在测试的 72 个项目中，至少有中等程度的标准有效性（PPV>0.7）的项目达到了 83%（60 个）。至少有中等程度的组内和组间可靠性（Kappa>0.4；ICC>0.75）的项目分别达到了 88%（84 个）和 87%（20 个）。
QHRFF 在大多数项目中具有可接受的有效性和可靠性；特别是那些确定相关合并症、高危因素和足部疾病并发症的项目。已经提出了改进或删除未来 QHRFF 版本中识别出的较弱项目的建议。总的来说，QHRFF 具有适当的实用性、有效性和可靠性，可以在多个高危人群中评估和捕捉相关的足部疾病项目。
