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Investigation of inter-rater and test-retest reliability of Y stability take a look at in school college students with versatile flatfoot | BMC Sports activities Science, Drugs and Rehabilitation

Examine design

This cross-sectional observational research was performed between September 10 and October 20, 2023, at Beijing Sports activities College, Beijing, China. The research adhered to STROBE pointers.

Pattern measurement calculation

A pattern measurement of a minimum of 30 individuals was calculated prematurely by PASS 2021(NCSS LLC., Kaysville, U.T., USA) to permit for an inter-rater test-retest reliability research that might end in an ICC of a minimum of 0.75, with an anticipated 0.9 and beta of 0.8. alpha was 0.05, and the dropout charge was 10%.


30 Contributors have been recruited from the Beijing Sports activities College by means of bulletins and private referrals. Contributors have been eligible for inclusion in the event that they have been 17  25 years school college students; had navicular drop take a look at > 10 mm; had no historical past of decrease limb harm inside 6 months; had no historical past of surgical procedure on hip, knee, and ankle joints; and had no critical medical situations. Contributors have been excluded if that they had vestibular dysfunction or different illnesses that affected stability; taking unknown medication; rheumatoid, neurological, or different causes that affected the hip and knee joints muscle tissue or operate.

Written knowledgeable consent was obtained from the individuals earlier than the beginning of the research. The Sports activities Science Experiment Ethics Committee of Beijing Sport College accredited the research protocol (2,023,154 H). This trial was registered on the Chinese language Scientific Trial Registry (ChiCTR2300075906) on 19/09/2023.

Testing procedures

The Pointers for Reporting Reliability and Settlement Research have been used to implement and report this interrater and test-retest reliability research [26]. To look at the inter-rater and test-retest reliability of the YBT, the extent of settlement and reproducibility have been calculated between the measurements by two totally different raters who have been totally skilled in the usage of YBT. Within the first trial, the participant would carry out 6 follow classes to get rid of the educational impact earlier than the formal YBT-LQ and carry out the take a look at by the rater inside 20 min of the follow session. Subsequently, after a 20-minute break, the take a look at was administered by one other rater. A 14-day interval was set between the take a look at and the retest to stop precise adjustments in dynamic stability skill and reminiscence results.

All raters have been pre-trained and proficient within the testing course of. Hiding take a look at knowledge instantly after completion of the take a look at in order that the rater didn’t have entry to every topic’s earlier rating to attenuate bias. All take a look at knowledge could be double-entered into the pc to make sure correct.

Navicular drop take a look at

The navicular drop take a look at (NDT) was carried out to measure the change in peak of the medial longitudinal arch of the foot. The participant seated in a chair with the knee flexed to 90° and the second toe aligned with the knee in order that the talonavicular joint was in a impartial place. The peak between the bottom and the navicular tuberosity was measured and famous by the evaluator utilizing a vernier caliper. Then, the participant stood up and measured the peak once more. The distinction between the peak of the navicular tubercle within the non-weight-bearing and weight-bearing positions of the foot was calculated. Repeated the take a look at 3 instances on each the appropriate and left sides and take the common worth. Navicular drop exceeding 10 mm was diagnostic of a versatile flatfoot [27].

Leg size measure

Contributors have been instructed to lie in a supine place. They lifted their hips and returned to the beginning place. To ensure the pelvis was in alignment, the participant have been passively straightened the legs. The individuals’ versatile flatfoot aspect leg size was measured centimeters from the anterior superior iliac backbone (ASIS) to essentially the most distal a part of the medial malleolus utilizing a fabric tape. This measurement was used to normalize the maximal attain distance. The leg size measurement was carried out earlier than the primary trial.

