Monash Health, Department of Podiatry, David Street, Dandenong, VIC, 3175, Australia.
Monash Health, Monash Imaging, David Street, Dandenong, VIC, 3175, Australia.
J Foot Ankle Res. 2020 Feb 11;13(1):7. doi: 10.1186/s13047-020-0375-5.
Charcot's Neuroarthropathy (Charcot foot) is a debilitating and destructive disorder resulting from neurological changes in the foot. Whilst the majority of cases are painless, as a result of disruption to sensory function, a common outcome is severe deformity that impacts considerably on foot function. The purpose of this study was to develop and validate a radiological severity scale to quantify resultant damage from acute mid foot Charcot's. This in turn can be used to evaluate clinical outcomes related to different degrees of offloading.
A four round Delphi process was used to develop five tool items. Level of consensus and agreement was set at 80%. Inter-rater and intra-rater reliability was evaluated using 3 raters and 24 plain x-rays of chronic mid-foot Charcot's. Strength of agreement of individual items and overall scores was calculated using weighted Kappa coefficients (S.E). Cronbach's α was used to determine internal consistency. Floor (> 15% score 0) and ceiling (> 15% score 11) effects were examined at each time point. Spearman's correlation coefficient was used to assess construct validity using Mobility and Usual Activity scores taken from the EQ-5D-5 L.
Twenty two patients participated. The five item severity scale demonstrated a Cronbach's α of 0.91. Intra-rater Kappa coefficients (SE) for total scores ranged from 0.84 (0.20) to 0.86 (0.20). Inter rater coefficients (SE) ranged from 0.72 (0.14) to 0.83 (0.14). Distribution was normal and no floor or ceiling effects were identified.
CONCLUSION/INTERPRETATION: This study suggests it may be possible to quantify resultant damage from mid foot Charcot's. Given the physical and emotional impacts from long periods of complete immobilisation defining a minimum standard would be an important development in the management of Charcot foot.
夏科氏关节病（夏科足）是一种由足部神经变化引起的使人虚弱和具破坏性的疾病。虽然大多数病例没有疼痛，但由于感觉功能的中断，常见的后果是严重的畸形，这对足部功能有很大的影响。本研究的目的是开发和验证一种放射学严重程度评分标准，以量化急性中足夏科氏病的结果性损伤。这反过来又可以用来评估与不同程度减压相关的临床结果。
采用四轮德尔菲法制定了 5 项工具项目。共识和一致性的水平设定为 80%。采用 3 名评估者和 24 例慢性中足夏科氏病的普通 X 线片评估组内和组间的可靠性。采用加权 Kappa 系数（S.E.）计算各项目和总分的一致性程度。采用 Cronbach's α 确定内部一致性。在每个时间点检查地板（>15%评分为 0）和天花板（>15%评分为 11）效应。采用 EQ-5D-5L 中的移动性和日常活动评分，使用 Spearman 相关系数评估结构效度。
共有 22 例患者参与研究。五项严重程度评分标准的 Cronbach's α 值为 0.91。总分的组内 Kappa 系数（SE）范围为 0.84（0.20）至 0.86（0.20）。组间系数（SE）范围为 0.72（0.14）至 0.83（0.14）。分布正常，未发现地板或天花板效应。
结论/解释：本研究表明，可能可以量化中足夏科氏病的结果性损伤。鉴于长时间完全固定所带来的身体和情感影响，定义一个最低标准可能是夏科氏足管理的一个重要发展。
