Methodological considerations for a randomised controlled trial of podiatry care in rheumatoid arthritis: lessons from an exploratory trial Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration. Off-the-shelf orthopedic footwear for people with rheumatoid arthritis. Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys. Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study The effect of foot orthoses on balance, foot pain and disability in elderly women with osteoporosis: a randomized clinical trial. The effect of different shoes on functional mobility and energy expenditure in post-stroke hemiplegic patients using ankle–foot orthosis Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: a randomized trial. Factors predicting the outcome of customised foot orthoses in patients with rheumatoid arthritis: a prospective cohort study A randomized controlled trial of foot orthoses in rheumatoid arthritis. Clinical effectiveness of customised sport shoe orthoses for overuse injuries in runners: a randomised controlled study Assessment of gait characteristics and orthotic management in children with Developmental Coordination Disorder: preliminary findings to inform multidisciplinary care. Reliability and Validity of 6 Measures of Pain, Function, and Disability for Ankle Arthroplasty and Arthrodesis Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines. Comparison of handheld computer-assisted and conventional paper chart documentation of medical records. A randomized, controlled trial. The Orthopaedic Research Institute-Ankle Strength Testing System: Inter-Rater and Intra-Rater Reliability Testing Validation of the Foot and Ankle Outcome Score in Adult Acquired Flatfoot Deformity
Background Whilst evidence exists to support the use of single treatments such as orthoses and footwear , the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis ( RA ) related foot problems is unknown . The aim of this study was to undertake an exploratory r and omised controlled parallel arm clinical trial ( RheumAFooT ) to inform the design and implementation of a definitive trial and to underst and the potential benefits of this care . Methods Patients with a definite diagnosis of RA , stable drug management 3 months prior to entry , and a current history of foot problems ( pain , deformity , stiffness , skin or nail lesions , or footwear problems ) were recruited from a hospital outpatient rheumatology clinic and r and omised to receive 12 months of podiatry treatment or no care . The primary outcome was change in foot health status using the impairment/footwear ( LFISIF ) and activity limitation/participation restriction ( LFISAP ) subscales of the Leeds Foot Impact Scale . Disease Activity Score ( DAS ) , Health Assessment Question naire ( HAQ ) score and walking speed ( m/s ) were also recorded . Results Of the 80 patients identified , 64 patients were eligible to participate in the pilot and 34 were recruited . 16 patients were r and omised to receive podiatry led foot care and 18 received no care . Against a backdrop of stable disease ( DAS and HAQ scores ) , there was a statistically significant between group difference in the change in foot health status for foot impairment ( LFISIF ) but not activity/participation ( LFISAP ) or function ( walking speed ) over 12 months . In the podiatry arm , 1 patient declined treatment following r and omisation ( did not want additional hospital visits ) and 3 self-withdrew ( lost to follow-up ) . Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions ( n = 3 ) , foot orthoses  ( n = 9 ) ,  footwear referral to the orthotist ( n = 5 ) , and ultrasound guided intra-articular steroid injection ( n = 1 ) . Conclusion In this exploratory trial patients were difficult to recruit ( stable drug management and co-morbid disease ) and retain ( lack of benefit/additional treatment burden ) but overall the intervention was safe ( no adverse reactions ) . Twelve months of podiatry care maintained but did not improve foot health status . These observations are important for the design and implementation of a definitive r and omised controlled trial . Trial Registration IS RCT N : OBJECTIVE To assess the perceived usability and use of custom- made footwear in diabetic patients who are at high-risk for foot ulceration , and to eluci date the determinants of usability and use . DESIGN Survey . SUBJECTS A total of 153 patients with diabetes , peripheral neuropathy , prior plantar foot ulceration and newly prescribed custom-made footwear , recruited from 10 Dutch multidisciplinary foot clinics . METHODS The Question naire of Usability Evaluation was used to assess the patients ' perception of weight , appearance , comfort , durability , donning/doffing , stability , benefit and overall appreciation of their prescription footwear ( all expressed as visual analogue scores ) . Data on priorities for usability and footwear use ( in h/day ) were obtained from patient reports . Multivariate logistic regression analysis was used to assess determinants of usability and use . RESULTS Median ( interquartile range ) score for overall appreciation was 8.3 ( 7.1 - 9.1 ) . Scores ranged from 6.5 ( 4.5 - 8.6 ) for weight to 9.6 ( 6.3 - 9.9 ) for donning/doffing . Footwear comfort was listed most often ( 33.3 % ) as the highest priority .  