Ekblom Maria, Nyholm Dag, Zetterberg Lena, Laurell Katarina, Virhammar Johan
Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
Department of Women's and Children's Health, Physiotherapy, Uppsala University, Uppsala, Sweden.
Fluids Barriers CNS. 2025 Sep 8;22(1):91. doi: 10.1186/s12987-025-00704-2.
Idiopathic normal pressure hydrocephalus (iNPH) predominantly manifests with gait disturbances, yet clinical assessments are vulnerable to confirmation bias, particularly post-shunt surgery. Blinded video evaluations are a method to enhance objectivity in gait assessment, but their reliability has never been systematically investigated. The aim was to evaluate the inter-rater reliability of blinded gait assessments in iNPH patients and to investigate how these assessments correlate with the Hellström iNPH scale and patient-reported health status following shunt surgery.
Thirty-nine patients (mean age 75.5 years) diagnosed with iNPH between 2019 and 2023 were recorded performing Timed Up and Go (TUG) test before and after shunt surgery. Patients who required a walking aid were excluded. Four specialized raters, blinded to timepoint, evaluated gait pattern and graded improvement. Inter-rater agreement was quantified by Krippendorff's α; Spearman's ρ assessed correlations between graded improvement, Hellström iNPH scale changes, and EuroQol 5-Dimension 5-Level Visual Analogue Scale (EQ-VAS) differences.
Agreement on video graded improvements was strong (α = 0.80, 95% CI: 0.76-0.84), whereas agreement on specific gait patterns was moderate (α = 0.53, 95% CI: 0.43-0.62). Graded improvement scores correlated moderately with changes in the Hellström iNPH scale (ρ = 0.67, p < 0.01) and showed fair correlation with EQ-VAS (ρ = 0.37, p < 0.01).
Blinded video assessments reliably captured postoperative gait improvements in iNPH and showed strong inter-rater agreement. While specific gait pattern ratings were less consistent, combining structured video scoring with clinical scales can improve outcome evaluation. More refined tools are needed to better detect subtle changes in gait and to reflect patient-perceived recovery.
特发性正常压力脑积水（iNPH）主要表现为步态障碍，但临床评估容易受到确认偏倚的影响，尤其是在分流手术后。盲法视频评估是一种提高步态评估客观性的方法，但其可靠性从未得到系统研究。目的是评估iNPH患者盲法步态评估的评分者间信度，并研究这些评估与赫尔斯特伦iNPH量表以及分流手术后患者报告的健康状况之间的相关性。
记录了2019年至2023年间诊断为iNPH的39例患者（平均年龄75.5岁）在分流手术前后进行定时起立行走（TUG）测试的情况。需要助行器的患者被排除。四名专业评分者在不知道时间点的情况下评估步态模式并对改善情况进行分级。评分者间的一致性通过克里彭多夫α系数进行量化；斯皮尔曼ρ系数评估分级改善、赫尔斯特伦iNPH量表变化和欧洲五维健康量表5级视觉模拟量表（EQ-VAS）差异之间的相关性。
视频分级改善的一致性很强（α = 0.80，95%可信区间：0.76 - 0.84），而特定步态模式的一致性为中等（α = 0.53，95%可信区间：0.43 - 0.62）。分级改善评分与赫尔斯特伦iNPH量表的变化中度相关（ρ = 0.67，p < 0.01），与EQ-VAS显示出中等相关性（ρ = 0.37，p < 0.01）。
盲法视频评估可靠地捕捉到了iNPH患者术后的步态改善，并显示出很强的评分者间一致性。虽然特定步态模式的评分不太一致，但将结构化视频评分与临床量表相结合可以改善结果评估。需要更精细的工具来更好地检测步态的细微变化并反映患者感知的恢复情况。
