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- Title
ZANESLJIVOST KLINIČNE ANALIZE HOJE MED PREISKOVALCI PRI BOLNIKIH PO TRANSTIBIALNI AMPUTACIJI.
- Authors
Zalar, Metka; Ivančič, Janja Polenšek; Drole, Simon; Vesel, Mateja; Podlogar, Veronika; Burger, Helena; Vidmar, Gaj
- Abstract
Background: Patients after lower limb amputation fitted with prosthesis have to learn how to walk and control the movement of prosthesis. In spite of modern prosthetic components, gait deviations in this population are still frequent. The physiotherapists (PTs) performing gait training have to be able to observe different gait abnormalities, understand their causes and try to improve them by using appropriate physiotherapeutic methods. Clinical gait analysis is part of the standard procedure of fitting a new prosthesis. It is therefore important that there is inter-rater agreement between different PTs. Methods: Fifty subjects after transtibial amputation, who had been amputated at least one year ago were recruited from our outpatient clinic. They had no other neurological or musculoskeletal disorders that might influence their gait, had to be able to walk independently with their prosthesis (walking aids were allowed) and had no problems with the prosthesis. Five PTs performed gait assessment; three of them were randomly selected to observe each patient when they got a new prosthesis. Randomisation was balanced so that each PT observed an equal number of subjects. The percentage of agreement between raters was calculated for each gait parameter (which were all dichotomous) Results: The subjects (43 men, 7 women) were on average 65 years old (range 17-91, median 67 years). The mean time since amputation was 11 years (range 1-66, median 4 years); 18 amputations were due to sequelae of diabetes mellitus, 16 due to injury, nine due to peripheral vascular disease, one due to tumour and six due to other reasons. In six minutes, the subjects walked 40 to 760 metres (mean 287 m, median 280 m). Only in five of the 13 observed gait parameters was the percentage of agreement higher than 80%. There was 100% agreement about functionality of gait and 98% of initial contact, 92% about knee hyperextension, 80% about not loading the prosthesis and 78% about loading it. Agreement about whether there was knee valgus during stance phase was better (88%) than about knee varus (62%). The lowest agreement was about gait rhythm (60%) and equality of step length (54%). Conclusions: Inter-rater reliability of clinical gait analysis in people after transtibial amputation between our PTs is not very satisfactory. It is necessarily to define more precisely what the observed parameters mean; it would also be beneficiary to adjust the assessment form accordingly.
- Subjects
LEG amputation; PERIPHERAL vascular diseases; GAIT in humans; ARTIFICIAL legs; PHYSICAL therapy assessment; INTER-observer reliability
- Publication
Rehabilitation / Rehabilitacija, 2019, Vol 18, Issue 1, p30
- ISSN
1580-9315
- Publication type
Article