Table 5 Criterion validity summary statistics for clinician (Sensitivity, specificity and positive predictive value) & inter-rater reliability between expert and clinician (Kappa and strength of agreement)
QHRFF field | % | K(SE) | Strength of agreement [[37]] | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) |
|---|---|---|---|---|---|---|
General demographics | ||||||
Any indigenous status | 100 | -- | -- | -- | 1.00 (0.90-1.00) | -- |
Health professionals attending (in the past week) | ||||||
Podiatrist | 88.4 | -- | -- | 0.88 (0.74-0.96) | -- | 0.88 (0.74-0.96) |
GP | 81.4 | 0.39 (0.17) | Fair | 0.40 (0.14-0.73) | 0.94 (0.78-0.99) | 0.67 (0.24-0.94) |
Nurse | 79.1 | 0.37 (0.16) | Fair | 0.33 (0.11-0.65) | 0.97 (0.81-1.00) | 0.80 (0.30-0.99) |
Orthotist | 100 | -- | -- | -- | 1.00 (0.90–1.00) | -- |
Physician | 97.6 | 0.66 (0.32) | Substantial | 1.00 (0.05-1.00) | 0.98 (0.86-1.00) | 0.50 (0.03-0.97) |
Surgeon | 90.7 | 0.45 (0.23) | Moderate | 0.67 (0.13-0.98) | 0.93 (0.79-0.98) | 0.40 (0.07-0.83) |
Other | 100 | -- | -- | -- | 0.98 (0.86-1.00) | -- |
Medical co-morbidity history | ||||||
Any medical (diabetes) history | 100 | 100 (0.01) | Near perfect | 1.00 (0.88-1.00) | 1.00 (0.60-1.00) | 1.00 (0.88-1.00) |
Diabetes duration# | 0.95 (0.90–0.97) | Strong | ||||
Recent BGLs > 15 mmol/L | 90.7 | 0.62 (0.17) | Substantial | 1.00 (0.40-1.00) | 0.90 (0.75-0.97) | 0.50 (0.17-0.83) |
HbA1c result# | 1.00 (0.99–1.00) | Strong | ||||
Hypertension | 86.0 | 0.68 (0.12) | Substantial | 0.87 (0.68-0.96) | 0.85 (0.54-0.97) | 0.93 (0.75-0.99) |
Dyslipidaemia | 79.1 | 0.58 (0.12) | Moderate | 0.76 (0.54-0.90) | 0.83 (0.58-0.96) | 0.86 (0.64-0.96) |
Smoker | 88.4 | 0.69 (0.13) | Substantial | 0.73 (0.39-0.93) | 0.94 (0.78-0.99) | 0.80 (0.44-0.96) |
CVD | 79.1 | 0.58 (0.12) | Moderate | 0.71 (0.48-0.88) | 0.86 (0.64-0.96) | 0.83 (0.58-0.96) |
CKD | 86.0 | 0.65 (0.13) | Substantial | 0.69 (0.39-0.90) | 0.93 (0.76-0.99) | 0.82 (0.48-0.97) |
ESRF | 97.7 | 0.66 (0.32) | Substantial | 1.00 (0.05-1.00) | 0.98 (0.86-1.00) | 0.50 (0.03-0.97) |
Other (non-listed) | 79.1 | 0.19 (0.19) | Slight | 0.89 (0.73-0.96) | 0.29 (0.05-0.7) | 0.86 (0.70-0.95) |
High-risk history | ||||||
Neuropathy | 93.0 | 0.73 (0.15) | Substantial | 0.95 (0.80-0.99) | 0.83 (0.36-0.99) | 0.97 (0.84-1.00) |
PAD | 86.0 | 0.72 (0.10) | Substantial | 0.76 (0.52-0.91) | 0.95 (0.75-1.00) | 0.94 (0.69-1.00) |
