Interrater and intrarater reliability and minimal detectable change of the Wisconsin Gait Scale when used to examine videotaped gait in individuals post-stroke

Abstract

BackgroundOften, interventions targeting the kinematic and temporal and spatial changes in gait commonly seen after a stroke are based on observations of walking. Having the capacity to objectively identify such changes and track improvements over time using reliable and valid measures is important. The Wisconsin Gait Scale (WGS), which is comprised of 14 items, was developed specifically to examine and document gait changes occurring after a stroke. The purpose of the study was to explore the interrater and intrarater reliability and minimal detectable change (MDC) of the WGS when used by physical therapists to examine gait in adults post-stroke.MethodsFourteen physical therapists from 3 different acute inpatient rehabilitation centers rated videotapes of the gait of 6 adults post-stroke using the WGS. To minimize subject variability from fatigue, videotapes created by using 4 cameras provided right and left lateral, anterior, and posterior views of walking on a level surface. One complete ambulation trial from each subject post-stroke, which included 4 views of the same ambulation trial, was examined by the licensed physical therapists using the WGS. An opportunity was provided to review the tool and a practice trial was performed using an additional videotape not included in the analysis. Gait was examined on 2 different occasions separated by a period of approximately 21 days to minimize the effects of recall bias. Intraclass Correlation Coefficients (ICC) were used to examine the interrater and intrarater reliability of the WGS.ResultsInterrater (ICC = 0.83) and intrarater (ICC = 0.91) reliability were both good. The standard error of the measurement (SEM) was 1.47 and the MDC95 was 4.24. There was no statistically significant difference between the scores on the WGS when comparing the 2 different sessions.ConclusionsThe WGS shows promise as an instrument that can make observational gait analysis more reliable. High intrarater reliability and low SEM suggests that the WGS is stable when administered across multiple sessions by the same rater. The ICC for interrater reliability was also good, which suggests that multiple examiners can effectively use the instrument. With minimal training, the physical therapists in the study were able to produce highly reliable results using the WGS to objectively document gait dysfunction.

Can an observational gait scale produce a result consistent with 3-dimensional gait analysis?: a prospective observational study

“…Higher scores correspond to poorer overall walking performance and more visible gait deviations [5.8]. Good intra-and inter-rater reliability of the WGS was demonstrated by a number of studies [6,8,[15][16][17].…”

“…The WGS has been shown to be accurate and reliable, therefore it can effectively be used to evaluate progress in gait rehabilitation after stroke [5][6][7][8]. The specific items of the scale focus on positions assumed by parts of the lower extremities and joints during the gait cycle, taking into account both the affected and the unaffected leg, which are then compared.…”

“…The specific items of the scale focus on positions assumed by parts of the lower extremities and joints during the gait cycle, taking into account both the affected and the unaffected leg, which are then compared. As a result, the walking pattern is described mainly in terms of gait symmetry [5,8]. Therefore, in the current study the authors decided to apply Symmetry Indexes (SI), calculated based on 3D gait parameters, and to compare the results of equipment-based 3D assessment to those obtained using observational gait analysis performed using the subjective WGS.…”

“…On the other hand, Boudarham et al [13] reported that predictors of walking performance in hemiplegic patients include hip impairment and inadequate knee function, affecting kinematic gait parameters. The WGS enables observational assessment of gait symmetry for such factors as stance time (temporal symmetry), step length (spatial symmetry), hip and knee range of motion (kinematic symmetry) [5,8].…”

Can an Observational Gait Scale Produce a Result Consistent with Symmetry Indexes Obtained from 3-Dimensional Gait Analysis?: A Concurrent Validity Study

“…The WGS consists of four subscales and assesses 14 observable gait parameters occurring during the consecutive gait phases, i.e., stance phase, toe off, swing phase, and heel strike of the affected leg. The WGS has been shown to be accurate and reliable in patients post-stroke, therefore it can effectively be used to evaluate progress in gait rehabilitation after a stroke [3][4][5][6][7][8]. Originally, the WGS was intended to be used as a tool to enable the assessment of effects achieved during a home-based gait training program designed for patients at a chronic stage of recovery post-stroke [3].…”