Reliability and minimal detectable difference in multisegment foot kinematics during shod walking and running
Introduction
There has been increased interest recently in measuring kinematics within the foot during gait. While several multisegment foot models have appeared in the literature, one in particular has been used frequently for both walking and running. The two segment plus hallux Oxford foot model was originally developed for use during barefoot walking [1]. This model was subsequently modified, which improved reliability of rearfoot motion when used with children walking barefoot [2]. This model has since been used to measure multisegment foot kinematics during both walking and running. Given this model's wide adoption in the field, this study will focus on reliability and minimum detectable difference (MDD) of the modified Oxford foot model.
Reliability of a marker set is of particular concern in longitudinal studies where changes must exceed the MDD to be considered meaningful [3]. Low reliability leads to large MDDs. Several studies have reported the reliability of the Oxford foot model or modified Oxford foot model. However, MDDs have not been reported. There is a need to provide MDDs for commonly studied variables in both walking and running to aid the interpretation of longitudinal studies. In particular, studies of different foot strike patterns during running have stimulated interest in kinematics within the foot. Similarly, investigations of walking in people with osteoarthritis or other pathologies indicate a need to track walking biomechanics longitudinally.
It is considered good practice in marker-based studies for a single investigator to place markers on all participants at all visits. This reduces the between subject variability by removing the influence of inter-rater differences. In interpreting findings for between-day reliability, it is important to note that there is a minimum MDD that reflects the inherent variability of human subjects. This within-session or inter-trial reliability is a floor in terms of the smallest MDD that can be achieved. Thus, within-session MDDs are useful for interpreting the effects of different conditions within a session, such as changing velocity or stride length. They are also useful in interpreting group differences in cross-sectional studies.
While several studies have reported the reliability for the Oxford foot model, most have reported reliability for barefoot walking [4], [5], [6], [7]. One study reported reliability for a multisegment foot using shoe mounted markers [8]. However, this model tracks shoe rather than foot motion and cannot provide insight into foot movement as foot and shoe likely move differently [9]. Thus, it is unknown whether similar reliability would be found for a model using skin-mounted markers during shod walking or for running. Since excursions and peak magnitudes of joint angles are larger in running than walking, MDDs should be reported separately for each. The purpose of this study was to determine between-day (intra-rater) and within-session (inter-trial) reliability of the modified Oxford foot model during shod walking and running. The focus was on variables which are commonly reported in the gait literature. In addition, MDDs were determined to aid the interpretation of the findings of gait studies.
Section snippets
Participants
Healthy male runners between 18 and 50 years of age were recruited for this study. All procedures were approved by the Institutional Review Board prior to the start of the study. All participants provided written informed consent to participate. Participants ran at least 10 miles per week and had been doing so for a year or more. Participants who answered ‘yes’ to any of the questions on the Physical Activity Readiness Questionnaire [10] were excluded. Those reporting a history of major lower
Results
The between-day reliability of multisegment foot variables during running ranged from an ICC of 0.644 to 0.993 (Table 1). Seven of 20 variables had excellent between-day reliability, and 5 more had good between-day reliability. The relative measures, excursion and range of motion, tended to have higher reliability than the absolute measures of angle at foot strike and peak angle. The between-day reliability of the remaining six variables could not be reported, as the assumptions for ICC
Discussion
The purpose of this study was to determine the reliability of the modified Oxford foot model during shod gait. Reliability during walking and running between days was determined using ICCs, and the MDD for absolute and relative variables of interest in the foot and ankle was calculated. Between-day reliability depends on both participant consistency from day to day and investigator consistency in placing markers on anatomical landmarks. Thus, within-session reliability and MDD were also
Conclusion
The reliability of the modified Oxford foot model was determined for shod walking and running in healthy adult men. Overall, between-day ICCs were comparable to those reported previously for adults walking barefoot. Our study is an extension in the use of the model to incorporate wearing a shoe while maintaining marker placement directly on the skin for each segment. Furthermore, these reliability data for walking and running will aid in the determination of meaningful differences in studies
Conflict of interest
The authors report no conflicts of interest.
References (20)
- et al.
Kinematic analysis of a multi-segment foot model for research and clinical applications: a repeatability analysis
J Biomech
(2001) - et al.
Repeatability of a model for measuring multi-segment foot kinematics in children
Gait Posture
(2006) - et al.
Intra-rater repeatability of the Oxford foot model in healthy children in different stages of the foot roll over process during gait
Gait Posture
(2009) - et al.
Repeatability of the modified Oxford foot model during gait in healthy adults
Gait Posture
(2011) - et al.
The influence of tester experience on the reliability of 3D kinematic information during running
Gait Posture
(2014) - et al.
The reliability, accuracy and minimal detectable difference of a multi-segment kinematic model of the foot–shoe complex
Gait Posture
(2013) - et al.
Ground reaction forces in distance running
J Biomech
(1980) - et al.
Comparison of surface mounted markers and attachment methods in estimating tibial rotations during walking: an in vivo study
Gait Posture
(2000) - et al.
Preferred placement of the feet during quiet stance: development of a standardized foot placement for balance testing
Clin Biomech
(1997) - et al.
Repeatability in the assessment of multi-segment foot kinematics
Gait Posture
(2012)
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