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ORIGINAL ARTICLE Reliability and Validity of Visual Assessments of Gait Using a Modified Physician Rating Scale for Crouch and Foot Contact Tishya A L Wren PhD Susan A Rethlefsen PT Bitte S Healy MS PT K Patrick Do BS Sandra W Dennis PT MS and Robert M Kay MD Abstract This study evaluates the visual assessment of gait using portions of the Physicians Rating Scale PRS Thirty children with pathologic gait were evaluated live and using full and slow speed video Interobserver reliability weighted kappa was 0 57 to 0 74 for foot contact 0 69 to 0 71 for crouch 0 30 to 0 40 for hip flexion 0 57 to 0 65 for knee flexion and 0 42 to 0 52 for dorsiflexion in stance Intraobserver reliability comparing the three conditions was 0 50 to 0 78 for foot contact 0 71 to 0 80 for crouch 0 26 to 0 44 for hip flexion 0 60 to 0 86 for knee flexion and 0 39 to 0 61 for dorsiflexion Observers were correct only 12 to 32 of the time when reporting less than 0 degrees of dorsiflexion and 0 to 29 of the time when reporting more than 20 degrees of hip flexion due to overestimation of hip flexion and underestimation of ankle dorsiflexion These errors could lead some clinicians to presume the presence of contractures that do not actually exist Visual assessment using the PRS does not appear to accurately measure what it is most commonly used to assess ankle position in stance Key Words gait analysis crouch equinus toe walking J Pediatr Orthop 2005 25 646 650 C omputerized gait analysis is becoming more widely used in evaluation and treatment planning for children with gait abnormalities 1 2 Even with the less sophisticated technology available decades ago computerized motion analysis was shown to be more accurate than observational gait analysis for assessment of gait deviations 3 Computerized gait analysis is not available in all communities since it requires specialized equipment and specially trained personnel When computerized gait analysis is not used gait problems are most often assessed

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