Previous foot ulcer | 79.1 | 0.28 (0.18) | Fair | 0.84 (0.67-0.93) | 0.50 (0.14-0.86) | 0.91 (0.75-0.98) |
Current foot ulcer | 97.7 | -- | -- | 1.00 (0.90-1.00) | 0 (0 – 0.95) | 0.98 (0.86-1.00) |
New foot ulcer | 97.4 | -- | -- | 0.90 (0.76-0.97) | 0 (0 – 0.95) | 0.97 (0.85-0.99) |
Previous amputation | 95.3 | 0.90 (0.07) | Near perfect | 0.88 (0.62-0.98) | 1.00 (0.84-1.00) | 1.00 (0.75-1.00) |
Clinical diagnoses of high-risk factors | ||||||
Neuropathy | 100 | 1.00 (0.01) | Near perfect | 1.00 (0.89-1.00) | 1.00 (0.46-1.00) | 1.00 (0.89-1.00) |
Any PAD | 95.3 | 0.91 (0.06) | Near perfect | 0.91 (0.69-0.98) | 1.00 (0.81-1.00) | 1.00 (0.80-1.00) |
Acute Charcot | 100 | 1.00 (0.01) | Near perfect | 1.00 (0.05-1.00) | 1.00 (0.90-1.00) | 1.00 (0.05-1.00) |
Foot deformity | 93.0 | 0.80 (0.11) | Substantial | 0.97 (0.82-1.00) | 0.80 (0.44-0.96) | 0.94 (0.79-0.99) |
Acute risk classify | 97.7 | -- | -- | 1.00 (0.90-1.00) | 0 (0 – 0.95) | 0.98 (0.86-1.00) |
Clinical diagnoses of foot disease | ||||||
Ulcer type: neuropathic | 83.7 | 0.55 (0.14) | Moderate | 1.00 (0.86-1.00) | 0.46 (0.20-0.74) | 0.81 (0.64-0.91) |
(Neuropathic or neuroisch.) | ||||||
Ulcer type is ischaemic | 79.1 | 0.57 (0.13) | Moderate | 0.74 (0.48-0.90) | 0.83 (0.62-0.95) | 0.78 (0.52-0.93) |
(Neuroisch. or ischaemic) | ||||||
Combined surface area mm2# | 0.99 (0.99–1.00) | Strong | ||||
Any clinical infection | 81.4 | 0.58 (0.13) | Moderate | 0.71 (0.42-0.90) | 0.86 (0.67-0.95) | 0.71 (0.42-0.90) |
UTWCS (Grade 1A) | 81.4 | 0.61 (0.12) | Substantial | 0.86 (0.56-0.97) | 0.79 (0.60-0.91) | 0.69 (0.41-0.86) |
Deep ulcer | 93.0 | 0.73 (0.15) | Substantial | 0.71 (0.30-0.95) | 0.97 (0.84-1.00) | 0.83 (0.36-0.99) |
(Grade 2 or 3)^ | ||||||
Clinical management principles performed | ||||||
Ulcer debridement is required | 95.3 | 0.39 (0.22) | Fair | 1.00 (0.89-1.00) | 0.50 (0.03-0.97) | 0.98 (0.86-1.00) |
Dressing is optimum | 97.7 | -- | -- | 0.98 (0.86-1.00) | -- | 1.00 (0.90-1.00) |
Antibiotics are required | 90.7 | 0.76 (0.11) | Substantial | 0.75 (0.43-0.93) | 0.97 (0.81-1.00) | 0.90 (0.54-0.99) |
Off-loading is optimum | 79.1 | 0.50 (0.14) | Moderate | 0.80 (0.44-0.96) | 0.79 (0.60-0.90) | 0.53 (0.27-0.78) |
Footwear is optimum | 79.1 | 0.47 (0.15) | Moderate | 0.70 (0.35-0.92) | 0.82 (0.64-0.92) | 0.54 (0.26-0.80) |
Educated patient | 100 | -- | -- | 1.00 (0.90-1.00) | -- | 1.00 (0.90-1.00) |