Footwear use was < 60 % of daytime ( where daytime was defined as 16 h out of bed ) in 58 % of patients . The only significant determinant of footwear use was the perceived benefit of the footwear ( p = 0.045 ) . CONCLUSION Perceived usability of footwear was mostly positive , although individual scores and priorities varied considerably . Footwear use was low to moderate and dependent only on the perceived benefit of the footwear . Therefore , practitioners should focus on enhancing the patient 's ap-preciation of the therapeutic benefit of custom-made footwear OBJECTIVES To assess the effectiveness of off-the-shelf orthopedic footwear for people with rheumatoid arthritis ( RA ) reporting chronic foot pain , in terms of self-reported pain and physical function , as well as objective ly measured gait variables using an electric footswitch walkway . METHODS A small , r and omized , controlled trial followed by a larger repeated measures analysis was used . RESULTS The control group ( n = 15 ) demonstrated no significant changes over a 2-month period in pain , physical function , or gait scores . In contrast , after supply of the footwear both the original footwear group ( n = 15 ) and the control group demonstrated significant improvements , with small to large effect sizes , in weight-bearing pain scores , physical function , gait velocity , and gait stride length without increases in use of arthritis medications or walking aids . CONCLUSION These data suggest that off-the-shelf orthopedic footwear is beneficial for people with RA even when subjects were unselected on basis of age , sex , disease duration , or disability as measured by the Stanford Health Assessment Question naire INTRODUCTION Measuring  patient-perceived outcomes  following orthopaedic procedures have become an important component of clinical research and patient care . General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients ' perceived health status . Unfortunately , paper-based , self-administered instruments remain inefficient for collecting data because of : ( a ) missing data ( b ) respondent error , and ( c ) the costs to administer and enter data . OBJECTIVE To study the comparability of palm-top computer devices and paper-pencil self-administered question naires in the collection of health-related quality of life ( HRQL ) information from patients . METHODS The comparability of administering HRQL question naires using palm-top computer and traditional paper-based forms was tested in a sample of 96 patients with complaints of hip and /or knee pain . Each patient completed mailed versions of the Medical Outcomes Study ( MOS ) , 36-item Health Survey ( SF-36 ) , and Western Ontario and McMasters University Arthritis Index ( WOMAC ) three weeks prior to presenting to clinic . At the clinic they were asked to complete the same outcomes measures using the palm-top computer or a paper- and -pencil version . ANALYSIS In the analysis , scale distributions , floor and ceiling effects , internal consistency and retest reliability of scales were compared across the two data collection methods . Because the baseline characteristics of the groups were not strictly comparable according to age , the data were analyzed for the entire sample and stratified according to age . RESULTS Few statistically significant differences were found for the means , variances and intra-class correlation coefficients between the methods of administration . While the scale distribution between the two methods was comparable , the internal consistency of the scales was dissimilar . CONCLUSIONS Administration of HRQL question naires using portable palm-top computer devices has the potential advantage of decreased cost and convenience . These data lend some support for the comparability of palm-top computers and paper surveys for outcomes measures widely used in the field of orthopaedic surgery . The present study identified the lack of reliability across modes of administration that requires further study in a r and omized comparability trial . These mode effects are important for orthopaedic surgeons to appreciate before implementing innovative data -capture technologies in their practice This r and omised feasibility study aim ed to examine the clinical and biomechanical effects of functional foot orthoses ( FFOs ) in the treatment of midfoot osteoarthritis ( OA ) and the feasibility of conducting a full r and omised controlled trial . Participants with painful , radiographically confirmed midfoot OA were recruited and r and omised to receive either FFOs or a sham control orthosis . Feasibility measures included recruitment and attrition rates , practicality of blinding