Serkan TAS, Sinem GUNERİ, Bayram KAYMAK, Zafer ERDEN

Diz osteoartritli hastalarda 3-boyutlu yürüme analizi ile gözlemsel yürüme analizi sonuçlarının karşılaştırılması

Amaç: Bu çalışmanın amacı, diz osteoartriti (OA) olan bireylerde, farklı klinik deneyimlere sahip fizyoterapistler tarafından yapılan gözlemsel yürüme analizinin (GYA), klinik kullanımda geçerlik, gözlemci içi ve gözlemciler arası güvenilirlik düzeylerinin araştırılmasıdır. Çalışma planı: Çalışmaya, yaşları 46–81 arasında değişen, klinik ve radyografik incelemeler sonucunda bilateral diz OA’sı tanısı konulan 22 kadın 11 erkek, toplam 33 birey ve bu bireylerin yürüyüşünü gözlemsel olarak değerlendiren 4 fizyoterapist dahil edildi. Fizyoterapistler mesleki deneyimlerine göre 10 yıl üstü ve altı olmak üzere 2 gruba ayrıldı. Bireyler 3-Boyutlu Yürüme Analizi ile değerlendirilirken eş zamanlı olarak video kaydına alındı. Elde edilen video kayıtları klinik deneyimlerine göre 2 farklı gruba ayrılmış fizyoterapistler tarafından en az 6 hafta aralıklar ile iki kez gözlemsel olarak değerlendirildi. GYA 11 kinematik 5 zaman mesafe parametresinden oluşan bir form aracılığıyla yapıldı. Bulgular: Topuk vuruşu fazında ayak bileği dorsifleksiyonu ve orta duruş fazında pelvis rotasyonu parametreleri en düşük geçerlik (r=0.06, p>0.05), gözlemciler arası (ICC:-0.12–0.06) ve gözlemci içi uyumun (ICC:0.30–0.45) kaydedildiği parametrelerdi. En yüksek gözlemci içi ve gözlemciler arası uyum zaman mesafe parametrelerinden adım genişliği, çift adım uzunluğu, tempo ve yürüme hızı parametrelerinde tespit edildi (ICC:0.61–0.80). En yüksek geçerlik duruş fazında pelvik tilt parametresinde bulunurken (r=0.74–0.78, p<0.001), duruş fazı dışında zaman mesafe parametrelerinde orta düzey veya kuvvetli uyum (r=0.52–0.69, p<0.05) olduğu bulundu. Çıkarımlar: Bu çalışmanın sonucunda GYA ile değerlendirilen zaman mesafe parametrelerinin orta veya kuvvetli geçerlik ve güvenilirliğe, değerlendirilen kinematik parametrelerin birçoğunun ise düşük veya orta derecede geçerlik ve gözlemciler arası güvenilirliğe, orta veya kuvvetli gözlemci içi güvenilirliğe sahip olduğu bulundu.

Anahtar Kelimeler:

Geçerlik; gözlemsel yürüme analizi; güvenilirlik; osteoartrit; yürüme analizi.

A comparison of results of 3-dimensional gait analysis and observational gait analysis in patients with knee osteoarthritis

Objective: This study aimed to investigate levels of validity, and inter- and intra-observer reliability of observational gait analysis (OGA) in clinical usage, done by the physical therapists with varying clinical experience, in subjects with knee osteoarthritis.Methods: The study included 33 subjects (22 female, 11 male; mean age: 58.24Å}9.14 years range: 46 to 81) clinically and radiographically diagnosed with bilateral knee osteoarthritis, and 4 physical therapists to observe the subjects’ gaits. The physical therapists were separated into two groups according to their professional experience: those with 10 or more years, and those with fewer than 10 years. Video recordings were made of the subjects undergoing three-dimensional gait analysis (3DGA). These recordings were then observationally assessed twice by the participating physical therapists with at least a 6-week interval between observations. OGA was done via a form comprising 11 kinematic and 5 temporo-spatial parameters.Results: Lowest levels of agreement in both validity (r=0.06, p>0.05), and inter- (ICC:–0.12-0.06) and intra-observer (ICC:0.30–0.45) reliability were found in the parameters of ankle dorsiflexion in initial contact phase and pelvic rotation in midstance phase. Highest inter- and intra-observer agreement was found in the temporo-spatial parameters of step width, double step length, cadence and velocity (ICC:0.61–0.80). Highest validity was found in pelvic tilt in stance phase (r=0.74–0.78, p<0.001). With the exception of stance phase, moderate or good agreement (r=0.52–0.69, p<0.05) was found in the temporo-spatial parameters.Conclusion: This study found that OGA assessment of temporo-spatial parameters had moderate or good validity and reliability. Assessment of the majority of kinematic parameters had fair or moderate validity and inter-observer reliabilty, and moderate or good intra-observer reliability.

Keywords:

Gait analysis, observational gait analysis, osteoarthritis, reliabilty validity,

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