Clinician agreement on gait pattern ratings in children with spastic hemiplegia

Area of Science:

• Orthopedics
• Pediatrics
• Rehabilitation Medicine

Background:

• Spastic hemiplegia significantly impacts children's gait patterns.
• Accurate classification of gait deviations is crucial for effective treatment planning.
• The Winters, Gage, and Hicks (WGH) scale is a tool used for classifying these gait patterns.

Purpose of the Study:

• To assess the inter-rater reliability of the Winters, Gage, and Hicks (WGH) classification scale for gait patterns in children with spastic hemiplegia.
• To compare clinician agreement when using 3D instrumented gait analysis reports versus video recordings.
• To evaluate the combined use of kinematic data and video for gait pattern classification.

Main Methods:

• Sixteen clinicians (physiotherapists and orthopedic surgeons) from international gait labs rated gait patterns of 34 children with spastic hemiplegia.
• Clinicians reviewed archived 3D gait analysis reports (kinematic and video data) and video clips.
• Inter-rater agreement was quantified using weighted kappa statistics (wkappa).

Main Results:

• Substantial agreement was found between clinicians when rating gait reports (wkappa = 0.77).
• Agreement was lower for video ratings (wkappa = 0.63) and when comparing reports to videos (wkappa = 0.62).
• Exact agreement for specific gait patterns was sometimes unacceptable, indicating limitations in the current classification categories.

Conclusions:

• The WGH tool demonstrates acceptable agreement among clinicians for classifying spastic hemiplegia gait patterns.
• Using both 3D instrumented gait analysis kinematic data and video recordings concurrently is recommended for optimal WGH scale application.
• Further refinement of the WGH classification scale is necessary to improve its comprehensiveness and accuracy.