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Hawthorne Effect in Gait Analysis of Children with In-Toeing Caused by Increased Femoral Anteversion

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Abstract

Background

In-toeing is one of the main reasons children are applying to the orthopedics clinic. In the clinical settings, during in-toeing gait assessment parents often define that their child does not walk same at the clinic as at home, linked possibly to Hawthorne effect.

Research Question

How does the in-toeing angle differ when children are aware, versus when they are not aware of their gait inspection?

Methods

This single center, clinical, cross-sectional, observational study looked into the variation in gait pattern of twelve children with in-toeing, with and without their awareness. Two videos for each child was recorded with a smart phone, once at the clinic while aware and once by the family without awareness, and uploaded into Kinovea software for gait analysis. The angle of foot in-toeing was measured and analyzed using SPSS comparison of means and correlations.

Results

The gait pattern evaluated with the angle of in-toeing showed a significant difference between the two videos of the same child. The angle difference returned a p value of 0.000 using paired sample t test and a Cohen’s d value of 1.4, representing the large significance between clinic and family recorded videos. The initial foot in-toeing angle showed a moderate positive Pearson’s correlation of 0.031 when compared with the angle difference in both settings.

Significance

These results highlight the importance of including family recorded videos in gait pattern analysis without the patient’s awareness. The study not only shows the significant difference found which can be explained by Hawthorne Effect but also suggests a clearer path of understanding the child’s condition with the family.

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Funding

This research did not receive any kind of funding.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey

    Ahmet Hamdi Akgülle, Mariam Haidar, Doruk Kaan Baştürk, Mert Gündoğdu & Özge Kenis Coşkun

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  1. Ahmet Hamdi Akgülle
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  2. Mariam Haidar
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  3. Doruk Kaan Baştürk
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  4. Mert Gündoğdu
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  5. Özge Kenis Coşkun
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Contributions

MH: The conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of the version to be submitted. DKB: The conception and design of the study, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of the version to be submitted. MG: Acquisition of data, drafting the article, final approval of the version to be submitted. ÖKC: Analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be submitted.

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Correspondence to Ahmet Hamdi Akgülle.

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Conflict of interest

The authors declare no conflicts of interest with respect to the authorship and/or publication of this article. The authors received no financial support for the research and/or authorship of this article.

Ethical review committee statement

This study was approved by the institutional ethics committee (Marmara University Medical School, Ethic Committee for Clinical Research: 09.2020.223).

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Akgülle, A.H., Haidar, M., Baştürk, D.K. et al. Hawthorne Effect in Gait Analysis of Children with In-Toeing Caused by Increased Femoral Anteversion. JOIO 56, 1789–1794 (2022). https://doi.org/10.1007/s43465-022-00729-x

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  • DOI: https://doi.org/10.1007/s43465-022-00729-x

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