Prospective Evaluation of Antalgic and Trendelenburg Gait Types in Forensic Medicine Practice: Comparison of Observational Assessment and Pedobarographic Gait Analysis Method
Project no. 24041 · Status: Kapanmış · 2022
Summary
<p>In this study, gait disorders, -one of the important topics evaluated by forensic medicine specialists and disability health boards and which are evaluated only observationally in practice- were studied. It was aimed to show the level of agreement between the results of gait evaluations made observationally by two forensic medicine specialists and the results of pedobarographic analysis with video recording and to study the usability of an objective and scientific method in this regard. In our study, cases with a history of lower extremity injury but without any neurologic/congenital disease that may cause gait disturbance were prospectively evaluated. Forensic Medicine Specialist observers evaluated the gait of the cases observationally. Thirty-one patients who were reported to have an antalgic or trendelenburg-type gait disorder by at least one observer were included in the study. Pedobarographic measurements were made by simultaneous two-way video recording of the subjects included in the study. An expert physiotherapist experienced in the use of pedobarography device analyzed the pedobarographic data by watching the video recordings and was asked to report the presence and type of gait disorder. Cohen's Kappa Test was used to determine the level of agreement between the opinions of the observers and the reporting results. The relationship between the reporting results and the data obtained from the pedobarography device in the extremity with a history of trauma was investigated with the Chi-Square Test. The agreement between observers was "poor" for the presence of antalgic gait and "below moderate" for the presence of trendelenburg gait. When the agreement between the results of the observers' assessments and the results of the pedobarographic analysis with video recording was examined, the best agreement was in the moderate to good level of agreement, mostly in the "below moderate level". A strong correlation was found between the results of the expert physiotherapist's report and the asymmetry of the "forefoot push off phase" between the extremities from the pedobarographic data. This data showed an increase on the side of the extremity with a history of injury in trendelenburg-type gait disorder and a decrease in antalgic gait. The diagnostic test performance statistics for this data showed high and statistically significant sensitivity, accuracy at the level of excellent diagnostic power, positive-negative predictive power and selectivity. Even among Forensic Medicine Specialist observers with high and close clinical experience, in terms of typing gait disorders, the fact that the observational evaluation results showed low agreement with each other revealed the subjectivity of this method. Based on the principle of fair reporting in accordance with scientific facts and control, we think that gait disorders should not be evaluated through observation in order to avoid harm to people and institutions, and other malfunctions caused by injury and which by their nature cause gait disorders should be taken into consideration as much as possible. Due to its high diagnostic predictive value, we think that the forefoot push of phase time can be used in the typing of gait disorders and other pedobarographic data can provide meaningful results if they are studied in larger case groups.</p>