Y stability take a look at decrease quarter

The take a look at was carried out by the standardized YBT methodology suggested by Plisky et al. [13]. The trial protocol was performed on the aspect leg with the versatile flatfoot, which was the one distinction from the YBT-LQ. The YBT-LQ was accomplished utilizing the Y Steadiness Check Equipment. Earlier than the take a look at, individuals have been proven the YBT demonstration video and offered detailed directions on tips on how to take it. In accordance with the earlier analysis protocol [28,29,30], the follow section consisted of six trials in three totally different instructions with a view to reduce the educational impact. Contributors carried out the YBT-LQ a minimum of 3 instances and as much as 6 instances in every course after the follow section. All exams have been performed with individuals standing barefoot on the pedals, with their single decrease limb supported by the flatfoot aspect. The distal finish of the second toe of the supporting leg was positioned behind the purple indicator line, and the contralateral decrease limb was prolonged in three instructions, pushing the oblong indicator block so far as doable with the tip of the foot. Then, recorded the studying of the proximal finish of the oblong block to the closest 0.5 cm. The result of that take a look at was deemed invalid if individuals have been (1) unable to controllably return to the beginning place, (2) speed up the oblong block with the outstretched foot to maneuver it farther, (3) contact the bottom with their forefoot, (4) or contact the highest of the oblong block for assist. The maximal attain distance in every course was recorded for the three legitimate exams.

The normalized maximal attain distance per attain course was calculated as follows (Eq. 1) and used as an end result measure. Moreover, Filipa et al. [31] equipped a system (Eq. 2) that was used to find out the normalized composite rating (CS).

$$start{array}{l}Normalized{rm{ }} maximal{rm{ }} attain{rm{ }} distance{rm{ }}left( {% {rm{ }} leg{rm{ }} size{rm{ }}left[ {LL} right]} proper){rm{ }} = {rm{ }}left( {absolute{rm{ }} maximal{rm{ }} attain{rm{ }} distance{rm{ }}left[ {cm} right]} proper){rm{ }}/{rm{ }}LL{rm{ }}left[ {cm} right]){rm{ }} instances {rm{ }} 100% finish{array}$$


$$start{array}{l}Composite{rm{ }} rating{rm{ }}left( {% {rm{ }}LL} proper){rm{ }} = {rm{ }}left{ {left( {AT{rm{ }} + {rm{ }}PM{rm{ }} + {rm{ }}PL} proper){rm{ }}/{rm{ }}left( {leg{rm{ }} size{rm{ }} instances {rm{ }}3} proper)} proper}{rm{ }} instances {rm{ }}100% finish{array}$$


Statistical evaluation

Reliability refers back to the consistency of a take a look at or measurement [32]. Calculating the ICC can reveal relative reliability, which is the diploma to which people preserve their location in a pattern with repeated measurements [33]. The maximal attain distance in every course and composite rating have been calculated as absolute values and values normalized to leg size. The relative reliability of the maximal attain distance in every course and of the composite rating was analyzed by calculating ICC. The inter-rater reliability was decided utilizing the ICC(2,1) and the test-retest reliability was decided utilizing the ICC(3,1).ICC< 0.50 was thought-about “poor”, 0.50<ICC< 0.75 was thought-about “average”, 0.75<ICC< 0.9 was thought-about “good”, and ICC ≥ 0.90 was thought-about “glorious” [24].

Absolutely the reliability of the information was assessed utilizing the usual error of measurement (SEM) that estimates the quantity of error associated to the measurement (Eq. 3). Furthermore, the minimal detectable change (MDC95%) and the smallest worthwhile change(SWC) have been calculated utilizing the system (Eq. 4 and Eq. 5) to make sure the variations between take a look at and re-test measurements have been actual and out of doors the error vary [24, 34]. It’s price mentioning that the research was performed on a inhabitants of school college students with versatile flatfoot, and there have been no strict inclusion necessities for the health standing of the individuals, so the SWC calculated by 0.6 multiplied by SD is related for each excessive and low health degree individuals [34]. For all analyses, the Statistical Package deal for the Social Sciences (SPSS model 27.0) was used (IBM Corp., Armonk, N.Y., USA).

$$SEM = SD * sqrt {1 – {rm{ICC}}}$$


$$MDC95% = 1.96 * sqrt 2 * SEM$$


Bland-Altman plot is an easy and intuitive graphical technique of responding to knowledge settlement. The 95% limits of settlement (LOA) was outlined as two normal deviations above and under the imply of the distinction scores. Plotting the distinction between the YBT-LQ and comparability take a look at values versus the imply of the YBT-LQ and comparability take a look at scores yielded Bland-Altman plots with 95% limits of settlement, which have been used to visually show measurement errors towards true values. Statistical analyses have been carried out utilizing MedCalc, model 19.4 for Home windows (MedCalc Software program, Ostend, Belgium).

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