踝足形态、活动度、力量及运动表现测量的可靠性
RELIABILITY OF ANKLE-FOOT MORPHOLOGY, MOBILITY, STRENGTH, AND MOTOR PERFORMANCE MEASURES.
作者信息
Fraser John J, Koldenhoven Rachel M, Saliba Susan A, Hertel Jay
机构信息
Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA 22904-4407, USA.
出版信息
Int J Sports Phys Ther. 2017 Dec;12(7):1134-1149. doi: 10.26603/ijspt20171134.
BACKGROUND
Assessment of foot posture, morphology, intersegmental mobility, strength and motor control of the ankle-foot complex are commonly used clinically, but measurement properties of many assessments are unclear.
PURPOSE
To determine test-retest and inter-rater reliability, standard error of measurement, and minimal detectable change of morphology, joint excursion and play, strength, and motor control of the ankle-foot complex.
DESIGN
Reliability study.
METHODS
24 healthy, recreationally-active young adults without history of ankle-foot injury were assessed by two clinicians on two occasions, three to ten days apart. Measurement properties were assessed for foot morphology (foot posture index, total and truncated length, width, arch height), joint excursion (weight-bearing dorsiflexion, rearfoot and hallux goniometry, forefoot inclinometry, 1 metatarsal displacement) and joint play, strength (handheld dynamometry), and motor control rating during intrinsic foot muscle (IFM) exercises. Clinician order was randomized using a Latin Square. The clinicians performed independent examinations and did not confer on the findings for the duration of the study. Test-retest and inter-tester reliability and agreement was assessed using intraclass correlation coefficients (ICC) and weighted kappa ( ).
RESULTS
Test-retest reliability ICC were as follows: morphology: .80-1.00, joint excursion: .58-.97, joint play: -.67-.84, strength: .67-.92, IFM motor rating: -.01-.71. Inter-rater reliability ICC were as follows: morphology: .81-1.00, joint excursion: .32-.97, joint play: -1.06-1.00, strength: .53-.90, and IFM motor rating: .02-.56.
CONCLUSION
Measures of ankle-foot posture, morphology, joint excursion, and strength demonstrated fair to excellent test-retest and inter-rater reliability. Test-retest reliability for rating of perceived difficulty and motor performance was good to excellent for short-foot, toe-spread-out, and hallux exercises and poor to fair for lesser toe extension. Joint play measures had poor to fair reliability overall. The findings of this study should be considered when choosing methods of clinical assessment and outcome measures in practice and research.
LEVEL OF EVIDENCE
背景
临床上常用评估足姿势、形态、节段间活动度、力量以及踝足复合体的运动控制，但许多评估的测量特性尚不清楚。
目的
确定踝足复合体形态、关节活动范围及间隙、力量和运动控制的重测信度和评分者间信度、测量标准误以及最小可检测变化。
设计
信度研究。
方法
24名无踝足损伤史的健康、有休闲活动习惯的年轻人由两名临床医生分两次进行评估，两次评估间隔3至10天。对足部形态（足姿势指数、全长和截短长度、宽度、足弓高度）、关节活动范围（负重背屈、后足和拇趾测角、前足倾角测量、第1跖骨移位）和关节间隙、力量（手持测力计）以及足内在肌（IFM）运动时的运动控制评分进行测量特性评估。临床医生顺序采用拉丁方随机排列。临床医生进行独立检查，在研究期间不就检查结果进行交流。采用组内相关系数（ICC）和加权kappa（ ）评估重测信度和测试者间信度及一致性。
结果
重测信度ICC如下：形态：0.80 - 1.00，关节活动范围：0.58 - 0.97，关节间隙： - 0.67 - 0.84，力量：0.67 - 0.92，IFM运动评分： - 0.01 - 0.71。评分者间信度ICC如下：形态：0.81 - 1.00，关节活动范围：0.32 - 0.97，关节间隙： - 1.06 - 1.00，力量：0.53 - 0.90，IFM运动评分：0.02 - 0.56。
结论
踝足姿势、形态、关节活动范围和力量的测量显示出良好至优秀的重测信度和评分者间信度。对于短足、脚趾展开和拇趾运动，感知难度和运动表现评分的重测信度良好至优秀，而对于小趾伸展则较差至一般。关节间隙测量总体信度较差至一般。在实践和研究中选择临床评估方法和结局指标时应考虑本研究结果。
证据水平
3级。
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