title: Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders II: interclinician and intraclinician reliability and validity of the newly established standard rating scales and Japanese Orthopaedic Association rating scale.
abstract: BACKGROUND
  This study evaluated the validity and inter- and intraclinician reliability of (1) the Japanese Society of Surgery of the Foot (JSSF) standard rating system for four sites [ankle-hindfoot (AH), midfoot (MF), hallux (HL), and lesser toe (LT)] and the rheumatoid arthritis (RA) foot and ankle scale and (2) the Japanese Orthopaedic Association's foot rating scale (JOA scale).
  
  
  METHODS
  Clinicians from the same institute independently evaluated participating patients from their institute by two evaluations at a 1- to 4-week interval. Statistical evaluation was as follows. (1) The intraclass correlation coefficient (ICC) was calculated from data collected from at least two examinations of each patient by at least two evaluating clinicians (Data A). (2) Total scores for the two evaluations were determined from the distribution of differences in data between the two evaluations (Data B); each item was evaluated by determining Cohen's coefficient of agreement. (3) The relation between patient satisfaction and total score was investigated only for patients who underwent surgery (Data C). Spearman's rank correlation coefficient was obtained.
  
  
  RESULTS
  Participants were 65 clinicians and 610 patients, including those with disorders of the AH (313), MF (47), HL (153), and LT (50) and those with RA (47). From Data A, the ICC was high for AH and HL by JSSF scales and for AH, MF, and LT by the JOA scale. From Data B, the coefficient showed high validity for both scales for AH, with almost no difference between the two scales; the validity for HL was higher with the JOA scale than with the JSSF scale. From Data C, correlations were significant between patient satisfaction and outcome for AH and HL by the JSSF scales and for AH, HL, and LT by the JOA scale.
  
  
  CONCLUSIONS
  The validity of both scales was high. Clinical evaluation of the therapeutic results using these scales would be highly reliable.
authors.affiliation: Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kanagawa 216-8511, Japan.
authors.forename: Hisateru
authors.initials: H
authors.lastname: Niki
authors.forename: Haruhito
authors.initials: H
authors.lastname: Aoki
authors.forename: Suguru
authors.initials: S
authors.lastname: Inokuchi
authors.forename: Satoru
authors.initials: S
authors.lastname: Ozeki
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Hideji
authors.initials: H
authors.lastname: Kura
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Noguchi
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Nomura
authors.forename: Masahito
authors.initials: M
authors.lastname: Hatori
authors.forename: Shinobu
authors.initials: S
authors.lastname: Tatsunami
mesh_terms: D000842:Ankle; D019937:Diagnostic Techniques and Procedures / Q000592:standards*; D005534:Foot Diseases / Q000175:diagnosis*; D006801:Humans; D007564:Japan; D015588:Observer Variation; D009985:Orthopedics / Q000592:standards*; D015203:Reproducibility of Results; D012955:Societies, Medical