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Edinburgh Visual Gait Score (EGVS)
Availability
Please visit this website for more information about the instrument: Edinburgh Visual Gait Score (EVGS)
Classification
Supplemental: Cerebral Palsy
Short Description of Instrument
The Edinburgh Visual Gait Score (EVGS) was developed to visually assess gait deviations for ambulatory children with cerebral palsy (CP) (Read et al., 2003). It is a valid and reliable visual gait analyses tool in the clinical setting (Read et al., 2003; del Pilar Duque Orozco et al., 2016).
 
The test consists of 17 observational parameters for each lower extremity that is scored on a 3-point ordinal scale (Read et al., 2003) These observational parameters are captured on coronal and sagittal video recordings (Read et al., 2003; Maathuis et al., 2005; del Pilar Duque Orozco et al., 2016).
Observational Parameters include:
1. Initial Contact in Stance
2. Heel Lift in Stance
3. Max Ankle Dorsiflexion in Stance
4. Hind-foot Varus/Valgus in Stance
5. Foot Rotation in Stance
6. Foot Clearance in Swing
7. Max Ankle Dorsiflexion in Swing
8. Knee Progression Angle in Mid-Stance
9. Peak Knee Extension in Stance
10. Knee Position in Terminal Swing
11. Peak Knee Flexion in Swing
12. Peak Hip Extension in Stance
13. Peak Hip Flexion during Swing
14. Pelvic Obliquity at Mid-Stance
15. Pelvic Rotation at Mid-Stance
16. Peak Sagittal Trunk Position in Stance
17. Maximum Trunk Lateral Shift  
Comments/Special Instructions
ICF Component: Body Functions
Specific ICF Domain: Gait Pattern Function (b 770)
Scoring and Psychometric Properties
Scoring:
The EVGS Three-point ordinal scale:
0 - Normal (within ± 1.5 standard deviations (SD) of normal mean)
1 - Moderate deviation (between 1.5 and 4.5 SD of normal mean)
2 - Marked deviation (greater than 4.5 SD of normal mean)
The maximum total score per lower extremity is 34. (Kearns & Jang, 2019).
 
Psychometric Properties:
Reliability. The EVGS for cerebral palsy has undergone evaluation and validation for intra- and inter-observer reliability for experienced and inexperienced observers in gait analysis (Abe et al., 2022; Viehweger et al., 2010) The complete agreement for inter-observer reliability has been reported to be between 55-96% with kappa values of 0.17-0.96 for all items of EVGS (Read et al. 2003; del Pilar Duque Orozco et al., 2016). Inter-observer reliability across inexperienced observers was noted to be slightly lower than experienced observers in most items at 64% versus 70%, respectively (Ong et al., 2008).
 
Decreased reliability and agreement noted in more proximal segments compared to distal segments in multiple studies (Read et al., 2003; del Pilar Duque Orozco et al., 2016; Ong et al., 2008; Viehweger et al., 2010; Abe et al 2022). Greater agreement between observers was noted for videos reviewed later in the studies (learning effect) and in children of lower GMFCS (del Pilar Duque Orozco et al., 2016; Viehweger et al., 2010).
 
Intra-observer agreement was reported at 64-92% for all items for two observers with no previous experience (del Pilar Duque Orozco et al., 2016) with Read et al., 2003 noting "good" intra-observer reliability. Similar to inter-observer agreement, intra-observer agreement noted to be better in experienced versus inexperienced users (Ong et al., 2008). In a recent study in Japan, both inter- and intra-observer reliability was noted to be good to excellent (Abe et al., 2022).  For longitudinal assessments, intra-observer reliability was significantly better then inter-observer reliability (Maathuis et al., 2005).
 
