Abstract
A major source of error in reliability of gait analysis arises from the palpation of anatomical landmarks (ALs). The purpose of this study was to investigate whether less reliance on manually identifying ALs could improve inter-assessor reliability of joint kinematics compared to two anatomical models. It was hypothesised that the Strathclyde functional cluster model (SFCM), in which the hip, knee and ankle joint centres and knee and ankle flexion axes were determined by functional methods, would obtain greater inter-assessor reliability. Ten able-bodied participants and seven assessors were recruited. Each participant completed three trials conducted by different assessors on non-consecutive days. Agreement and inter-assessor reliability between the models were compared and analysed, whilst factor effects of assessor experience and body mass index (BMI) were investigated. The SFCM obtained excellent agreement with anatomical models for all sagittal angles and hip ab/adduction angle, and it showed slightly higher inter-assessor reliability with smaller variations in the knee and ankle. The assessor experience was not a significant factor, but the BMI had a significant effect on the inter-assessor reliability. The results demonstrate that the SFCM may be more beneficial for less experienced assessors.
Highlights
Three-dimensional gait analysis is an important clinical tool for understanding pathological movement patterns and evaluating the efficacy of therapeutic interventions
As the correct interpretation of data relies on the ability of the model to detect small variations between measurements, reliable gait assessment is critical for clinical investigations or research studies, especially when multiple measurements are performed by different assessors (McGinley et al 2009)
The results indicate that the application of functional methods for estimating the knee joint centre and ankle joint parameters may contribute to improve the reliability of the ankle joint
Summary
Three-dimensional gait analysis is an important clinical tool for understanding pathological movement patterns and evaluating the efficacy of therapeutic interventions. A major source of kinematic errors in human gait analysis is the identification of superficial anatomical landmarks (ALs) (Della Croce et al 2005; Leardini et al 2005). Inaccurate location of ALs can result in errors in the location of joint centres, alteration of the orientation in anatomical coordinate systems (ACSs) and consequent inaccuracy in joint kinematics and kinetics (Della Croce et al 1999; Stagni et al 2000). The inter-assessor reliability of joint kinematics is largely dependent on the precision of AL position determination. Reduction of these errors related to palpation protocols in identifying the ALs can be obtained by improving the AL identification procedure or using functional methods for the determination of the joint location
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