## 4 Discussion
Moreover, as the physiotherapist conducting the rGMFM-66 was aware of the study's purpose, full blinding was not feasible, which may have introduced a bias toward a shorter assessment duration. Although the rGMFM-66 is a standardized test, using a single clinician may limit variability in administration. Although conducting both assessments on the same day may not be ethically justifiable in pediatric rehabilitation due to the potential burden and fatigue for the children, future studies should, whenever feasible, implement a randomized or counterbalanced design in which the order of GMFM-66 and rGMFM-66 assessments is varied between participants. This would allow for the control of possible order or learning effects and thereby strengthen the robustness of agreement analyses [27]. In future studies, it could be beneficial to consider the potential impact of multiple clinicians on the results. As partial blinding was implemented, the knowledge of the study objective by the assessor conducting the rGMFM-66 may have consciously or unconsciously influenced the test duration. A systematic review and meta-analysis by [PERSON] et al. (2023) found that outcome assessments without blinding are associated with a moderate risk of overestimating positive effects [28]. Future studies should therefore implement full blinding or introduce appropriate control mechanisms to minimize potential bias in administration time. While the rGMFM-66 offers substantial time savings and supports efficient clinical workflows, it is essential to emphasize that AI-based assessments should not replace clinical judgment. The clinical expertise and contextual evaluation by therapists remain indispensable in interpreting motor function. AI tools should be regarded as supportive instruments that aid trained professionals in making nuanced decisions, without serving as a replacement for their expertise. Their implementation requires ethical oversight to ensure transparency, accountability, and the respectful use of patient data, especially when guiding therapeutic decisions or evaluating outcomes [9; 29]. A detailed summary of the key characteristics and differences between the GMFM-66 and the rGMFM-66 is presented in Table 3.  
Although the sample size does not allow for statistically significant comparisons between the individual GMFCS levels, descriptive trends indicate differences in the extent of time savings achieved through the use of the rGMFM-66. Children with higher GMFCS levels (IV and V) tended to benefit particularly from the shortened test duration, as their motor impairments meant they were only able to complete a limited number of test items, which automatically led to a shorter completion time. Children with lower GMFCS levels (I and II), who were able to complete a wider range of items, showed smaller absolute time reductions but also benefited from the structured and focused design of the rGMFM-66 [30]. Future studies with larger samples stratified by GMFCS level are needed to systematically validate these observations. Future directions should include stratified analyses by GMFCS level to more precisely evaluate the applicability and time efficiency of the rGMFM-66 across different functional profiles. While descriptive trends from this study indicate greater time savings in children with higher GMFCS levels, larger and more heterogeneous samples are required to systematically validate these observations [21; 22]. Moreover, although AI-based assessments contribute to efficiency gains, their use must be accompanied by appropriate ethical oversight. Clinical expertise should remain central to decision-making, and the implementation of such tools must ensure transparency and adherence to data protection standards [23; 29; 31]. Future applications of AI-based assessments should ensure ethical oversight, particularly as such tools may indirectly influence how therapists and physicians are evaluated. While AI can support clinical decision-making, it must not replace professional judgment.