Wellmon Robert, Degano Amy, Rubertone Joseph A, Campbell Sandra, Russo Kelly A
Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA USA.
Drexel University, College of Nursing and Health Professions, Philadelphia, PA USA.
Arch Physiother. 2015 Oct 5;5:11. doi: 10.1186/s40945-015-0011-z. eCollection 2015.
Often, 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.
Fourteen 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.
Interrater (ICC = 0.83) and intrarater (ICC = 0.91) reliability were both good. The standard error of the measurement (SEM) was 1.47 and the MDC was 4.24. There was no statistically significant difference between the scores on the WGS when comparing the 2 different sessions.
The 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.
通常，针对中风后常见的步态运动学、时间和空间变化的干预措施是基于对行走的观察。能够使用可靠且有效的测量方法客观地识别这些变化并跟踪随时间的改善情况非常重要。威斯康星步态量表（WGS）由14个项目组成，专门用于检查和记录中风后发生的步态变化。本研究的目的是探讨物理治疗师使用WGS检查中风后成年人步态时的评分者间信度、评分者内信度以及最小可检测变化（MDC）。
来自3个不同急性住院康复中心的14名物理治疗师使用WGS对6名中风后成年人的步态录像进行评分。为了最大限度地减少疲劳导致的受试者变异性，使用4台摄像机拍摄的录像提供了在水平表面行走的右侧和左侧侧面、正面和背面视图。每位中风后受试者的一次完整步行试验，包括同一步行试验的4个视图，由持牌物理治疗师使用WGS进行检查。提供了一个机会来复习该工具，并使用分析中未包含的另一盘录像带进行了一次实践试验。在大约21天的间隔内分两次不同时间检查步态，以尽量减少回忆偏倚的影响。组内相关系数（ICC）用于检查WGS的评分者间信度和评分者内信度。
评分者间信度（ICC = 0.83）和评分者内信度（ICC = 0.91）都很好。测量标准误（SEM）为1.47，最小可检测变化（MDC）为4.24。比较两次不同检查时，WGS的评分之间没有统计学上的显著差异。
WGS有望成为一种能使观察性步态分析更可靠的工具。高评分者内信度和低SEM表明，同一评分者在多个检查中使用WGS时该量表是稳定的。评分者间信度的ICC也很好，这表明多名检查者可以有效地使用该工具。经过最少的培训，本研究中的物理治疗师能够使用WGS产生高度可靠的结果，以客观记录步态功能障碍。
