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The term diplegia should be enhanced. Part III: inter-observer reliability of the new rehabilitation oriented
R Pascale1, S Perazza, G Borelli
1Division of Child Neurology and Psychiatry, University of Pisa, Pisa, Italy.
Insights
This study confirms a new gait classification for children with spastic diplegic cerebral palsy (CP) is reliable. The classification effectively categorizes walking patterns, aiding clinical and research applications in CP gait analysis.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Spastic diplegic cerebral palsy (CP) significantly impacts gait patterns in children.
- Accurate classification of CP gait is crucial for targeted interventions and research.
- A recent classification system aimed to categorize CP gait into specific patterns.
Purpose of the Study:
- To validate a novel gait classification system for spastic diplegic cerebral palsy.
- To assess the inter-rater reliability of the classification among various scorers.
Main Methods:
- Video recordings of gait from 50 children and adolescents with CP were analyzed.
- Scoring was performed by "maximum experts," ten expert observers, and 206 trained rehabilitation professionals.
- Statistical analysis included Cohen's kappa (k) and intra-class correlation coefficients (ICC).
Main Results:
- High agreement (almost perfect) was observed between "maximum experts" and among expert observers.
- Reliability was good even with one-day trained scorers, with few unclassified cases.
- Observer profession and prior knowledge did not significantly affect reliability.
Conclusions:
- The proposed gait classification for diplegic children is reliable and can be applied using short video recordings.
- This validated classification system shows promise for clinical practice and research in CP.
- Further studies are recommended to fully establish its utility in clinical and research settings.
Aim:
The aim of this study was to validate a recent classification of gait in children with the spastic diplegic form of cerebral palsy (CP) by checking the reliability of different scorers in assigning subject walking performance to one of the four specific patterns described in the classification.
Methods:
The gait patterns of 50 children and adolescents with CP (23 males, 27 females; age range 3-17 years) were selected among patients whose videos were stored in the archives of the Pisa and Reggio Emilia Hospitals. Only video recordings of gait with homogeneous features (duration of at least 90 s, simultaneous recordings on sagittal and frontal views, and other criteria) were taken for examination. The videos were blindly scored using an observational gait scale, at first by two of the authors of the classification system (defined as ''maximum experts''), then by ten expert observers, and finally by 206 professionals of rehabilitation after a one-day training on the classification. Cohen's kappa statistics (k) and intra class correlations (ICC) were calculated.
Results:
Kappa and ICC indicate an almost perfect agreement both between the two maximum experts and among the ten expert observers. Good results were also obtained in the group of one-day trained scorers. Only a few cases were assigned to the ''unclassified'' category. The profession of the observer (doctor or therapist) and previous knowledge of the classification had no significant influence on reliability scores.
Conclusion:
The results suggest that the proposed classification can be reliably applied, even utilizing short video recordings, to arrange diplegic children into different patterns. Further studies are needed to validate the use of this classification system for clinical and research aims.
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