The Gait Outcomes Assessment List for Children with Lower Limb Difference (GOAL-LD) : Assessment of reliability and validity

Journal article


Griffiths, Alison L., Donnan, Leo T., Iobst, Christopher, Kelley, Simon, Bouchard, Maryse and Narayanan, Unni. (2021). The Gait Outcomes Assessment List for Children with Lower Limb Difference (GOAL-LD) : Assessment of reliability and validity. Journal of Pediatric Orthopaedics. 41(7), pp. 450-456. https://doi.org/10.1097/BPO.0000000000001866
AuthorsGriffiths, Alison L., Donnan, Leo T., Iobst, Christopher, Kelley, Simon, Bouchard, Maryse and Narayanan, Unni
Abstract

Background:
The Gait Outcomes Assessment List for children with Lower Limb Difference (GOAL-LD) is a patient and parent-reported outcome measure that incorporates the framework of the International Classification of Functioning, Disability, and Health. This prospective multicenter cohort study evaluates the validity and reliability of the GOAL-LD and the differences between parent and adolescent report.

Method:
One hundred thirty-seven pediatric patients aged over 5 years attending limb reconstruction clinics at the participating sites were assessed at baseline, and a self-selected cohort also completed an assessment 2 to 6 weeks later. Construct and criterion validity were assessed by comparing GOAL-LD scores with a measure of limb deformity complexity (LLRS-AIM) and the Pediatric Outcomes Data Collection Instrument, using Spearman correlation coefficients. Face and content validity were determined through ratings of item importance. Test-retest reliability was reported as an intraclass correlation coefficient and internal consistency using Cronbach α. Adolescent reports were compared with their parents using paired t tests.

Results:
The GOAL-LD demonstrated a moderate negative correlation with the LLRS-AIM (r=−0.40, P<0.001) and was able to discriminate between deformity complexity groups as defined by the LLRS-AIM (χ2=11.43, P=0.022). Internal consistency was high across all domains (α≥0.68 to 0.97). Like domains of the Pediatric Outcomes Data Collection Instrument and the GOAL-LD were well correlated. Parents reported a lower total GOAL-LD score when compared with adolescents (mean difference 3.04; SE 1.06; 95% confidence interval, 0.92-5.16; P<0.01); however this difference was only significant for body image and self-esteem (Domain F) and gait appearance (Domain D). Test-retest reliability remained high over the study period (intraclass correlation coefficient 0.85; SE 0.03; 95% confidence interval, 0.77-0.91).

Conclusions:
The GOAL-LD is a valid and reliable self and parent-reported outcome measure for children with lower limb difference. Parents report a lower level of function and attribute a higher importance to items when compared with their children. The GOAL-LD helps to communicate parent and child perspectives on their function and priorities and therefore has the capacity to facilitate family centered treatment planning and care.

Level of Evidence:
Level II—diagnostic. Prospective cross-sectional and a longitudinal cohort design.

Keywordspediatric; limb deficiency; limb deformity; outcome measure; reliability; validity; assessment
Year2021
JournalJournal of Pediatric Orthopaedics
Journal citation41 (7), pp. 450-456
PublisherLippincott Williams and Wilkins
ISSN0271-6798
Digital Object Identifier (DOI)https://doi.org/10.1097/BPO.0000000000001866
Scopus EID2-s2.0-85110023928
Page range450-456
FunderOrthopaedic Department Research Fund
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online2021
Publication process dates
Deposited24 Nov 2022
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