title: Validity of self-assessment of hallux valgus using the Manchester scale.
abstract: BACKGROUND
  Hallux valgus (HV) is a common condition involving the progressive subluxation of the first metatarsophalangeal joint due to lateral deviation of the hallux and medial deviation of the first metatarsal. The objective of this study was to evaluate the re-test reliability and validity of self-assessment of HV using a simple clinical screening tool involving four standardised photographs (the Manchester scale), in order to determine whether this tool could be used for postal surveys of the condition.
  
  
  METHODS
  HV was assessed with the Manchester scale in 138 people aged 65 to 93 years of age (102 women and 36 men) as part of a larger randomised controlled trial. At the six month follow-up assessment, HV was reassessed to determine re-test reliability, and participants were asked to self-assess their degree of HV independent of the examiners. Associations between (i) baseline and follow-up assessments of the examiners and (ii) participant and examiner assessments were performed using weighted kappa statistics. Analyses were then repeated after HV was dichotomised as present or absent using unweighted kappa, and sensitivity and specificity of self-assessment of HV was determined.
  
  
  RESULTS
  Re-test reliability of the examiners was substantial to almost perfect (weighted kappa = 0.78 to 0.90), and there was a substantial level of agreement between observations of the participants and the examiners (weighted kappa = 0.71 to 0.80). Overall, there was a slight tendency for participants to rate their HV as less severe than the examiners. When the Manchester scale scores were dichotomised, agreement was substantial to almost perfect for both re-test comparisons (kappa = 0.80 to 0.89) and substantial for comparisons between participants and examiners (kappa = 0.64 to 0.76). The sensitivity and specificity of self-assessment of HV using the dichotomous scale were 85 and 88%, respectively.
  
  
  CONCLUSIONS
  The Manchester scale demonstrates high re-test reliability, and self-assessment scores obtained by participants are strongly associated with scores obtained by examiners. These findings indicate that the tool can be used with confidence in postal surveys to document the presence and severity of HV.
  
  
  BACKGROUND
  ACTRN12608000065392.
authors.affiliation: Faculty of Health Sciences, La Trobe University, Musculoskeletal Research Centre, Bundoora, Victoria 3086, Australia. h.menz@latrobe.edu.au
authors.forename: Hylton B
authors.initials: HB
authors.lastname: Menz
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Fotoohabadi
authors.forename: Elin
authors.initials: E
authors.lastname: Wee
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Spink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006215:Hallux Valgus / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D010808:Physical Examination / Q000379:methods*; D026761:Physical Therapy Specialty / Q000379:methods; D012647:Self-Assessment; D012720:Severity of Illness Index