THE INTERRATER AND INTRARATER RELIABILITY OF THE WISCONSIN GAIT SCALE WHEN ADMINISTERED BY PHYSICAL THERAPISTS TO INDIVIDUALS POST-STROKE.

Wellmon R, Campbell SL, Rubertone JA, Ellison MA, King RM, Meduri C, Spatafore AE, Talley JM, and Van Dyke AC. Widener University, Chester, PA.

Purpose: The purpose of this study was to examine the inter and intrarater reliability of the Wisconsin Gait Scale (WGS) when administered by physical therapists to individuals post-stroke. The WGS is comprised of 14 items and was developed specifically to examine gait changes occurring after a stroke. Hip, knee, and ankle kinematics, interlimb movement symmetry, balance/guardedness, assistive device use, and selected temporal and distance gait parameters are examined and quantified using the WGS and observational gait analysis.

Subjects: Thirty licensed physical therapists (mean years of experience = 6.08 ± 4.02 yrs; range = 0.5-14 yrs) and six individuals 5-106 months post-stroke (mean age = 70.33 ± 11.72 years; range 51-82 years) participated in the study. All subjects post-stroke were independent for ambulation.

Methods: Subjects post-stroke were videotaped using four cameras, which provided right and left lateral, anterior, and posterior views of them walking on a level surface. One complete ambulation trial from each subject post-stroke, which included four views of the same trial were selected by the researchers for review by the licensed physical therapists. The videotapes were then shown, in a predetermined order, to the physical therapy participants who used the WGS to examine gait. An opportunity was provided to review the tool and a practice trial was performed using one of the six videotapes. After the practice trial, the therapists (n=30) reviewed and scored the five remaining tapes to establish the interrater reliability of the WGS. Two to three weeks later, a subset of the 30 physical therapists (n=14) reviewed the videotapes a second time to establish intrarater reliability. Analysis: An intraclass correlation coefficient (ICC) was used to examine the interrater and intrarater reliability of the WGS for the summative total score and individual subscale scores.

Results: The ICCs for intrarater, 0.93, and interrater, 0.90, reliability were statistically significant (p < .001). ICCs for sub-scale scores were all statistically significant (p < .001) and ranged from 0.22-0.89 for intrarater reliability and 0.24-0.93 for interrater reliability.

Conclusions: This study demonstrated that the inter and intrarater reliability of the WGS was high when administered by licensed physical therapists.

Clinical Relevance: With minimal training, the physical therapists in the study were able to produce highly reliable results using the WGS. This tool is readily available for clinical use and is a promising outcome measure for physical therapists to use when analyzing the gait of individuals post-stroke. The WGS provides therapists with an objective means to document the findings from observational gait analysis, which is an approach frequently, used in clinical settings to examine gait.

Paper presented at the American Physical Therapy Association 2003 Combined Sections Meeting, Tampa, FL.