title: Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy: Intra-rater reliability and agreement across two repeated sessions.
abstract: The Gait Deviation Index (GDI) and Gait Profile Score (GPS) are the most used summary measures of gait in children with cerebral palsy (CP). However, the reliability and agreement of these indices have not been investigated, limiting their clinimetric quality for research and clinical practice. The aim of this study was to investigate the intra-rater reliability and agreement of summary measures of gait (GDI; GPS; and the Gait Variable Score (GVS) derived from the GPS). The intra-rater reliability and agreement were investigated across two repeated sessions in 18 children aged 5-12 years diagnosed with spastic CP. No systematic bias was observed between the sessions and no heteroscedasticity was observed in Bland-Altman plots. For the GDI and GPS, excellent reliability with intraclass correlation coefficient (ICC) values of 0.8-0.9 was found, while the GVS was found to have fair to good reliability with ICCs of 0.4-0.7. The agreement for the GDI and the logarithmically transformed GPS, in terms of the standard error of measurement as a percentage of the grand mean (SEM%) varied from 4.1 to 6.7%, whilst the smallest detectable change in percent (SDC%) ranged from 11.3 to 18.5%. For the logarithmically transformed GVS, we found a fair to large variation in SEM% from 7 to 29% and in SDC% from 18 to 81%. The GDI and GPS demonstrated excellent reliability and acceptable agreement proving that they can both be used in research and clinical practice. However, the observed large variability for some of the GVS requires cautious consideration when selecting outcome measures.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: helrasmussen@health.sdu.dk.
authors.forename: Helle Mätzke
authors.initials: HM
authors.lastname: Rasmussen
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: zirdennis@hotmail.com.
authors.forename: Dennis Brandborg
authors.initials: DB
authors.lastname: Nielsen
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: niels.w.pedersen@rsyd.dk.
authors.forename: Niels Wisbech
authors.initials: NW
authors.lastname: Pedersen
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: soeren.overgaard@rsyd.dk.
authors.forename: Søren
authors.initials: S
authors.lastname: Overgaard
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: ahlarsen@health.sdu.dk.
authors.forename: Anders
authors.initials: A
authors.lastname: Holsgaard-Larsen
mesh_terms: D001696:Biomechanical Phenomena / Q000502:physiology; D002547:Cerebral Palsy / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results
keywords: Cerebral palsy; Gait Deviation Index; Gait Profile Score; Instrumented gait analysis; Reliability