Short CommunicationInter- and intra-rater reliability of the GAITRite system among individuals with sub-acute stroke
Introduction
Walking assessment post-stroke is important to inform physiotherapy intervention [1]. Clinical gait assessment can be facilitated by technology, such as pressure-sensitive mats that detect footfall location and timing during walking [2], [3]. This technology objectively calculates measures such as walking speed (a measure of overall gait function) [4], stride-to-stride variability (a measure of dynamic stability control) [5], and symmetry (a measure of gait quality) [6]. The GAITRite walkway is one such pressure-sensitive mat with good test–retest reliability at comfortable walking speeds among individuals with stroke (intraclass correlation coefficients (ICCs): 0.72–0.98) [7], [8]. Since GAITRite is a computerized assessment tool with semi-automated processing it may be assumed that rater reliability is not a concern. However, many individuals with impaired gait, such as those with stroke, exhibit atypical gait patterns. Use of a gait aid, shuffling steps, and heel or toe drag often requires input by the user for data processing (e.g. deleting a portion of or an entire footfall), which may influence reliability. This study aimed to determine inter- and intra-rater reliability of GAITRite for evaluating spatio-temporal gait characteristics post-stroke.
Section snippets
Participants
This study involved secondary analysis of data collected during routine care at Toronto Rehabilitation Institute. We randomly selected 50 patients from a pool of 195 who completed a walking assessment on admission to in-patient stroke rehabilitation. Three patients were subsequently removed due to an insufficient number of footfalls (<18), and one patient was removed because, upon chart review, diagnosis of recent stroke was not confirmed by neuroimaging. Thus, gait data of 46 patients were
Inter-rater and intra-rater reliability
For inter-rater reliability, the mean ICCs for all gait measures were ≥0.94, except step width, which had ICCs of 0.81 and 0.84 for left and right step width, respectively (Table 2). Velocity, step time and step length had acceptable reliability (ICC lower confidence limit > 0.90). ICCs for intra-rater reliability ranged from 0.77 to >0.99. Velocity, step time and step length displayed excellent intra-rater reliability (>0.90). Intra-rater reliability was lower for left and right step width, with
Discussion
This study suggests that GAITRite demonstrates good inter- and intra-rater reliability for spatio-temporal characteristics of gait post-stroke. Nearly all variables met the reliability criterion for application to patient care (ICC > 0.90), except for step width. Previous studies of test–retest reliability of GAITRite within healthy individuals also found that step width was less reliable than other spatio-temporal characteristics of walking [11], [12]. The authors assumed lower step width
Conclusions
Overall, the results suggest that GAITRite is a reliable assessment tool for most gait measures among individuals with sub-acute stroke. Wherever possible, we recommend that the same rater process all GAITRite data. For clinical applications or large research studies this may not be possible; therefore, we recommend that investigators determine inter-rater reliability for individuals who will be processing gait data and for the specific variables of interest prior to generating clinical reports
Conflict of interest statement
The authors declare no conflict of interest.
Acknowledgements
This study was supported by the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery and the Canadian Institutes of Health Research. The authors acknowledge the support of the Toronto Rehabilitation Institute. Equipment and space have been funded with grants from the Canada Foundation for Innovation, Ontario Innovation Trust and the Ministry of Research and Innovation. The views expressed do not necessarily reflect those of the Ministry.
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