Inconsistent Weight-Bearing in Standing Frames for Children with Cerebral Palsy: A Reliability Study Using Objective Force-Plate Monitoring

AIMS: Knowledge is limited on the weight-bearing load in standing frames, potentially leading to variability in therapeutic application and outcomes. This study investigated the inter-rater reliability and agreement of weight-bearing load during repeated standing-frame sessions in the education setting, measured by integrated force-plate devices, in children with cerebral palsy (CP). METHODS: Eighteen children with CP (aged 3-17 years, GMFCS levels III-V) each completed three 10-minute standing-frame sessions: one supervised by a physiotherapist, and two by different education staff. Weight-bearing load was continuously recorded using foot-plate integrated force-plate devices, with the device outputs blinded to the physiotherapist and education staff. Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), and agreement using a modified Bland-Altman approach for multiple observers (Limits of Agreement with the Mean, LOAM). RESULTS: Across all sessions, inter-rater reliability was moderate (ICC = 0.64 [95% CI, 0.39; 0.83]). The modified Bland-Altman analysis revealed wide LOAM (±14.2%), demonstrating substantial between-rater variability for the same child. CONCLUSIONS: Weight-bearing load during standing-frame use showed moderate inter-rater reliability but wide limits of agreement, indicating inconsistency in clinical practice. Incorporating objective feedback offers a feasible solution for real-time load monitoring and may support standardization; however further research is needed to determine whether such monitoring improves clinical outcomes.