Observational gait assessment tools in paediatrics--a systematic review.

Instrumented gait analysis (IGA) is an expensive technique used to objectively detect gait abnormalities in children. Observational gait assessment is considered as a cost effective alternate for IGA in regular clinical practice. This article is aimed at systematically reviewing the available paediatric gait analysis tools and examines their reliability and validity compared to IGA. This review also examines the structure of these tools, their clinical use and limitations. Articles were searched from PubMed, CINHL, AMED, BNI, EMBASE, PEDro and Cochrane library from the earliest record on the database to December 2012. Hand searches were carried out in a few journals. Studies that examined children's gait using a structured assessment tool were included and analysed for their quality, reliability and validity. Pre-established criteria were used to judge the quality of methodology and reliability and validity. Five observational gait tools for children with Cerebral Palsy (CP) and one for children with Downs Syndrome were identified. Nine studies related to children with CP were enrolled for this review. None of the tools have accomplished the level of IGA's consistency. Edinburgh Visual Gait Score (EVGS) was found to have better reliability and validity than the other tools. Very limited studies were available for most of the gait assessment tools therefore their clinical use cannot be judged based on the existing evidence. EVGS was found to have better concurrent validity and reliability and it should be considered to assess CP gait in regular practice. Future work to investigate the use of low cost technology to improve observers' accuracy of EVGS is suggested.