title: A consensus definition and rating scale for minimalist shoes.
abstract: BACKGROUND
  While minimalist running shoes may have an influence on running biomechanics and on the incidence of overuse injuries, the term "minimalist" is currently used without standardisation. The objectives of this study were to reach a consensus on a standard definition of minimalist running shoes, and to develop and validate a rating scale that could be used to determine the degree of minimalism of running shoes, the Minimalist Index (MI).
  
  
  METHODS
  For this modified Delphi study, 42 experts from 11 countries completed four electronic questionnaires on an optimal definition of minimalist shoes and on elements to include within the MI. Once MI was developed following consensus, 85 participants subjectively ranked randomly assigned footwear models from the most to the least minimalist and rated their degree of minimalism using visual analog scales (VAS), before evaluating the same footwear models using MI. A subsample of thirty participants reassessed the same shoes on another occasion. Construct validity and inter- and intra-rater reliability (intraclass correlation coefficients [ICC]; Gwet's AC1) of MI were evaluated.
  
  
  RESULTS
  The following definition of minimalist shoes was agreed upon by 95 % of participants: "Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices". Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score. Total MI score was highly correlated with VAS (r = 0.91). A significant rank effect (p < 0.001) confirmed the MI's discriminative validity. Excellent intra- and inter-rater reliability was found for total MI score (ICC = 0.84-0.99) and for weight, stack height, heel to toe drop and flexibility subscales (AC1 = 0.82-0.99), while good inter-rater reliability was found for technologies (AC1 = 0.73).
  
  
  CONCLUSIONS
  This standardised definition of minimalist shoes developed by an international panel of experts will improve future research on minimalist shoes and clinical recommendations. MI's adequate validity and reliability will allow distinguishing running shoes based on their degree of minimalism, and may help to decrease injuries related to footwear transition.
authors: Faculty of Medicine, Laval University, Quebec City, QC Canada ; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, 525, Boulevard Wilfrid Hamel, Quebec City, QC Canada, G1M 2S8 ; The Running Clinic, Quebec City, QC Canada.
authors: Jean-Francois
authors: JF
authors: Esculier
authors: Faculty of Medicine, Laval University, Quebec City, QC Canada ; The Running Clinic, Quebec City, QC Canada.
authors: Blaise
authors: B
authors: Dubois
authors: Faculty of Medicine, Laval University, Quebec City, QC Canada ; Axe Santé des populations et pratiques optimales en santé, Centre de recherche FRQS du CHU de Québec, Quebec City, QC Canada.
authors: Clermont E
authors: CE
authors: Dionne
authors: Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, 525, Boulevard Wilfrid Hamel, Quebec City, QC Canada, G1M 2S8.
authors: Jean
authors: J
authors: Leblond
authors: Faculty of Medicine, Laval University, Quebec City, QC Canada ; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, 525, Boulevard Wilfrid Hamel, Quebec City, QC Canada, G1M 2S8.
authors: Jean-Sébastien
authors: JS
authors: Roy
keywords: Consensus statement; Delphi; Foot; Footwear; Reliability; Running; Running injuries; Validity