爱丁堡观察性步态评估量表在脑性瘫痪儿童中的信度与效度检验

关键词：爱丁堡观察性步态评估量表  脑性瘫痪  步态分析  一致性检验

Keywords:Edinburgh visual gait score  cerebral palsy  gait analysis  consistency test

摘要：

      摘要 目的：研究爱丁堡观察性步态评估量表（Edinburgh visual gait score， EVGS）的信度，并与三维步态分析进行比较，评价其有效性；同时分析EVGS各项内部以及与脑性瘫痪（cerebral palsy， CP）儿童粗大运动功能分级系统（gross motor function classification system， GMFCS）的相关性，为EVGS在临床应用提供客观依据。 方法：从2019年至2021年所有在同济大学附属养志康复医院三维步态分析实验室进行三维步态分析的727例痉挛型CP儿童中随机抽取20例CP，分别由4名不同经验背景的评估者采用EVGS对20例CP的步行视频进行评估，并在间隔1个月后再次评估同一视频。采用同类相关系数分析（intragroup correlation coefficient， ICC）检验4名评估者的间信度，以及同一评估者的重测信度；采用Spearman等级相关系数检验EVGS总分及各项与三维步态分析数据和GMFCS之间的相关性。 结果：评估者间第一次评估ICC值为0.947（P<0.001），第二次评估ICC值为0.952（P<0.001），两次评定结果均显示不同评估者对同一组视频采用EVGS的一致性结果较好。各评估者前后两次重测结果显示ICC系数均≥0.75（P<0.0010），表明间隔1个月，同一评估者前后两次评估结果具有较高一致性。相关性分析结果发现，EVGS与三维步态分析结果为中等相关，在校学生评估的总分与校标相关性最大。EVGS与GMFCS等级具有相关性。EVGS各项内相关性分析结果表明，足、骨盆及躯干控制的评估分项对EVGS评估整体步态的结果具有影响。 结论：EVGS量表的评估者间信度以及同一评估者重测信度均具有较高可信性，未有丰富的临床经验背景下的评估者使用EVGS同样可以达到较高信效度。相关性分析结果表明，EVGS评估结果的准确性仍存在不足，EVGS评估结果与CP儿童运动功能障碍水平具有相关性，在设备有限情况下，EVGS可以作为步态分析的替补工具，是目前较为可靠的观察性步态评估量表之一。

Abstract:

      Abstract Objective： To evaluate the reliability of the Edinburgh visual gait score（ECGS） and assess its validity by comparing the results to three-dimensional gait analysis. Additionally, the study examines the correlation between EVGS and gross motor function classification system （GMFCS）. The findings are expected to support the clinical application of EVGS. Method： Twenty children with cerebral palsy（CP） were randomly selected from 727 children who underwent three-dimensional gait analysis at Yangzhi Rehabilitation Hospital between 2019 and 2021.The walking videos of CP were evaluated using EVGS by four evaluators with different experience backgrounds， and repeated by the same evaluators after one month. Intragroup correlation coefficient （ICC） was used to test inter- and intra-evaluator reliability. Spearman was used to test EVGS， three-dimensional gait analysis data and GMFCS. Result： The ICC of the first assessment among evaluators was 0.947 （P<0.001）， the ICC of the second assessment was 0.952 （P<0.001）， indicating high inter- and intra-evaluator reliability. The Spearman correlation analysis results showed a moderate relationship between ECGS and three-dimensional gait data， with poor validity in coronal items. A significant correlation was found between EVGS and GMFCS. Further, the intra-item correlation analysis of EVGS showed that the foot， pelvis and trunk significantly influenced the overall EVGS outcomes. Conclusion： The inter- and intra-evaluator reliability among the four evaluators were highly reliable. The validity of EVGS was lower when compared with three-dimensional gait analysis. However, EVGS were correlated with the motor dysfunction levels in CP. Overall， EVGS can be used as a substitute tool for gait analysis， which is the most reliable visual gait score at present.