Intra- and inter-rater reliability in the assessment and classification of the longitudinal plantar arch of children 6 to 10 years of age

Thiago Weyk De Oliveira Beliche,Celmo Celeno Porto,Roberta Carneiro De Toledo,Cibelle Kayenne Martins Roberto Formiga,Thailyne Bizinotto,Tânia Cristina Dias Da Silva Hamu,Rafaela Noleto Dos Santos

doi:10.1590/s1980-657420210000151

Thiago Weyk De Oliveira Beliche, Celmo Celeno Porto + Show 5 more

Open Access

https://doi.org/10.1590/s1980-657420210000151

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Abstract

Aims: This study aimed to analyze the intra- and inter-rater reliability in the assessment and classification of the longitudinal plantar arch of children from 6 to 10 years old in the eyes-open (EO) testing condition. Methods: A total of two-hundred and seventy-eight Brazilian children (556 feet), boys and girls, from 6 to 10 years of age participated in the study. The children’s feet were examined on a baropodometric platform, and the Staheli index was used for calculating the plantar arch index. Footprint analyses were performed at two different times, with an interval of 7 to 10 days, by three physical therapists in a single testing condition, resulting in 3,336 footprints. To determine the reliability of the continuous measurements, the Intraclass Correlation Coefficients (ICC) with 95% confidence intervals (CIs), Standard error of the mean (SEM), absolute value and percentage, and the Minimum Detectable Change (MDC) were calculated. To determine the reliability of the longitudinal arch classification, inter-rater reliability was evaluated by Weighted Fleiss Kappa Coefficient and the test-retest reliability was estimated by Weighted Cohen Kappa Coefficient. Results: Regarding inter-rater reliability, we observed values of ICC ranging from 0.79 to 0.96; thus, the results were classified as substantial to excellent reliability), being the lowest ICC values occur for line B, mainly in the first assessments. SEM ranges from 0.08 to 0.21 (percentage: 3.74 to 28.7), being the best, the lowest SEM values occur for Plantar Arch Index assessments and the MDC varies between 0.22 and 0.59. Regarding intra-rater reliability, the results indicated excellent reliability: values of ICC range from 0.92 to 0.99, being the lowest ICC values also occurs for line B analysis. SEM ranges from 0.03 to 0.20 (percentage: 2.32 to 26.6), being the lowest SEM values occur for Plantar Arch Index assessments and MDC varies between 0.09 and 0.54. Analyzing the inter-rater reliability for the longitudinal arch classifications, we observed values of Weighted Fleiss Kappa Coefficient ranging from 0.83 to 0.87, expressing almost perfect agreement among the raters before and after evaluations. The test-retest reliability of the longitudinal arch classification resulted in values of Weighted Cohen Kappa Coefficient ranging from 0.80 to 0.996, expressing substantial to almost perfect agreement intra-rater. Conclusion: The study showed high reliability in the clinical assessment of the longitudinal plantar arch index of children from 6 to 10 years of age indicating that the Staheli method is applicable to pressure platform assessments with intra- and inter-rate reliability.

Highlights

The foot is essential for supporting body weight, and changes in its structure can cause musculoskeletal disorders, unstable postural control, and symptoms in children and adolescents[1]
Regarding inter-rate reliability, we observed values of Intraclass Correlation Coefficients (ICC) ranging from 0.79 to 0.96, the results were classified as substantial to excellent reliability), being the lowest ICC values occurs for line B, mainly in the first assessments
The variability (SEM) ranges from 0.08 to 0.21, being the best, the lowest Standard Error of the Mean (SEM) values occur for Plantar Arch Index assessments and MDC varies between 0.22 and 0.59

Summary

Introduction

The foot is essential for supporting body weight, and changes in its structure can cause musculoskeletal disorders, unstable postural control, and symptoms in children and adolescents[1]. The development of the longitudinal arch of the foot occurs within the first six years of life, with variability in the structure and function of the feet; it is very important to monitor this parameter in the clinical practice[2]. The feet are anatomical structures that make it easier to perform important tasks (such as maintaining the orthostatic posture) and help in the strategies to maintain balance. Balance is an essential component influenced by motor development and skills that are important to movement[3]. Range of Reliability in the assessment and classification of the plantar arch of children motion (ROM) and morphology are associated with foot function in children[8] and can be measured through questionnaires[9] and clinical assessments[10,11]

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