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Identifying Clinically Meaningful Tools for Measuring Comfort Perception of Footwear


Medicine & Science in Sports & Exercise: October 2010 - Volume 42 - Issue 10 - p 1966-1971
doi: 10.1249/MSS.0b013e3181dbacc8
Applied Sciences

Purpose: Measures of comfort are important in the prescription and development of footwear. The purpose of our study was to examine three commonly used scales (visual analog scale (VAS), Likert scale, and ranking scale) to determine the most reliable, to calculate a minimal clinically important change in rating scales, and to explore dimensions of comfort important to the patient.

Methods: Twenty subjects were allocated consecutively to two experiments consisting of five sessions of repeated measures. Using comfort measures from each subject's usual jogging shoe, experiment 1 examined the reliability of VAS and Likert scale over six dimensions of the foot, including overall comfort. The second experiment examined the reliability of ranking scale by assessing the ranked position of the shoe. Comfort measures were obtained in both walking and jogging.

Results: The ranking scale was the most stable scale. Mixed linear modeling found that VAS was more stable than the Likert scale. The VAS required two sessions to become reliable for all measures but those obtained from the heel, which required more. Using a data-derived approach, a clinically important change in comfort was 9.59 mm on the 100-mm VAS; using an anchor-based approach, it was 10.2 mm. Subjects identified arch comfort as the most important consideration in footwear comfort.

Conclusions: Ranking scale and VAS are reliable measures of footwear comfort. Using the VAS, changes of 9.59 and 10.2 mm indicate a clinically relevant change in comfort. The most important dimensions to the patient are overall comfort and the arch.

1School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, AUSTRALIA; and 2Department of Physical Therapies, Australian Institute of Sport, Canberra, AUSTRALIA

Address for correspondence: Bill Vicenzino, Ph.D., School of Health and Rehabilitation Sciences, Division of Physiotherapy, The University of Queensland, Brisbane, Queensland 4072, Australia; E-mail:

Submitted for publication November 2009.

Accepted for publication March 2010.

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©2010The American College of Sports Medicine