and adherence rates . Clinical outcome measures were : change from baseline to 12 weeks for severity of pain ( numerical rating scale ) , foot function ( Manchester Foot Pain and Disability Index ) and patient global impression of change scale . To investigate the biomechanical effect of foot orthoses , in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks . Of the 119 participants screened , 37 were r and omised and 33 completed the study ( FFO = 18 , sham = 15 ) . Compliance with foot orthoses and blinding of the intervention was achieved in three quarters of the group . Both groups reported improvements in pain , function and global impression of change ; the FFO group reporting greater improvements compared to the sham group . The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group . The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses . This feasibility study provides useful clinical , biomechanical and statistical information for the design and implementation of a definitive r and omised controlled trial to evaluate the effectiveness of FFOs in treating painful midfoot OA OBJECTIVE To evaluate the effect of insoles with medial arch support and metatarsal pad on balance , foot pain and disability in elderly women with osteoporosis . METHODS This was a r and omized controlled clinical trial . Ninety-four elderly women ( > 60 years ) with osteoporosis in treatment in the outpatient clinic of the Rheumatology Division of UNICAMP were r and omly assigned to an intervention group ( IG ) with foot orthoses or to a control group ( CG ) without orthoses .  The Berg Balance Scale ( BBS ) , the Timed Up and Go test ( TUG ) , the Manchester Foot Pain and Disability Index ( MFPDI ) and a numeric pain scale ( NPS ) were assessed at baseline and after 4 weeks . The chi-squared test , Fisher 's exact test and Mann-Whitney test were applied to compare baseline values between the two groups . Repeated measures of analysis of variance followed by Tukey 's test for multiple comparisons and the contrast profile test were used to compare the longitudinal measures . For numeric variable relationship analysis , the Spearman correlation coefficient was used . RESULTS The groups were similar at baseline . Only subjects from the IG displayed improvements in balance ( both BBS and TUG ) , foot pain ( NPS ) and disability ( MFPDI ) ( P < 0.001 ) . Minor adverse effects were noted . CONCLUSION Foot orthoses were effective for improving balance and for reducing pain and disability in elderly women .  Orthoses can be used as an adjuvant strategy to improve balance and to prevent falls in the elderly Background : Ankle – foot orthoses could be utilized both with and without shoes . While several studies have shown that ankle – foot orthoses improve gait abilities in hemiplegic patients , it remains unclear whether they should be used with shoes or without . Objectives : The study purpose was to compare the effect of st and ard shoes and rocker shoes on functional mobility in post-stroke hemiplegic patients utilizing ankle – foot orthosis .  Study design : R and omized clinical study . Methods : Thirty post-stroke hemiplegic patients participated in this study r and omly assigned to two groups . Group I received st and ard shoes + ankle – foot orthosis and group II were provided with rocker shoes + ankle – foot orthosis . Their functional mobility and energy expenditure parameters including timed up and go , timed up stairs , timed down stairs , preferred walking speed , and oxygen ( O2 ) cost ( mL/kg/m ) were measured . Results : In group I , no significant changes were seen in outcome measures after wearing st and ard shoes . While in group II , O2 cost and timed up and go time significantly decreased , and preferred walking speed increased when patients wore rocker shoes . Also , there was a significant difference between rocker shoes and st and ard shoes in improvement of timed up and go , preferred walking speed , and O2 cost . Conclusion : When patients using ankle – foot orthosis wore rocker shoes , their functional mobility improved and oxygen cost diminished . Also , rocker shoes was significantly more effective than st and ard shoes in improving functional mobility parameters . Clinical relevance This study suggests that in post-stroke hemiplegic patients using ankle – foot orthosis , wearing rocker shoes can lead to much more improved functional mobility and decreased energy expenditure compared to ankle – foot orthosis only . Thus , in stroke patients , the combination of ankle – foot orthosis-rocker shoes is recommended for both rehabilitation programs and ankle – foot orthosis efficacy investigations OBJECTIVE . To compare the clinical efficacy of custom foot orthotics , prefabricated " off-the-shelf " shoe inserts , and supportive athletic shoes worn alone , on reducing pain and improving function for children with juvenile idiopathic arthritis ( JIA ) . METHODS Children with JIA and foot pain ( n = 40 ) were r and omized