Rakuwa Villa Ilios, Kyoto, Japan.
Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan.
PLoS One. 2019 Oct 24;14(10):e0224202. doi: 10.1371/journal.pone.0224202. eCollection 2019.
Gait disturbance is a major symptom of idiopathic normal-pressure hydrocephalus (iNPH) and is assessed by raters of different professions or with different degrees of experience. Agreement studies are usually done by two raters or more, and comparisons among multiple groups of raters are rare. In this study, we aimed to examine the agreement among multiple groups of raters on gait patterns and a grading scale through a video-assisted gait analysis in patients with iNPH. Fifteen participants with iNPH were enrolled. Gait was assessed according to seven patterns, including freezing and wide-based gaits. The levels of severity (evident, mild, none) were rated by three groups of raters (two neurosurgeons [DR2], three experienced physiotherapists [PTe3], and two less experienced physiotherapists [PTl2]) through a simultaneous video viewing session. Severity of gait disturbance (GSg) was rated using the Japanese iNPH grading scaleiNPHGS, and Krippendorff alpha was computed to assess agreement, with alpha ≥0.667 indicating good agreement and alpha ≥0.8 indicating excellent agreement. For group comparisons, 84%, not 95%, confidence intervals were applied. Among the seven gait patterns in the first assessment, excellent agreement was observed in wide-based and short-stepped gaits in only DR2. Good agreement was observed in four patterns, but the agreement by two groups was in shuffling and wide-based gait. There were no gait patterns showing good agreement among three groups. In the second assessment, excellent agreement was observed in three patterns but no gait patterns showed good agreement between two groups or more. Learning effect was observed only for standing difficulty in DR2. In contrast, good or nearly good agreement on GSg was observed among the three groups with excellent agreement in two groups. Agreement on gait patterns among the three groups of raters was not high, but agreement on the iNPHGS was high, indicating the importance of a precise description facilitating differentiation between neighboring grades.
步态障碍是特发性正常压力脑积水（iNPH）的主要症状，由不同专业或经验程度的评分者进行评估。通常由两名或更多评分者进行一致性研究，而对多组评分者进行比较的情况较为少见。在本研究中，我们旨在通过视频辅助步态分析检查 iNPH 患者的步态模式和分级量表在多组评分者之间的一致性。共纳入 15 名 iNPH 患者。根据包括冻结步态和宽基底步态在内的七种模式评估步态。三组评分者（两名神经外科医生[DR2]、三名经验丰富的物理治疗师[PTe3]和两名经验较少的物理治疗师[PTl2]）通过同时观看视频进行严重程度（明显、轻度、无）的评分。使用日本 iNPH 分级量表 iNPHGS 对步态障碍严重程度（GSg）进行评分，并计算 Krippendorff alpha 以评估一致性，alpha≥0.667 表示良好一致性，alpha≥0.8 表示极好一致性。对于组间比较，应用 84%，而非 95%的置信区间。在首次评估的七种步态模式中，仅在 DR2 中观察到宽基底和短步步态具有极好的一致性。四种模式表现出良好的一致性，但两组的一致性在于拖曳步态和宽基底步态。没有任何步态模式在三组之间表现出良好的一致性。在第二次评估中，在三种模式中观察到极好的一致性，但两组之间没有任何步态模式表现出良好的一致性。在 DR2 中仅观察到站立困难有学习效应。相反，三组之间对 GSg 的评估具有极好的一致性，其中两组之间的一致性也很好。三组评分者之间的步态模式一致性不高，但对 iNPHGS 的一致性较高，表明需要精确描述以促进相邻等级之间的区分。
