A novel method of presenting kinematic gait analysis data to healthcare professionals : the ‘Traffic lights system'

Abstract

Background: In recent years, the use of instrumented gait analysis has become an important addition to the clinical management of musculoskeletal and neurological conditions. However, its use remains limited by the inability of most healthcare professionals to interpret complex data outputs generated during testing. Aim: The aim of this study was to design and validate a visual method of displaying gait analysis results, one based on the Traffic Lights System (TLS). Methodology: Following the design of this new approach, the TLS was compared to the Traditional Graphical System (TGS) currently employed for the presentation of results in order to ascertain its validity, inter-rater and intra-rater reliability. Gait analysis data outputs from simulated gait patterns were converted from the Traditional Graphical System to the Traffic Lights System. An online form was created and disseminated to healthcare professionals for the comparison of data interpretation of gait analysis results, as portrayed by both the Traditional Graphical System and the newly proposed Traffic Lights System. To obtain validity results, the TLS results were statistically compared to a gold standard response of the Traditional Graphical System obtained via consensus by two experienced gait analysts. Intrarater reliability of the TGS was obtained by comparing results from 2 raters who had prior training in this system, who interpreted the results twice, over a period of 1 month, whilst that of the TLS was established from the results of 1 rater who also responded twice. Inter-rater reliability for both the TLS and the TGS was established by statistically analysing the results of all the raters. Results: Utilising Cronbach’s Alpha, validity results for the TLS were 0.92, even when the rater was untrained. Intra-rater reliability of both systems were high, although that of the TLS was higher (TGS 0.733 to 1.00; TLS 0.867 to 1.00). When comparing results obtained between the interpretation of data output in the TGS vs the TLS, it was noted that the TLS obtained a higher Fleiss Multirater Kappa coefficient, demonstrating the higher inter-rater reliability of this new, proposed approach, even though 64% of individuals had some prior training in the TGS and none of the respondents had prior training in the TLS. The majority of healthcare professionals preferred the Traffic lights System due to its ease of operation and interpretation, when compared to the graphical system. Conclusion: This new proposed system, utilising an untrained rater, has been shown to be valid and has equivalent intra-rater reliability to the TGS utilising trained raters. The TLS also has higher inter-rater reliability than the TGS. Although further studies need to be carried out for the optimisation of this method of displaying visual data, the TRAFFIC LIGHT SYSTEM for reporting of gait analysis data is noted to have a strong potential to become the preferred system of choice by healthcare workers, for the benefit of the patient.