Validation of the Malta Gait Scale: A Time-Efficient Tool for Poststroke Assessment

Over 80% of stroke survivors experience walking dysfunction, impacting quality of life. Rehabilitation is crucial for gait recovery, and accurate assessments facilitate tailored programs. While computerized gait analysis is the gold standard, it is costly and requires specialized training, making observational gait analysis (OGA) more common. However, OGA can also be time-consuming. This study validates the Malta Gait Scale (MGS), a concise, illustrated 7-item observational tool using video recordings for gait measurements. The aim is to provide an effective, time-efficient method for gait evaluations by comparing the MGS with the established Wisconsin Gait Scale (WGS) and Gait Assessment Intervention Tool (GAIT), which have 14 and 31 items, respectively. Forty-nine participants were included in a retrospective study to validate the MGS. We evaluated its reliability using weighted Cohen's kappa (κ) for intrarater and interrater reliability. Concurrent validity was assessed by comparing the MGS with the WGS and GAIT scales using Spearman's rho (ρ). The Wilcoxon test assessed the efficacy of the MGS in detecting rehabilitation-induced changes, differentiating healthy from stroke participants, and evaluating time efficiency. The MGS demonstrated almost perfect agreement, with interrater and intrarater κ values of 0.952 and 0.977, respectively. It showed high positive correlations with the WGS and GAIT, with ρ values of 0.898 and 0.877. MGS required an average administration time of 7 min and 29 s, significantly less than the WGS (27 min and 46 s) and GAIT (50 min and 6 s) (p < 0.001). Following rehabilitation, significant improvements were observed in patients using both the MGS and WGS scales (p = 0.018), and the MGS effectively distinguished between healthy individuals and stroke patients (p < 0.001). The MGS is a valid, reliable, and efficient tool for gait assessment in stroke survivors, supporting smartphone use and facilitating rapid measurements in clinical settings where time is critical.