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Shen X, Wang S, Chen J, Li J, Li C, Xiang R, Zhao C, Xu X. Inter-rater reliability and test-retest reliability of the foot posture index (FPI-6) for assessing static foot posture in elderly female patients with knee osteoarthritis and its association with quadriceps muscle tone and stiffness. Front Bioeng Biotechnol 2024; 12:1385986. [PMID: 38983600 PMCID: PMC11232489 DOI: 10.3389/fbioe.2024.1385986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024] Open
Abstract
Objective 1. To assess the Inter-rater reliability and test-retest reliability of FPI-6 total score and individual scores in static foot posture evaluation among elderly female patients with knee osteoarthritis (KOA), aiming to establish the reliability of the FPI-6 scale. 2. To investigate the disparity between dominant and non-dominant quadriceps characteristics in elderly female KOA patients, as well as explore the correlation between quadriceps characteristics and abnormal foot posture, thereby offering novel insights for the prevention and treatment of KOA. Methods The study enrolled a total of 80 lower legs of 40 participants (all female) with unilateral or bilateral KOA, who were assessed by two raters at three different time points. The inter-rater and test-retest reliability of the FPI-6 was evaluated using the intra-class correlation coefficient (ICC), while the absolute reliability of FPI-6 was examined using the standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The internal consistency of FPI-6 was assessed using Spearman's correlation coefficient. Additionally, MyotonPRO was employed to assess quadriceps muscle tone and stiffness in all participants, and the association between quadriceps muscle tone/stiffness and the total score of FPI-6 was analyzed. Result Our study found excellent inter-rater and test-retest reliability (ICC values of 0.923 and 0.931, respectively) for the FPI-6 total score, as well as good to excellent reliability (ICC values ranging from 0.680 to 0.863 and 0.739-0.883) for individual items. The SEM and MDC values for the total score of FPI-6 among our study inter-rater were 0.78 and 2.15, respectively. and the SEM and MDC values for the test-retest total score of FPI-6 were found to be 0.76 and 2.11, respectively. Furthermore, the SEM and MDC values between inter-rater and test-retest across six individual items ranged from 0.30 to 0.56 and from 0.84 to 1.56. The Bland-Altman plots and respective 95% LOA showed no evidence of systematic bias. In terms of the mechanical properties of the quadriceps on both sides, the muscle tone and stiffness of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were significantly higher in the non-dominant leg compared to the dominant leg. Additionally, in the non-dominant leg, there was a significant positive correlation between the muscle tone and stiffness of VM, VL, RF and the total score of FPI-6. However, in the dominant leg, only VM's muscle tone and stiffness showed a significant positive correlation with the total score of FPI-6. Conclusion The reliability of the FPI-6 total score and its six individual items was good to excellent. Our findings offer a straightforward and dependable approach for researchers to assess foot posture in elderly female patients with KOA. Furthermore, we observed significantly greater quadriceps tension and stiffness in the non-dominant leg compared to the dominant leg. The FPI-6 total score exhibited a significant correlation with changes in quadriceps muscle performance among KOA patients. These observations regarding the relationship between changes in quadriceps muscle performance and foot posture in elderly female KOA patients may provide novel insights for disease prevention, treatment, and rehabilitation.
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Affiliation(s)
- XingXing Shen
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Wang
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahao Chen
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruian Xiang
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanxi Zhao
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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Wukich DK, Schaper NC, Gooday C, Bal A, Bem R, Chhabra A, Hastings M, Holmes C, Petrova NL, Santini Araujo MG, Senneville E, Raspovic KM. Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023). Diabetes Metab Res Rev 2024; 40:e3646. [PMID: 37218537 DOI: 10.1002/dmrr.3646] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023]
Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This is the first guideline on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes published by the IWGDF. We followed the GRADE Methodology to devise clinical questions in the PACO (Population, Assessment, Comparison, Outcome) and PICO (Population, Intervention, Comparison, Outcome) format, conducted a systematic review of the medical literature, and developed recommendations with the rationale. The recommendations are based on the evidence from our systematic review, expert opinion when evidence was not available, and also taking into account weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to an intervention. We here present the 2023 Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus and also suggest key future topics of research.
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Affiliation(s)
- Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicolaas C Schaper
- Division of Endocrinology, MUMC+, CARIM and CAPHRI Institute, Maastricht, The Netherlands
| | - Catherine Gooday
- Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Arun Bal
- Secretary, International Association of Diabetic Foot Surgeons, Mumbai, India
| | - Robert Bem
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mary Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Crystal Holmes
- The Division of Metabolism, Endocrinology and Diabetes, The University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nina L Petrova
- Department of Diabetes, Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Matković A, Ferenc T, Dimjašević L, Drinković M, Lovreković B, Popić J, Mužar RM, Vidjak V. Patient's knowledge regarding radiation exposure from various imaging modalities: a pilot study. RADIATION PROTECTION DOSIMETRY 2023; 200:91-96. [PMID: 37930816 DOI: 10.1093/rpd/ncad276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
To determine patients' knowledge about ionising radiation used in diagnostic imaging and whether they were adequately informed about the procedure they were referred to. A cross-sectional study was conducted at the University Hospital Merkur, Zagreb, Croatia during 2019-20. A questionnaire with 14 questions was given to patients in waiting rooms for imaging examinations. Statistical analysis was conducted using the standard software package. Chi-square with Yates correction was used to determine differences in patients' answers between those who received the explanation about the procedure and those who did not. The differences depending on the educational level were also evaluated. The survey was completed by 374 participants (200 women, 174 men) with a mean age of 55.45 ± 15.92 y. Of all patients, 8.63% had no formal education or only finished elementary school, 52.83% had finished high school and 38.55% had a college or a higher degree. The referring physicians informed 63.66% of participants about the radiological exam they were being referred to, and 226 thought that the given explanation was sufficient. Most patients knew that some radiological procedures use ionising radiation. Only 47.37% of respondents correctly identified MRI as a non-ionising method, whereas 37.40% of participants recognised chest X-ray as the modality with the lowest radiation dose. Higher-educated patients had better knowledge of radiological procedures and the potential risks. The study demonstrated suboptimal patients' knowledge about ionising radiation, and additional efforts in their education are needed.