to one of 3 groups receiving : ( 1 ) custom-made semirigid foot orthotics with shock absorbing posts ( n = 15 ) , ( 2 ) off-the-shelf flat neoprene shoe inserts ( n = 12 ) , or ( 3 ) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone ( n = 13 ) . Foot pain and functional limitations were measured using the Pediatric Pain Question naire-visual analog scale ( VAS ) , Timed Walking , Foot Function Index ( FFI ) , and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory ( PedsQL ) . Measures were administered by personnel blinded to group status at baseline ( before wearing the assigned intervention ) and at 3 months ' followup . RESULTS Children in the orthotics group showed significantly greater improvements in overall pain ( p = 0.009 ) , speed of ambulation ( p = 0.013 ) , activity limitations ( p = 0.002 ) , foot pain ( p = 0.019 ) , and level of disability ( p = 0.024 ) when compared with the other 2 groups . Both children and parents in the orthotics group reported clinical ly meaningful improvement in child health-related quality of life , although the group by time interaction did not show statistical significance . Except for a reduction in pain for supportive athletic shoes ( paired t test , p = 0.011 ) , neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures . CONCLUSION In children with JIA , custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain , speed of ambulation , and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone Background Conservative management of foot problems in patients with rheumatoid arthritis ( RA ) may consist of the prescription of customised foot orthoses . Indications for foot orthoses are not clear and the effectiveness of the intervention is highly variable among patients . Knowledge on which patients benefit the most from foot orthoses can help to select patients eligible for this type of intervention . The objective of the present study was to determine clinical and demographic factors that predict the outcome of customised foot orthoses on pain and disability in patients with RA . Methods A total of 135 RA patients who were supplied with customised foot orthoses were included in this prospect i ve cohort study . Pain and disability were measured before and after the intervention period using a Numeric Rating Scale ( NRS ) for foot pain , the Foot Function Index ( FFI ) , the Western Ontario and McMasters Universities Osteoarthritis Index ( WOMAC ) and a 10-meter walking test . The intervention period consisted of one or more appointments with the podiatrist during which the foot orthoses were customised . Swollen foot joint count , foot deformity scores , forefoot peak pressure , disease duration , age , gender , body mass index and baseline values of the outcome measures were selected as potential factors predicting outcome . Multivariate linear regression analyses were performed to determine factors associated with change in pain and disability ( at P < 0.05 ) . Results Disease duration was negatively associated with the change scores in NRS foot pain ( P = 0.018 ) , WOMAC pain ( P = 0.001 ) , FFI disability ( P = 0.003 ) and WOMAC physical function ( P = 0.002 ) . Age was negatively associated with the change score in 10 meter walking time ( P = 0.008 ) . For all outcome measures baseline values were positively associated with the change scores ( P < 0.001 ) . Conclusions Shorter disease duration predicted greater improvements in self-reported foot pain and disability , and younger age predicted greater improvements in walking time after intervention with foot orthoses . Also , higher baseline values of pain and disability predicted greater improvements . Referral for conservative management with foot orthoses in the early stage of RA seems important when aim ing to achieve reduction in pain and improvement in daily activities OBJECTIVE To investigate the clinical effectiveness of early foot orthosis intervention for painful correctable valgus deformity of the rearfoot in rheumatoid arthritis ( RA ) . METHODS Patients with RA were r and omized to receive custom manufactured rigid foot orthoses under podiatry supervision ( n = 50 ) or enter a control group ( n = 48 ) . The control group received foot orthoses only when prescribed under normal medical care . Foot pain and disability , using the Foot Function Index ( FFI ) , along with disease activity , tolerance , and adverse reactions , were serially measured over 30 mo continuous treatment . RESULTS The group assigned foot orthoses demonstrated an immediate clinical improvement , the effect peaking at 12 mo . At 30 mo the FFI total score was reduced by 23.1 % from baseline in the intervention group . Area under the curve analysis showed a statistically significant reduction in FFI scores for total score ( p = 0.026 ) , foot pain ( p = 0.014 ) , and foot disability ( p = 0.016 ) when intervention was compared to control scores . There were no confounding effects from differences between groups for disease activity or