title: Inter- and intrarater clinician agreement on joint motion patterns during gait in children with cerebral palsy.
abstract: This study aimed to quantify the inter- and intrarater clinician agreement on joint motion patterns in children with spastic cerebral palsy (CP), which were recently specified by a Delphi consensus study. It also examined whether experience with three-dimensional gait analysis (3DGA) is a prerequisite for using the patterns.
  
  
  
  The experimental group consisted of 82 patients with CP (57 males, 25 females; uni-/bilateral CP [n=27/55]; Gross Motor Function Classification System levels I to III; mean age 9y 5mo [range 4y-18y]). Thirty-two clinicians were split into 'experienced' and 'inexperienced' rater groups. Each rater was asked to classify 3DGA reports of 27 or 28 patients twice. Inter- and intrarater agreement on 49 joint motion patterns was estimated using percentage of agreement and kappa statistics.
  
  
  
  Twenty-eight raters completed both classification rounds. Intrarater agreement was 'substantial' to 'almost perfect' for all joints (0.64<ĸ<0.91). Interrater agreement reached similar results (0.63<ĸ<0.86), except for the knee patterns during stance (ĸ=0.49, 'moderate agreement'). Experienced raters performed significantly better on patterns of the knee during stance and ankle during swing.
  
  
  
  Apart from some specific knee patterns during stance and ankle patterns during swing, the results suggested that clinicians could use predefined joint motion patterns in CP with good confidence, even in case of limited experience with 3DGA.
authors.affiliation: Neuromotor Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Nieuwenhuys
authors.affiliation: Neuromotor Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Eirini
authors.initials: E
authors.lastname: Papageorgiou
authors.affiliation: Department of Development and Regeneration, KU Leuven, Leuven, Belgium.|Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Molenaers
authors.affiliation: Faculty of Engineering Science, KU Leuven, Leuven, Belgium.
authors.forename: Davide
authors.initials: D
authors.lastname: Monari
authors.affiliation: Faculty of Engineering Science, KU Leuven, Leuven, Belgium.
authors.forename: Tinne
authors.initials: T
authors.lastname: de Laet
authors.affiliation: Neuromotor Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000145:classification* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000502:physiology; D006282:Health Personnel; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index