Inter and intra‐rater repeatability of the scoring of foot pain drawings

Abstract

BackgroundFoot pain drawings (manikins) are commonly used to describe foot pain location in self-report health surveys. Respondents shade the manikin where they experience pain. The manikin is then scored via a transparent overlay that divides the drawings into areas. In large population based studies they are often scored by multiple raters. A difference in how different raters score manikins (inter-rater repeatability), or in how an individual rater scores manikins over time (intra-rater repeatability) can therefore affect data quality. This study aimed to assess inter- and intra-rater repeatability of scoring of the foot manikin.MethodsA random sample was generated of 50 respondents to a large population based survey of adults aged 50 years and older who experienced foot pain and completed a foot manikin. Manikins were initially scored by any one of six administrative staff (Rating 1). These manikins were re-scored by a second rater (Rating 2). The second rater then re-scored the manikins one week later (Rating 3). The following scores were compared: Rating 1 versus Rating 2 (inter-rater repeatability), and Rating 2 versus Rating 3 (intra-rater repeatability). A novel set of clinically relevant foot pain regions made up of one or more individual areas on the foot manikin were developed, and assessed for inter- and intra-rater repeatability.ResultsScoring agreement of 100% (all 50 manikins) was seen in 69% (40 out of 58) of individual areas for inter-rater scoring (range 94 to 100%), and 81% (47 out of 58) of areas for intra-rater scoring (range 96 to 100%). All areas had a kappa value of ≥0.70 for inter- and intra-rater scoring. Scoring agreement of 100% was seen in 50% (10 out of 20) of pain regions for inter-rater scoring (range 96 to 100%), and 95% (19 out of 20) of regions for intra-rater scoring (range 98 to 100%). All regions had a kappa value of >0.70 for inter- and intra-rater scoring.ConclusionsIndividual and multiple raters can reliably score the foot pain manikin. In addition, our proposed regions may be used to reliably classify different patterns of foot pain using the foot manikin.

Epidemiology of Posterior Heel Pain in the General Population: Cross‐Sectional Findings From the Clinical Assessment Study of the Foot

“…The strengths of this study include a large population size, the community setting, and the use of a detailed, previously validated foot manikin that allows accurate characterization of pain location . The use of weighted logistic regression modeling has also allowed us to adjust for nonresponse to the initial survey and to account for confounding variables in our assessment of associations for posterior HP.…”

“…The Health Survey questionnaire contained the filter question “In the past month, have you had any ache or pain that has lasted for one day or longer in your feet?” Respondents reporting foot ache or pain in the past month were asked to shade the location of their foot ache/pain on a foot manikin showing the dorsal, plantar, and posterior aspects of both feet . The manikins were scored with a transparent overlay, dividing the images of the feet into 26 mutually exclusive areas . Any area with shading was considered to be painful, and any area with no shading not to be painful.…”

“…Any area with shading was considered to be painful, and any area with no shading not to be painful. Posterior HP in either foot was defined as reporting foot ache or pain in the past month and shading the posterior heel (area 26) on either foot . Bilateral posterior HP was defined as responding positively to the filter question and shading the posterior heel (area 26) in both feet (Figure ).…”

Measuring the Pain Area: An Intra‐ and Inter‐Rater Reliability Study Using Image Analysis Software

“…Other studies have proposed modifications to the Margolis pain drawing, including more square areas . Other modifications using the principle of the “grid system” can be observed in the study by Chatterton et al . The authors investigated inter‐ and intrarater repeatability when using pain drawings (manikins) to score foot pain and found that all regions had good inter‐ and intrarater scoring ( k > 0.70).…”

Midfoot osteoarthritis: potential phenotypes and their associations with demographic, symptomatic and clinical characteristics

“…The Health Survey questionnaire included items on demographics and socio-economic status (age, sex, education, occupation), general health, foot pain and symptoms (pain in the last 12 months, pain severity in the last month using a 0e10 numerical rating scale [NRS], duration of pain, and the Manchester Foot Pain and Disability Index (MFPDI) 20 ). Foot pain location was recorded by participants marking or shading the corresponding area on a foot manikin 21,22 ( © The University of Manchester 2000, all rights reserved). Dorsal and plantar midfoot pain were then determined according to the region(s) selected.…”