APPLICATION OF THE EDINBURGH VISUAL GAIT SCORE: INTEROBSERVER & INTRAOBSERVER RELIABILITY.

Abstract

Introduction: With the evolution and the complexity of the treatments in cerebral palsy (CP) patients it is essential to assess their outcome using validated tools. Technical analysis offers objective data which may be associated to more subjective functional evaluation and health related quality of life tests. Simplified visual tests were proposed as an alternative to the complex and expensive instrumented three-dimensional gait analysis. The Edinburgh Visual Gait Score (EVGS) was proposed for routine clinical use when complete technical analysis is not available or may represent a part of a global patient evaluation.

The purposes of our study were: 1) to apply a French translation of the EVGS to standard video recordings of a group of independent walking spastic diplegic CP patients 2) to evaluate the intraobserver and interobserver reliability and 3) to compare the results of gait analysis with experienced and inexperienced observers.

Material & methods: A series of ten standard video recordings of spastic diplegic CP patients, acquired during routine clinical gait analysis were examined by eight observers, two times, with two weeks in between the assessments. Observers were selected from following specialties: three paediatric orthopaedic surgeons, one resident in orthopaedic surgery, one neurosurgeon, one physiatrist and two physiotherapists. Observers were separated into two groups according to their experience with gait analysis interpretations. Kappa statistics and intraclass correlation coefficient were calculated.

Results: Better intraobserver and interobserver reliability was observed for foot and knee scores with significant difference between stance and swing phase results. Pelvis, hip and trunk score results were significantly lower. The interobserver reliability for segment scores and the global EVGS showed better results than the intraobserver reliability. The gait analysis experienced observer group showed significantly higher intraobserver and interobserver reliability.

Discussion & conclusion: Our reliability results about the use of the EVGS are close to the results of Read et al. Interestingly we showed a significant difference between the two observer groups. Observers familiar with gait analysis obtained better reliability results. That shows the importance to either be used to clinical gait analysis interpretation including learning the visualisation of the different gait phases, or to benefit of a video analysis training before using the visual score as a standard clinical evaluation tool. For this study we did not use the patient preparation recommendations of the initial authors to improve accuracy of scoring because the possibility to use historic standard videos wanted to be tested. Poor score reliability of the pelvis and hip may be improved. Further studies of multilevel surgery outcome evaluation by visual analysis trained observers are needed to explore clinical changes in CP patients over time.