Visual judgements of steadiness in one-legged stance: reliability and validity

There is a paucity of information about the validity and reliability of clinicians' visual judgements of steadiness in one-legged stance. Such judgements are used frequently in clinical practice to support decisions about treatment in the fields of neurology, sports medicine, paediatrics and orthopaedics. The aim of the present study was to address the validity and reliability of visual judgements of steadiness in one-legged stance in a group of physiotherapists.

A videotape of 20 five-second performances was shown to 14 physiotherapists with median clinical experience of 6.75 years. Validity of visual judgement was established by correlating scores obtained from an 11-point rating scale with criterion scores obtained from a force platform. In addition, partial correlations were used to control for the potential influence of body weight on the relationship between the visual judgements and criterion scores. Inter-observer reliability was quantified between the physiotherapists; intra-observer reliability was quantified between two tests four weeks apart.

Mean criterion-related validity was high, regardless of whether body weight was controlled for statistically (Pearson's r = 0.84, 0.83, respectively). The standard error of estimating the criterion score was 3.3 newtons. Inter-observer reliability was high (ICC (2,1) = 0.81 at Test 1 and 0.82 at Test 2). Intra-observer reliability was high (on average ICC (2,1) = 0.88; Pearson's r = 0.90). The standard error of measurement for the 11-point scale was one unit.

The finding of higher accuracy of making visual judgements than previously reported may be due to several aspects of design: use of a criterion score derived from the variability of the force signal which is more discriminating than variability of centre of pressure; use of a discriminating visual rating scale; specificity and clear definition of the phenomenon to be rated.