Reliability of walking ability measurements in children with cerebral palsy: A mixed-methods study

Objective This study aimed to compare the reliability of the Timed Up and Go Test (TUG) and 1-Minute Walk Test (1MWT) in children with cerebral palsy (CP); tests were administered by clinically experienced physiotherapists and physiotherapy students. Methods In this mixed-methods study, 30 ambulatory children (mean age: 13 years) with CP were administered TUG and 1MWT by five licensed physiotherapists and 18 physiotherapy students. Results The intraclass correlation coefficient for inter-rater reliability between the physiotherapists and students was 0.99 (95% confidence interval [CI]: 0.98–0.99) for TUG and 0.92 (95% CI: 0.83–0.96) for 1MWT. Α Bland–Altman analysis identified a fixed bias in the negative and positive directions for TUG and 1MWT, respectively. Statistical analysis revealed a proportional bias in TUG. A qualitative analysis showed that while physiotherapists followed the instruction manual and provided clear instructions, the students did not follow the manual and were tense, triggering a negative response from the children. Conclusions The difference in clinical experience of professionals administering the TUG and 1MWT to children with CP impacted measurement outcomes. In contrast to physiotherapy students, more experienced physiotherapists ensured that the child was not anxious, provided clear instructions, and performed measurements as per the manual.