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Affiliation(s)
- Andro Matković
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Lucija Dimjašević
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Martin Drinković
- Department of Radiology, Polyclinic Drinković, 10000 Zagreb, Croatia
| | - Bruno Lovreković
- Department of General and Sports Traumatology and Orthopedic Surgery, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Jelena Popić
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, 10000 Zagreb, Croatia
- Department of Radiology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Rhea M Mužar
- Department for Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Vinko Vidjak
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
- Department of Radiology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Peiffer M. Letter to the Editor: Lisfranc Injury Diagnosis: What Is the Diagnostic Reliability of New Radiographic Signs Using Three-dimensional CT? Clin Orthop Relat Res 2023; 481:2494-2495. [PMID: 37678553 PMCID: PMC10642884 DOI: 10.1097/corr.0000000000002844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Matthias Peiffer
- Orthopaedic Surgery Resident, Ghent University Hospital, Ghent, Belgium
- PhD Research Fellow, Foot and Ankle Research and Innovation Laboratory (FARIL), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rozis M, Zachariou D, Vavourakis M, Vasiliadis E, Vlamis J. Anterior Incisura Fibularis Corner Landmarks Can Safely Validate the Optimal Distal Tibiofibular Reduction in Malleolar Fractures-Prospective CT Study. Diagnostics (Basel) 2023; 13:2615. [PMID: 37568978 PMCID: PMC10417129 DOI: 10.3390/diagnostics13152615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Distal tibiofibular injuries are common in patients with malleolar fractures. Malreduction is frequently reported in the literature and is mainly caused by insufficient intraoperative radiological evaluation. In this direction, we performed a prospective observational study to validate the efficacy of the anatomical landmarks of the anterior incisura corner. METHODS Patients with malleolar fractures and syndesmotic instability were reduced according to specific anatomic landmarks and had a postoperative bilateral ankle CT. The quality of the reduction was compared to the healthy ankles. RESULTS None of the controlled parameters differed significantly between the operated and healthy ankles. Minor deviations were correlated to the normal incisura morphology rather than the reduction technique. CONCLUSIONS The anterior incisura anatomical landmarks can be an efficient way of reducing the distal tibiofibular joint without the need for intraoperative radiological evaluation.
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Affiliation(s)
- Meletis Rozis
- 3rd Orthopedic Department, University of Athens, KAT Hospital, 145 61 Athens, Greece; (D.Z.); (J.V.)
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Virtual fracture clinic reduces patient X-ray volume for common wrist and ankle fractures. Ir J Med Sci 2021; 191:2117-2121. [PMID: 34655402 PMCID: PMC8520104 DOI: 10.1007/s11845-021-02812-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
Background Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction. Aims Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle. Methods A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification. Findings A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, − 0.976 (p = 0.00025), and Weber A ankle fractures, − 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, − 0.701 (p = 0.129) and Weber B ankle fractures, − 0.786 (p = 0.235), though not achieving statistical significance. Conclusions Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.
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Mabry LM, Patti TN, Ross MD, Bleakley CM, Gisselman AS. Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies. J Am Podiatr Med Assoc 2021; 111:470036. [PMID: 34478529 DOI: 10.7547/20-047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach. METHODS Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed. RESULTS Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient. CONCLUSIONS Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.
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Non-weightbearing compared with weightbearing x-rays in hallux valgus decision-making. Skeletal Radiol 2020; 49:1441-1447. [PMID: 32318757 PMCID: PMC7360537 DOI: 10.1007/s00256-020-03441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/29/2020] [Accepted: 04/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report the effect of weightbearing x-ray imaging on clinical decisions in hallux valgus. Weightbearing (WB) x-ray is standard imaging for symptomatic hallux valgus (HV). In our clinical practice, often patients are presenting with non-weightbearing (NWB) x-rays. Repeated imaging requires additional radiation, justified only if expected to benefit patient's treatment. In this study, the influence of WB status on radiological HV parameters and on clinical decisions was analyzed. METHODS In the dataset of WB and NWB x-rays, the hallux valgus (HVA) and intermetatarsal angle (IMA) were measured and differences analyzed. Clinical decisions for 10 x-ray pairs were studied among 40 respondents. RESULTS The WB and NWB HVA difference ranged - 16 to 16° (p < 0.001) and IMA - 3.4 to 5.8° (p < 0.001). In only 45% of cases, the decisions based on NWB and WB imaging were consistent (kappa (95% CI) = 30.0 (23.7-36.3)). CONCLUSIONS Clinical decisions based on WB and NWB radiographs vary significantly. NWB films overestimate early and underestimate advanced HV deformity. Repeating radiographs is justified in patients presenting with NWB radiographs of symptomatic HV.
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