The development and validity of the Salford Gait Tool: an observation-based clinical gait assessment tool.

OBJECTIVES: To develop the construct, content, and criterion validity of the Salford Gait Tool (SF-GT) and to evaluate agreement between gait observations using the SF-GT and kinematic gait data. DESIGN: Tool development and comparative evaluation. SETTING: University in the United Kingdom. PARTICIPANTS: For designing construct and content validity, convenience samples of 10 children with hemiplegic, diplegic, and quadriplegic cerebral palsy (CP) and 152 physical therapy students and 4 physical therapists were recruited. For developing criterion validity, kinematic gait data of 13 gait clusters containing 56 children with hemiplegic, diplegic, and quadriplegic CP and 11 neurologically intact children was used. For clinical evaluation, a convenience sample of 23 pediatric physical therapists participated. INTERVENTIONS: We developed a sagittal plane observational gait assessment tool through a series of design, test, and redesign iterations. The tool's grading system was calibrated using kinematic gait data of 13 gait clusters and was evaluated by comparing the agreement of gait observations using the SF-GT with kinematic gait data. MAIN OUTCOME MEASURES: Criterion standard kinematic gait data. RESULTS: There was 58% mean agreement based on grading categories and 80% mean agreement based on degree estimations evaluated with the least significant difference method. CONCLUSIONS: The new SF-GT has good concurrent criterion validity.

Inter- and intraobserver repeatability of the Salford Gait Tool: an observation-based clinical gait assessment tool.

OBJECTIVE: To evaluate the inter- and intraobserver repeatability of the Salford Gait Tool (SF-GT), a new observation-based gait assessment tool for evaluating sagittal plane cerebral palsy (CP) gait. DESIGN: Masked comparative evaluation. SETTING: University in the United Kingdom. PARTICIPANTS: A convenience sample of 23 pediatric physical therapists with varying degrees of clinical experience recruited from the Greater Manchester area. INTERVENTION: Participants viewed videotapes of the sagittal plane gait of 13 children and used the SF-GT to analyze their 13 different gait styles on 2 occasions. Eleven children had hemiplegic, diplegic, or quadriplegic CP and 2 were neurologically intact. MAIN OUTCOME MEASURES: Inter- and intraobserver repeatability of hip, knee, and ankle joint positions at 6 different phases of the gait cycle. RESULTS: The SF-GT demonstrated good interobserver (77%) and intraobserver (75%) repeatability. CONCLUSIONS: We have established that the SF-GT is a repeatable clinical assessment tool with which to guide the diagnosis, treatment planning, and evaluation of interventions by pediatric physical therapists of sagittal plane gait deviations in CP.

Cluster analysis for the extraction of sagittal gait patterns in children with cerebral palsy.

Classification of gait disorders would facilitate standardisation of gait management and communication across professional boundaries. In the past, such classification was undertaken using a variety of approaches with often unclear methodology and validation procedures. This study describes the application of hierarchical cluster analysis on sagittal kinematic gait data derived from 56 children with cerebral palsy and 11 neurologically intact children in order to define existing clusters of gait patterns in the children's data. A structured rationale was developed to seek and validate the optimal number of homogenous gait types within the data resulting in 13 different gait clusters that were organised into 'crouch gait type', 'equinus gait type' and 'other gait type'. Applying cluster analysis in combination with visual assessment of gait data and a structured protocol, we have been able to define valid gait groupings.

The status of gait assessment among physiotherapists in the United Kingdom.

OBJECTIVES: To evaluate how physiotherapists are trained in and use clinically orientated gait assessment tools and instrumented gait analysis, and to identify if a need exists for a standardized methodology. DESIGN: Survey. SETTING: UK National Health Service. PARTICIPANTS: Physiotherapists working with a variety of patient groups in 210 randomly selected Health Care Trusts. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Amount of gait assessment training, frequency of gait laboratory use, types and frequency of standardized gait assessment tools used, and expressed need for a gait assessment tool in clinical practice. RESULTS: A total of 1826 (43.5%) physiotherapists responded. Management of abnormal gait constituted a major aspect of physiotherapy practice; yet, there was no systematic use of standardized gait assessment tools. Gait video images were typically collected and analyzed without the use of standardized protocols. Only 23.1% of all respondents had a patient assessed in a gait laboratory. Clinicians indicated that they need training in gait assessment (66.4%) and desire guidance at a national level. Exactly 91.8% of physiotherapists requested a new gait assessment tool that can be used easily and quickly within a busy schedule without compromising reliability and validity. CONCLUSIONS: Gait assessment plays a pivotal role for physiotherapists managing gait problems. The challenge for developers of gait assessment tools is to find a balance between the practicalities of use and scientific merit.