Inter-observer agreement and distal pedobarographic asymmetry patterns in trauma-related antalgic and Trendelenburg gait: A pilot study.

Abstract

Observational gait assessment is commonly used in clinical and medicolegal practice, although the reliability in differentiating antalgic and Trendelenburg gait patterns is questionable. This prospective pilot study examined the interobserver agreement in observational gait classification and explored associations between observational gait patterns and distal pedobarographic asymmetry parameters in a trauma-related patient sample. Adult participants with lower-extremity trauma were prospectively enrolled (n = 31). Two observers independently performed blinded observational gait assessments. Pedobarographic measurements were obtained using a standardized protocol, and asymmetry parameters were analyzed by a physiotherapist blinded to observational classifications. Cohen's κ was used to assess inter-observer agreement between the two clinical observers. Pedobarographic measurements were analyzed independently, and exploratory analyses examined associations between inter-limb asymmetry parameters and observational gait classifications. Inter-observer agreement for antalgic gait was low (κ = 0.10; 95 % CI - 0.20 to 0.43), whereas agreement for Trendelenburg gait ranged from fair to moderate. Inter-limb asymmetry in forefoot push-off phase duration showed the strongest exploratory association with observational gait classification (p < 0.001; Cliff's δ =  - 0.89). In this trauma-related pilot sample, observational classification of antalgic and Trendelenburg gait demonstrated limited inter-observer agreement. Distal pedobarographic asymmetry patterns may be associated with observational gait categories; however, in the absence of an independent kinematic reference standard, these results should be interpreted as hypothesis-generating.