title: The reproducibility of acquiring three dimensional gait and plantar pressure data using established protocols in participants with and without type 2 diabetes and foot ulcers.
abstract: BACKGROUND
  Several prospective studies have suggested that gait and plantar pressure abnormalities secondary to diabetic peripheral neuropathy contributes to foot ulceration. There are many different methods by which gait and plantar pressures are assessed and currently there is no agreed standardised approach. This study aimed to describe the methods and reproducibility of three-dimensional gait and plantar pressure assessments in a small subset of participants using pre-existing protocols.
  
  
  METHODS
  Fourteen participants were conveniently sampled prior to a planned longitudinal study; four patients with diabetes and plantar foot ulcers, five patients with diabetes but no foot ulcers and five healthy controls. The repeatability of measuring key biomechanical data was assessed including the identification of 16 key anatomical landmarks, the measurement of seven leg dimensions, the processing of 22 three-dimensional gait parameters and the analysis of four different plantar pressures measures at 20 foot regions.
  
  
  RESULTS
  The mean inter-observer differences were within the pre-defined acceptable level (<7 mm) for 100 % (16 of 16) of key anatomical landmarks measured for gait analysis. The intra-observer assessment concordance correlation coefficients were > 0.9 for 100 % (7 of 7) of leg dimensions. The coefficients of variations (CVs) were within the pre-defined acceptable level (<10 %) for 100 % (22 of 22) of gait parameters. The CVs were within the pre-defined acceptable level (<30 %) for 95 % (19 of 20) of the contact area measures, 85 % (17 of 20) of mean plantar pressures, 70 % (14 of 20) of pressure time integrals and 55 % (11 of 20) of maximum sensor plantar pressure measures.
  
  
  CONCLUSIONS
  Overall, the findings of this study suggest that important gait and plantar pressure measurements can be reliably acquired. Nearly all measures contributing to three-dimensional gait parameter assessments were within predefined acceptable limits. Most plantar pressure measurements were also within predefined acceptable limits; however, reproducibility was not as good for assessment of the maximum sensor pressure. To our knowledge, this is the first study to investigate the reproducibility of several biomechanical methods in a heterogeneous cohort.
authors.affiliation: Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811 Australia ; Institute of Sports and Exercise Science, Gait analysis Laboratory, James Cook University, Townsville, Australia.
authors.forename: Malindu
authors.initials: M
authors.lastname: Fernando
authors.affiliation: Institute of Sports and Exercise Science, Gait analysis Laboratory, James Cook University, Townsville, Australia ; Sport and Exercise, School of Health and Wellbeing, University of Southern Queensland, Queensland, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Crowther
authors.affiliation: Department of Health Science, University of Stirling, Stirling, Scotland United Kingdom.
authors.forename: Margaret
authors.initials: M
authors.lastname: Cunningham
authors.affiliation: Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia ; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lazzarini
authors.affiliation: Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, QLD Australia.
authors.forename: Kunwarjit S
authors.initials: KS
authors.lastname: Sangla
authors.affiliation: Tropical Health Solutions Pty Ltd, Townsville, QLD Australia ; Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.
authors.forename: Petra
authors.initials: P
authors.lastname: Buttner
authors.affiliation: Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811 Australia ; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Queensland, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Golledge
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D017719:Diabetic Foot / Q000503:physiopathology*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D016138:Walking / Q000502:physiology*
keywords: Diabetic foot; Foot ulcer; Gait; Locomotion; Plantar pressure; Reproducibility of results
references.citation: Biometrics. 1989 Mar;45(1):255-68
references.pmid: 2720055
references.citation: Diabetologia. 2006 Aug;49(8):1747-54
references.pmid: 16758177
references.citation: Gait Posture. 2005 Feb;21(2):197-211
references.pmid: 15639399
references.citation: Diabetes Care. 2000 May;23(5):606-11
references.pmid: 10834417
references.citation: Gait Posture. 2008 Aug;28(2):207-16
references.pmid: 18206374
references.citation: Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S6-S10
references.pmid: 11054880
references.citation: Gait Posture. 2005 Feb;21(2):226-37
references.pmid: 15639401
references.citation: Gait Posture. 1999 Dec;10(3):255-63
references.pmid: 10567758
references.citation: Diabetes Metab Res Rev. 2012 Oct;28(7):574-600
references.pmid: 22730196
references.citation: Gait Posture. 2008 May;27(4):706-9
references.pmid: 17693087
references.citation: PLoS One. 2014;9(6):e99050
references.pmid: 24915443
references.citation: Gait Posture. 2009 Apr;29(3):360-9
references.pmid: 19013070
references.citation: PLoS One. 2014;9(5):e96988
references.pmid: 24865351
references.citation: Clinics (Sao Paulo). 2009;64(2):113-20
references.pmid: 19219316
references.citation: Diabetologia. 2004 Aug;47(8):1343-53
references.pmid: 15309286
references.citation: Clin Biomech (Bristol, Avon). 2013 Oct;28(8):831-45
references.pmid: 24035444
references.citation: Diabetes Technol Ther. 2013 Dec;15(12):1025-32
references.pmid: 23984803
references.citation: J Foot Ankle Res. 2010 Jun 18;3:11
references.pmid: 20565812
references.citation: Phys Ther. 1994 Apr;74(4):299-308; discussion 309-13
references.pmid: 8140143
references.citation: Gait Posture. 2013 Sep;38(4):723-8
references.pmid: 23583607
references.citation: Diabetes Care. 1998 May;21(5):855-9
references.pmid: 9589255
references.citation: Dtsch Arztebl Int. 2009 May;106(19):335-9
references.pmid: 19547734
references.citation: BMC Endocr Disord. 2015;15:59
references.pmid: 26499881
references.citation: Phys Ther Sport. 2014 May;15(2):112-6
references.pmid: 23988839
references.citation: Phys Ther. 1993 Jul;73(7):478-83
references.pmid: 8316581
references.citation: Gait Posture. 2013 Jul;38(3):544-8
references.pmid: 23454044
references.citation: J Foot Ankle Surg. 2002 Jul-Aug;41(4):206-12
references.pmid: 12194509
references.citation: Diabetes Res Clin Pract. 2003 Apr;60(1):57-61
references.pmid: 12639766
references.citation: Clin Biomech (Bristol, Avon). 2005 Nov;20(9):892-9
references.pmid: 15996799
references.citation: J Biomech. 1993;26 Suppl 1:23-40
references.pmid: 8505350
references.citation: Ann Ist Super Sanita. 2012;48(3):259-71
references.pmid: 23007050