Influence of gait analysis on decision-marketing for lower extremity surgery

Accuracy and reliability of a new tele-rehabilitation system for administration of the Edinburgh Visual Gait Scale for children with cerebral palsy.


  1. 1. Cerebral Palsy League of Queensland;
  2. 2. Division of Physiotherapy, University of Queensland;
  3. 3. Queensland Children’s Gait Laboratory, Royal Children’s Hospital, Brisbane, Australia

Background: Formal observational gait analysis (OGA) is essential for appropriate management of mobility concerns in children with cerebral palsy (CP). For children and families living in rural areas, travel required to access to this typically metropolitan-based service is expensive and time consuming. New tele-rehabilitation technology has the potential to relieve this burden, if accurate and reliable remote gait assessment processes can be developed.

Objectives: To determine the accuracy and reliability of peforming OGA for children with CP using tele-rehabilitation technology compared with a traditional split-screen technique.

Design: Instrument development and validation study.

Participants: Participants included a prospectively recruited convenience sample of 26 children (16 males, 10 females; age 4-17y; mean 9y6mo) with CP attending routine OGA in a metropolitan facility. Children included had informed parental consent and could walk at least four repetitions fo the 10m laboratory walking track independently. Exclusion criteria were bony or soft tissue surgery in the previous 12 months, or behavioural problems that precluded the ability to walk reliably.

Method: OGA was performed using the Edinburgh Visual Gait Score for Cerebral Palsy (EVGS) via: (1) traditional face-to-face split-screen methodology and (2) a tele-rehabilitation system. Split-screen methodology involved video-recording and subsequent review of footage via a television monitor. The tele-rehabilitation system collected video footage via web cameras, automatically saved the data at both low (bitrate=384Kbit/s) and high (bitrate=56Kbit/s) compression levels and then transferred the data to an independent rater’s computer via the internet. Measurement agreement for EVGS variables was analyzed  between split-screen and tele-rehabilitation method at each compression level using the percentage level of exact agreement (%EA and %EA +_1) and quadratic weighted kappa. Intrarater and interrater reliability was determined using %EA, %EA +_1 and intra-class correlation coefficients (ICCs).

Results: Good to excellent measurement agreement was shown between the traditional split-screen and new tele-rehabilitation Mehtod at low (%EA+_1: 96-100%; %EA: 67-96%; kappa EVGS total 0.98) and high compression (%EA+_1: 94-100%; %EA: 65-92%; kappa EVGS total 0.95). Intrarater reliability was excellent for all Method (split-screen ICC=0.97; tele-rehabilitation low compression ICC=0.98; high compression ICC=0.98). Interrater reliability was lower, but still very good for all Method (split-screen ICC=0.87; tele-rehabilitation low compression, ICC=0.90; high compression, ICC=0.90).

Conclusions: OGA via tele-rehabilitation technology, following data transfer at high or low compression levels, is as reliable as traditional split-screen methodology. Findings support tele-rehabilitation as a modern, cost-effective solution for providing greater equity in health service delivery for children with CP living outside metropolitan areas

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