Inter- and intra-rater reliability of the head-shaft angle in children with cerebral palsy

Abstract

PurposeChildren with cerebral palsy (CP) are at increased risk for hip dislocation. This can be prevented in most cases using surveillance programmes that include radiographic examinations. Known risk factors for hip dislocation include young age, high Gross Motor Function Classification System (GMFCS) level and high migration percentage (MP). The head-shaft angle (HSA) has recently been described as an additional risk factor. The study aim was to determine inter- and intra-rater reliability of the HSA in a surveillance programme for children with CP.MethodsWe included hip radiographs from the CP surveillance programme CPUP in southern Sweden during the first half of 2016. Fifty radiographs were included from children at GMFCS levels II-V, with a mean age of 6.6 (SD 3.2) years. Three raters measured the HSA of one hip (left or right) at baseline and four weeks later; intraclass correlation coefficient (ICC) was used to estimate inter- and intra-rater reliability.ResultsInter- and intra-rater reliability were excellent for the HSA, with ICC 0.92 (95% CI 0.87-0.96) and ICC 0.99 (95% CI 0.98-0.99), respectively.ConclusionThe HSA showed excellent inter- and intra-rater reliability for children with CP, providing further evidence for use of the HSA as an additional factor for identifying risk for further hip displacement or dislocation.

The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V

“…Nevertheless, the good intraobserver and interobserver agreement in our study confirmed the findings of previous studies that HSA measurements are sufficiently reliable in clinical use. 11 , 14 , 21 The strengths of the present study are that it is population-based and longitudinal and that follow-up could be performed in all the patients.…”

The head shaft angle is associated with hip displacement in children at GMFCS levels III-V - a population based study

“…A single observer measured the HSA in all 640 hips. Training in the measurement was given and, reassuringly, Hermanson et al [ 10 ] have reported excellent observer reliability for HSA. The present study is based on the radiographs of children at the time of registration into the CPIPS programme and effects of time or intervention on hip centration or HSA were not considered.…”

Evaluación del seguimiento radiográfico para desplazamiento de cadera en pacientes con parálisis cerebral en el Centro Hospitalario Pereira Rossell

“…El porcentaje de migración de la cabeza femoral se midió según el método de Reimers (4) (figura 1). Dado que la confiabilidad inter e intraobservador es excelente para el ACD con un coeficiente de correlación intraclase (CCI) de 0,92 (95% intervalo de confianza [IC] y un CCI 0,99 (95% IC 0,98-0,99) (19) y la confiabilidad inter e intraobservador del PM es alta (CCI=0,93; 95% IC 0,91-0,95) (20) , la medición fue realizada por un único examinador (21) . En relación con el cálculo de CPUP Score (17) , este se realizó a través de la aplicación para dispositivos móviles, y se introdujeron manualmente los datos solicitados (GMFCS, edad, valor de PM y ACD) para cada cadera evaluada, arrojando como resultado el riesgo de progresión de migración expresado en porcentaje.…”

“…A los pacientes GMFCS nivel III se les realizó una nueva radiografía de pelvis en promedio a los 23 meses (15-28) posteriores a la radiografía índice. A los GMFCS nivel IV se les realizó a los 27 meses (20-40) y a los pacientes GMFCS V se les realizó a los 25 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”