pharmacological or other management strategies . Most patients ( 96 % ) used their orthoses and most found them comfortable ( 97 % ) , although minor adverse reactions , such as tender spots , blisters , and callus , were reported in 30 % of patients in the early stages of treatment and persisted in 12 % for 30 mo . CONCLUSION Custom design ed foot orthoses used continuously over a 30 mo treatment period result ed in a reduction in foot pain by 19.1 % , foot disability by 30.8 % , and functional limitation by 13.5 % . Clinical effectiveness might be enhanced by their use in the early stages of rearfoot pain and deformity Background and objectives Treatment of chronic running-related overuse injuries by orthopaedic shoe orthoses is very common but not evidence -based to date . Hypothesis Polyurethane foam orthoses adapted to a participant 's barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners . Design Prospect i ve , r and omised , controlled clinical trial . Intervention 51 patients with running injuries were treated with custom-made , semirigid running shoe orthoses for 8 weeks . 48 served as a r and omised control group that continued regular training activity without any treatment . Main outcome measures Evaluation was made by the vali date d pain question naire Subjective Pain Experience Scale , the pain disability index and a comfort index in the orthoses group ( ICI ) . Results There were statistically significant differences between the orthoses and control groups at 8 weeks for the pain disability index ( mean difference 3.2 ; 95 % CI 0.9 to 5.5 ) and the Subjective Pain Experience Scale ( 6.6 ; 2.6 to 10.6 ) . The patients with orthoses reported a rising wearing comfort ( pre-treatment ICI 69/100 ; post-treatment ICI 83/100 ) that was most pronounced in the first 4 weeks ( ICI 80.4/100 ) . Conclusion Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners Developmental Coordination Disorder ( DCD ) is a neurodevelopmental disorder characterised by impaired motor co-ordination and awkward gait . Despite self-reported findings of pes planus and joint hypermobility in children with DCD , there is little objective evidence regarding the clinical management of the foot in children with DCD . The aims of this research were to report clinical findings of foot posture and lower limb hypermobility in children with DCD and to evaluate the impact of foot orthoses on spatio-temporal gait parameters . Children with DCD were recruited into the study . Participants were r and omly assigned to an intervention group who received foot orthoses at the start of their rehabilitation programme or to a second group who received foot orthoses at the end of their intervention programme . Foot posture was assessed with the Foot Posture Index and lower limb hypermobility assessed with the Lower Limb Assessment Score . The effect of foot orthoses  was evaluated through assessment of spatio-temporal gait characteristics at baseline and post-rehabilitation programme . Fourteen children were recruited ( mdn age 7.5 years ) with nine children assigned to the group receiving orthoses early ( mdn age 8 years ) and five children assigned to the post-rehabilitation orthoses group ( mdn age 6.5 years ) . A pes planus foot posture ( FPI score=8 ) and lower limb hypermobility ( LLAS score=11 ) were observed . Changes in spatio-temporal gait parameters failed to reach significance ( p>.012 ) following orthotic invention but demonstrated a trend towards a decreased cadence and increased double support duration . Despite non-significant findings this work offers preliminary support for podiatric intervention in the rehabilitation of children with DCD . Further work is required to underst and the biomechanics of gait in children with DCD and appreciate the role of podiatry as a component of multidisciplinary care Background : Patient-reported outcome measures are increasingly used evaluating clinical care . Many measures used to assess operative hindfoot interventions vary in content , and some have not been psychometrically vali date d in this population . The purpose of this study was to compare measurement properties of  6 lower-extremity patient-reported outcome measures  , and to evaluate their reliability and validity in light of patients ’ preferences . Methods : Cross-sectional survey of 42 preoperative and 100 postoperative patients completed 6 lower-extremity outcome measures  on 2 occasions : Foot Function Index ( FFI ) , Ankle Osteoarthritis Scale ( AOS ) , patient-reported items of the  American  Orthopaedic Foot & Ankle Society Question naire ( AOFAS ) , Lower Extremity Functional Scale ( LEFS ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the Short Musculoskeletal Function Assessment ( SMFA ) , as well as measures of preference , and symptoms . Results : Internal consistency was good to excellent for all scales and subscales ( α = .84-.97 ; ICC [ 2,1 ] = .81-.96 ) . Correlations between scales ranged from .50 ( WOMACStiffness and