Reliability and reference norms of heel-to-toe walking, lateral walking, and step-over walking among young adults: a cross-sectional study

Introduction
Clinimetric properties play an essential part in clinical practice in order to select the appropriate measurement instrument and reference value aid in the evaluation of intervention efficacy and precision of tool. This study aims to establish inter-rater and intrarater reliability as well as normative reference values of heel-to-toe walking, lateral walking, and step-over walking among young adults.

Material and methods
In this cross-sectional study, 400 young adults in the age group between 18 and 25 years were recruited according to the eligibility criteria. All the tests were recorded 3 times with the help of a stopwatch to calculate inter-rater and intra-rater reliability. The mean values were statistically analysed. Kolmogorov Smirnov test was used for the normality of the data. The descriptive statistics are reported as geometric mean (GM) with 95% confidence interval (CI).

Results
Heel-to-toe (ICC = 0.99, Cronbach’s α - 0.994), lateral (ICC = 0.96, Cronbach’s α - 0.988), and step-over walking (ICC = 0.96, Cronbach’s α - 0.987) demonstrated excellent intra-rater reliability. Inter-rater reliability was excellent for heel-to-toe walking (ICC = 0.92, Cronbach’s α - 0.923), lateral walking (ICC = 0.84, Cronbach’s α - 0.846), and step-over walking (ICC = 0.92, Cronbach’s α - 0.929). Reference norms for step-over, heel-to-toe walking, and lateral walking came out to be 24.71s, 35.02s, and 20.09s, respectively.

Conclusions
Findings indicate that heel-to-toe walking, lateral walking, and step-over walking are reliable tests and can be further recommended to measure coordination among young adults