Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy

PURPOSE: Structured visual gait assessment is essential for the evaluation of pediatric patients with neuromuscular conditions. The purpose of this study was to evaluate the benefit of slow-motion video recorded on a standard smartphone to augment visual gait assessment. METHODS: Coronal and sagittal plane videos of the gait of five pediatric subjects were recorded on a smartphone, including four subjects with ambulatory cerebral palsy and one subject without gait pathology. Twenty-one video scorers were recruited and randomized to evaluate slow-motion or normal-speed videos utilizing the Edinburgh Visual Gait Score. The slow-motion group (N = 11) evaluated the videos at one-eighth speed, and the normal-speed group (N = 10) evaluated the same videos at normal speed. Interrater reliabilities were determined by calculating intraclass correlation coefficients for each group as a whole, for each Edinburgh Visual Gait Score item, and after stratification by evaluator experience level. RESULTS: The slow-motion group exhibited an intraclass correlation coefficient of 0.65 (95% confidence interval: 0.58–0.73), whereas the normal-speed group exhibited an intraclass correlation coefficient of 0.57 (95% confidence interval: 0.49–0.65). For less-experienced scorers, intraclass correlation coefficients of 0.62 (95% confidence interval: 0.53–0.71) and 0.50 (95% confidence interval: 0.40–0.59) were calculated for slow motion and normal speed, respectively. For more-experienced scorers, intraclass correlation coefficients of 0.69 (95% confidence interval: 0.61–0.76) and 0.67 (95% confidence interval: 0.58–0.75) were calculated for slow motion and normal speed, respectively. CONCLUSIONS: Visual gait assessment is enhanced by the use of slow-motion smartphone video, a tool widely available throughout the world with no marginal cost. LEVEL OF EVIDENCE: level I, randomized study.