Within- and Between-Assessor Reliability of Lower-Limb Inter-Joint Coordination During Gait in Individuals With and Without Cerebral Palsy
Bibliographic record
Abstract
Abstract Background Inter-joint coordination plays a key role in walking, particularly in people with cerebral palsy (CP), who experience altered movement patterns. The Continuous Relative Phase (CRP) method quantifies lower-limb coordination by assessing the phase relationships between joints. However, the reliability of CRP measurements during walking in individuals with CP remains unexplored, and may be affected by measurement variability due to marker placement errors, soft tissue artifacts, and natural movement fluctuations. Quantifying this reliability is important for appropriate clinical comparisons. This study aimed to quantify within- and between-assessor reliability of lower-limb CRP measurements in individuals with CP and their non-impaired (NI) peers. Methods CP (n=19, age=18.4±7.3 years, GMFCS I–III) and NI (n=19, age=18.3±11.2 years) individuals completed two gait assessment sessions, each including 3D motion capture of at least 10 walking trials. Two trained assessors independently placed reflective markers and conducted gait analyses. Standard error of measurement (SEM) and minimal detectable change (MDC) were computed for knee-hip and ankle-knee coordination across gait subphases. Findings The SEM and MDC were lower for knee-hip than ankle-knee coordination, suggesting higher measurement reliability for proximal joint coupling. For knee-hip coordination, MDC reached 15.1±0.7°(CP) and 9.3±0.6°(NI) between assessors, and 23.8±3.0°(CP) and 9.1±1.6°(NI) within assessors. For ankle-knee coordination, MDC reached 29.0±2.6°(CP) and 25.0±3.5°(NI) between assessors, peaking at 47.3±10.9°(CP) and 28.6±1.5°(NI) in mid-swing within assessors. Interpretation This study provides the first metrological reference for reliability of CRP-based inter-joint coordination during gait in CP. Results showed poor reliability, emphazing that such measurements must be interpreted with caution. Highlights - Knee-hip showed greater reliability than ankle-knee coordination across gait phases - Cerebral palsy individuals showed higher variability than non-impaired peers The beginning and the end of gait cycle showed the poorest reliability Pre-post comparisons should account for MDC thresholds to avoid misinterpretation
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".