FFIActivity Limitations ) to .92 ( LEFS and SMFAOverall , WOMACPain and AOSOverall , FFIOverall and AOFASOverall ) . Higher correlations occurred within instruments ( r = .97 AOSPain and AOSOverall ) and between similar subscales from different instruments ( r = .91 WOMACPain and AOSPain ) . Construct validity showed moderate to high correlations to global ratings of Pain , Stiffness , and difficulty performing Daily Activities . The highest correlations ( r > .75 ) occurred between Pain and AOSOverall ( r = .84 ) , stiffness and WOMACStiffness ( r = .81 ) , and Daily Activities and AOSDisability ( r = .87 ) . Patients rated instruments by preference . FFI , WOMAC , LEFS , and SMFA rated favorably for length . FFI , WOMAC , LEFS , and AOFAS rated high for underst and ability . FFI was rated by postoperative patients as most likely to capture change due to surgery . SMFA rated the best overall . Conclusions : Direct comparison of instruments revealed similarity between scales in construct validity and reliability . Patient preferences supported the use of these scales . Foot-specific instruments offered no clear advantage over lower-extremity instruments . Level of Evidence : Level II , prospect i ve comparative study OBJECTIVE To develop clinical practice guidelines for the use of foot orthotics ( FO ) in the treatment of knee and hip osteoarthritis . METHOD The SOFMER ( French Physical Medicine and Rehabilitation Society ) methodology , associating a systematic review of the literature , input from every day clinical practice and external review by a multidisciplinary expert committee , was used . The selected analysis criteria were  pain , disability , medications used and X-ray evolution of osteoarthritis .  The recommendations are classified according to the level of proof in Grade A , B or C according to the French National Agency for Health Accreditation and Evaluation ( NAHAE ) . RESULTS In medial knee osteoarthritis , foot pronation orthotics -- when there are no contraindications -- can be proposed for their symptomatic impact , especially in the decrease of NSAIDs consumption ( Grade B ) . To this day , there is no evidence of a structural or functional impact on osteoarthritis ( Grade B ) . Outside of this specific clinical framework , there is no vali date d indication for prescribing foot orthotics in the treatment of knee or hip OA ( Grade C ) . CONCLUSION It is necessary to have further r and omized controlled trials to better define the indication of Foot orthotics ( severity of knee OA , genu varum ) , test the efficacy of other orthoses such as cushioning FO . The long-term side effects , mainly on the external femorotibial compartment could also be assessed . A medical and economical assessment of FO prescriptions is also quite necessary BACKGROUND Daily documentation and maintenance of medical record quality is a crucial issue in orthopaedic surgery . The purpose of the present study was to determine whether the introduction of a h and held computer could improve both the quantitative and qualitative aspects of medical records . METHODS A series of consecutive patients who were admitted for the first time to a thirty-six-bed orthopaedic ward of an academic teaching hospital for a planned operation or any other treatment of an acute injury or chronic condition were r and omized to daily documentation of their clinical charts on a h and held computer or on conventional paper forms . The electronic documentation consisted of a specially design ed software package on a h and held computer for bedside use with structured decision trees for examination , obtaining a history , and coding . In the control arm , chart notes were compiled on st and ard paper forms and were subsequently entered into the hospital 's information system . The number of documented ICD ( International Classification of Diseases ) diagnoses was the primary end point for sample size calculations . All patient charts were reread by an expert panel consisting of two surgeons and the surgical quality assurance manager . These experts assigned quality ratings to the different documentation systems by scrutinizing the extent and accuracy of the patient histories and the physical findings as assessed by daily chart notes . RESULTS Eighty patients were r and omized to one of the two documentation arms , and seventy-eight ( forty-seven men and thirty-one women ) of them were eligible for final analysis . Documentation with the h and held computer increased the median number of diagnoses per patients from four to nine ( p < 0.0001 ) , but it produced some overcoding for false or redundant items . Documentation quality ratings improved significantly with the introduction of the h and held device ( p < 0.01 ) with respect to the correct assessment of a patient 's progress and translation into ICD diagnoses . Various learning curve effects were observed with different operators . Study physicians assigned slightly better practicability ratings to the h and