Validity. The validity (good to excellent) of the EVGS for cerebral palsy has been tested in several studies through comparison with 3D gait analysis (3DGA) data (Read et al., 2003; Ong et al., 2008; del Pilar Duque Orozco et al., 2016). Agreement with 3DGA for 10 of the numerical items in the EVGS was 47-83% for Read et al., while it was found to be between 45-73 % across all 17 areas for Del Pilar Duque Orozco et al., 2006. Ong et al. (2008) reported inexperienced observers having 52% agreement with 3DGA and experienced observers having 64% complete agreement with 3DGA. Abe et al. (2022) reported significant correlation between EVGS and GMFM-66 scores.
  
Concurrent validity with Gillette Gait Index and Gait Profile Score has also been reported (Hillman et al., 2007; Robinson et al., 2015) Minimal detectable change (MDC) has been reported in various studies, ranging from 2.4 to 6.0 (Read et al., 2003; Robinson et al., 2017; Abe et al., 2022).
Rationale/Justification
Strengths: The EVGS has been validated in children with unilateral and bilateral CP. Has also been validated in children with CP at GMFCS level I-III. It is an option for use when the gold standard of instrumented gait analysis is not available. Minimal clinically significant difference useful for evaluating changes over time and/or with interventions has been evaluated and likely to be closer to 6.0 than previously reported lower values.
 
Weaknesses: This is an observational score with 3DGA remaining the gold standard. Experienced observers have a higher reliability than inexperienced observers. Reliability is also better in children with mild CP. Reliability is also better in distal segments (knee and ankle) as compared to proximal segments. For longitudinal studies or repeated measures, reliability is best when the same observer is used for all evaluations. Validation and reliability studies done primarily in USA, Scotland, and Japan without reporting of ethnicity of individuals with CP being analyzed.  
References
Key References:
Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop. 2003 May-Jun;23(3):296-301.
 
Del Pilar Duque Orozco M, Abousamra O, Church C, Lennon N, Henley J, Rogers KJ, Sees JP, Connor J, Miller F. Reliability and validity of Edinburgh visual gait score as an evaluation tool for children with cerebral palsy. Gait Posture. 2016 Sep;49:14-18.
 
Additional References:
Abe H, Koyanagi S, Kusumoto Y, Himuro N. Intra-rater and inter-rater reliability, minimal detectable change, and construct validity of the Edinburgh Visual Gait Score in children with cerebral palsy. Gait Posture. 2022 May;94:119-123.
 
Hillman SJ, Hazlewood ME, Schwartz MH, van der Linden ML, Robb JE. Correlation of the Edinburgh Gait Score with the Gillette Gait Index, the Gillette Functional Assessment Questionnaire, and dimensionless speed. J Pediatr Orthop. 2007 Jan-Feb;27(1):7-11.
 
Maathuis KG, van der Schans CP, van Iperen A, Rietman HS, Geertzen JH. Gait in children with cerebral palsy: observer reliability of Physician Rating Scale and Edinburgh Visual Gait Analysis Interval Testing scale. J Pediatr Orthop. 2005 May-Jun;25(3):268-72.
 
Ong AM, Hillman SJ, Robb JE. Reliability and validity of the Edinburgh Visual Gait Score for cerebral palsy when used by inexperienced observers. Gait Posture. 2008 Aug;28(2):323-6.
 
Robinson LW, Clement N, Fullarton M, Richardson A, Herman J, Henderson G, Robb JE, Gaston MS. The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I-III. Gait Posture. 2015 Feb;41(2):741-3.
 
Robinson LW, Clement ND, Herman J, Gaston MS. The Edinburgh visual gait score - The minimal clinically important difference. Gait Posture. 2017 Mar;53:25-28.
 
Viehweger E, Zürcher Pfund L, Hélix M, Rohon MA, Jacquemier M, Scavarda D, Jouve JL, Bollini G, Loundou A, Simeoni MC. Influence of clinical and gait analysis experience on reliability of observational gait analysis (Edinburgh Gait Score Reliability). Ann Phys Rehabil Med. 2010 Nov;53(9):535-46. English, French.
 
Document last updated June 2024