Objective: To determine the reliability of freezing of gait scoring through post-hoc video analysis in raters with a physiotherapy background.

Background: Freezing of gait affects approximately 50% of people with Parkinson’s disease. It has been associated with falls, disability, and poorer quality of life. The recognised standard for evaluating gait freezing is currently the post-hoc analysis of video-recorded gait performance. However, the inter- and intra-rater reliability of this method was previously reported to be poor-to-moderate. As physiotherapists regularly evaluate freezing in clinical practice, this study aimed to determine the reliability of freezing of gait scoring through post-hoc video analysis in raters with a physiotherapy background.

Method: Thirty participants were recruited through snowball sampling (physiotherapy students, n = 10; neurological physiotherapists, n = 10; physiotherapists from other specialisations, n = 10). All participants had to have managed at least one person with Parkinson’s disease. For neurological physiotherapists, a minimum of five years spent in the specialisation was required for eligibility. As the study was fully online, those who had no access to computers were excluded.

Fourteen videos of people with Parkinson’s performing a Timed Up and Go test were presented to participants in a random order. Of these, ten were unique and four were repeated. Participants were required to record frequency and duration of freezing events observed. Unlimited views were allowed. Intraclass correlation coefficient (ICC) and one-way analysis of variance (ANOVA) were used to analyse reliability and between-group differences respectively.

Results: Inter- and intra-rater reliability was excellent across all groups (ICC range: 0.94 – 0.99). A specialisation in neurological physiotherapy was not found to affect reliability. There were significant differences in frequency or duration of freezing events between student and graduate physiotherapist groups for 3 videos (p = 0.002 – 0.04), with the student group recording fewer freezing episodes or shorter freezing duration. This could be related to the difficulties in distinguishing festination from the parkinsonian shuffling gait.

Conclusion: Given the high reliability, the use of post-hoc video analysis by physiotherapists for evaluating freezing of gait is supported. Future studies should prioritise random sampling to facilitate generalisability of these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/are-physiotherapists-reliable-in-their-scoring-of-freezing-of-gait/