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Navicular Drop Measurement in People With Rheumatoid Arthritis: Interrater and Intrarater Reliability

JA Shrader, PT, CPed, is Senior Clinical Specialist and Foot Clinic Coordinator, Physical Therapy Section, Department of Rehabilitation Medicine, Mark O. Hatfield Clinical Research Center, National Institutes of Health, Department of Health and Human Services, 10 Center Dr, CRC Rm 1–1469, Bethesda, MD 20892-1604 (USA) (joseph_shrader{at}nih.gov)
JM Popovich, Jr, PT, DPT, is a PhD student in biomechanics, Musculoskeletal Biomechanics Research Laboratory, Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, Calif
GC Gracey, PT, MPT, CPed, is Physical Therapist, Contractor, Medical Section, Department of Rehabilitation Medicine, National Institutes of Health
JV Danoff, PT, PhD, is Research Consultant, Physical Therapy Section, Department of Rehabilitation Medicine, National Institutes of Health, and Associate Professor, Department of Exercise Science, School of Public Health, George Washington University, Washington, DC

Address all correspondence to Mr Shrader

Background and Purpose. Navicular drop (ND) measurement may be a valuable examination technique for patients with rheumatoid arthritis (RA). However, no data exist on reliability for this technique in patients with RA. The purposes of this study were: (1) to determine interrater and intrarater reliability of ND measurements in people with RA, (2) to compare ND values of people with RA with published normative data, and (3) to investigate ND measurement error associated with the use of skin markings. Subjects. Ten women (20 feet) with RA consented to participate. Methods. Patients completed demographic and function questionnaires. Navicular height (NH) measurements were taken by 2 physical therapists and 1 physical therapist student, following four 1-hour training sessions, using standardized methods and a digital height gauge. Four different NH measurements were taken 3 times on each foot by each of the 3 examiners during a morning session and then repeated during an afternoon session on the same day. Navicular drop values were calculated, including ND1 (as reported in the literature), ND2 (compensating for skin error), and ND3 (single-limb stance). Intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs) were used to establish reliability. Results. Means (±SD) for each ND measure for sessions 1 and 2, respectively, were as follows: ND1=8.36±5.29 mm and 8.29±5.24 mm, ND2=9.95±5.44 mm and 9.57±5.37 mm. The ICCs (2,1 and 2,k, respectively) for all interrater measurements ranged from .67 to .92 (SEM=2.0–3.3 mm) and from .85 to .97 (SEM=1.1–2.0 mm). The ICCs (2,1 and 2,k, respectively) for intrarater measurements ranged from .73 to .95 (SEM=1.3–2.8 mm) and from .90 to .98 (SEM=0.7–1.6 mm). Paired t tests showed the means of ND1 and ND2 for each examiner and for both sessions were significantly different. Discussion and Conclusion. The results suggest that ND measurements for people with RA can be taken reliably by clinicians with varied experience. The ND values for our subjects were slightly greater than reported normal values of 6 to 8 mm. Error associated with skin markings was statistically significant for all sessions and examiners.

Key Words: Digital height gauge • Foot pronation • Navicular height • Single-limb stance • Skin marking error

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