held device . CONCLUSIONS The preliminary data from this study suggest that h and held computers may improve the quality of hospital charts in orthopaedic surgery . LEVEL OF EVIDENCE Therapeutic study , Level I-1a ( r and omized controlled trial [ significant difference ] ) . See Instructions to Authors for a complete description of levels of evidence Achilles tendinosis is a degenerative overuse tendinopathy involving the primary ankle plantarflexors , namely the soleus and gastrocnemius muscles forming the tendo Achilles . The Orthopaedic Research Institute-Ankle Strength Testing System ( ORI-ASTS ) was design ed to record objective measurements of force generated with a resisted ankle plantarflexion test . Testing normal subjects ( n=6 ) was used to establish the reliability of the ORI-ASTS for measuring ankle plantarflexion force . Testing patients with Achilles tendonitis ( n=5 ) over time and comparing Achilles tendon analogue pain scores to ankle plantarflexion force measurements was used to assess the validity of the ORI-ASTS for monitoring progression of Achilles tendinopathy . Inter-rater reliability of the ORI-ASTS with normal subjects was excellent , with single measure intraclass correlation coefficients ( ICC ) for right mean peak force of 0.92 , left mean peak force of 0.96 , right mean total force of 0.89 , left mean total force of 0.91 . The ORI-ASTS also had excellent intra-rater reliability for normal subjects with the following single measure ICC scores : right mean force 0.96 , left mean force 0.92 , right mean total force 0.97 , left mean total force 0.92 . The relative technical errors of measurement were calculated from these results , and ranged from 1.0 % to 2.7 % . Testing patients with Achilles tendinosis ( n=5 ) , and comparing analogue activity pain scores to ORI-ASTS testing demonstrated a strong negative relationship between the two parameters ( Spearman Rho −0.87 to −1.0 , Kendall tau b −0.82 to −1.0 ) . The relationship was statistically significant at the p=0.01 level for two of the five patients . The ORI-ASTS shows excellent reliability for testing ankle plantarflexor force , and appears valid for objective ly assessing and monitoring patients with Achilles tendinosis Introduction : The American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Score has been under recent scrutiny . The Foot and Ankle Outcome Score ( FAOS ) is an alternative subjective survey , assessing outcomes in 5 subscales . It is vali date d for lateral ankle instability and hallux valgus patients . The aim of our study was to vali date the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity ( AAFD ) . Methods : Patients from the authors ’ institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study . In all , 126 patients who completed the FAOS and the Short-Form 12 ( SF-12 ) on the same visit were included in the construct validity component . Correlation was deemed moderate if the Spearman ’s correlation coefficient was .4 to .7 . Content validity was assessed in 63 patients by a question naire that asked patients to rate the relevance of each FAOS question , with a score of 2 or greater considered acceptable . Reliability was measured using intraclass correlation coefficients ( ICCs ) in 41 patients who completed a second FAOS survey . In 49 patients , preoperative and postoperative FAOS scores were compared to determine responsiveness . Results : All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains . Mental health related domains showed poor correlation . Content validity was high for the Quality of Life ( QoL ; mean 2.26 ) and Sports/Recreation subscales ( mean 2.12 ) . All subscales exhibited very good test – retest reliability , with ICCs of .7 and above . Symptoms , QoL , pain , and daily activities ( ADLs ) were responsive to change in postoperative patients ( P < .05 ) . Conclusion : This study has vali date d the FAOS for AAFD with acceptable construct and content validity , reliability , and responsiveness . Given its previous validation for patients with ankle instability and hallux valgus , the additional findings in this study support its use as an alternative to less reliable outcome surveys . Level of Evidence : Level II , prospect i ve comparative study
The present review shows that current scientific literature concerning the usability of orthopaedic shoes focuses mainly on effectiveness at the expense of the other domains of usability , i.e. , efficiency , satisfaction and context of use
Objective : To determine the method ological quality of studies evaluating  orthopaedic shoes and orthopaedic shoe provisions .
To what extent do studies evaluating  orthopaedic shoes prescribed for patients with degenerative disorders of the foot , rheumatoid arthritis , diabetes mellitus and neurological foot disorders , focus on the aspects of the International Organization for St and ardization ( ISO ) definition of usability , i.e. , effectiveness , efficiency , satisfaction , and context of use ?