Measurement properties of the box and block test in children with unilateral cerebral palsy

Abstract

This study aimed to examine the reliabilities (test–retest reliability and measurement error), construct validity, and the interpretability (minimal clinically important difference) of the Box and Block Test (BBT) to interpret test scores precisely for children with UCP. A total of 100 children with UCP were recruited and 50 children from the whole sample assessed the BBT twice within 2-week interval. The BBT, the Melbourne Assessment 2, the Bruininks–Oseretsky Test of Motor Proficiency, 2nd Edition, and the Pediatric Motor Activity Log Revised were measured before and immediately after a 36-h intensive neurorehabilitation intervention. Measurement properties of the BBT were performed according to the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The test–retest reliability of the BBT was high (intraclass correlation coefficient = 0.98). The measurement error estimated by the MDC95 value was 5.95. Construct validity was considered good that 4 of 4 (100%) hypotheses were confirmed. The interpretability estimated by the MCID ranged from 5.29 to 6.46. The BBT is a reliable and valid tool for children with UCP. For research and clinical applications, an improvement of seven blocks on the BBT is recommended as an indicator of statistically significant and clinically important change.

Assessment of Manual Abilities Using the Box and Block Test in Children with Bilateral Cerebral Palsy

“…Within this frame of reference, the test–retest reliability of the test has already been reported in healthy children and in children with unilateral and bilateral CP [ 14 , 15 ]. A comprehensive study of the psychometric properties of the BBT (construct validity, test–retest reliability, minimal clinically important difference, and interpretability) has been carried out in children with unilateral CP [ 31 ].…”

Children With Bilateral Cerebral Palsy Exhibit Bimanual Asymmetric Motor Deficits and EEG Evidence of Dominant Sensorimotor Hemisphere Overreliance During Reaching

“…A recent study determined that the minimal clinically important difference in unilateral CP was 7 blocks, which was far exceeded by both hands in this study. 35 This cohort with CP also demonstrated slightly more asymmetry than TD in scores across hands, also clinically significant but still probably far more subtle than asymmetries across hands in unilateral CP. A prominent hand preference is an important red flag in early development that may be strongly indicative of unilateral brain or peripheral injury (eg, neonatal stroke or brachial plexus palsy, respectively).…”

Assessment of Upper Extremity Function in People With Stroke Based on the Framework of the ICF: A Narrative Review

“…The time to administer the BBT is less than 5 minutes, and training to administer the BBT is not mandatory. The test-retest reliability and construct validity of the BBT have been verified in diverse populations, including older adults, children, and patients with stroke [ 44 45 46 47 ]. Because a previous study found that the score of the BBT was not sensitive to the change of UE function until 5 weeks after onset for stroke patients in the acute phase [ 48 ], the BBT is an effective tool to identify patterns of change in the hand dexterity of stroke patients in at least the subacute stage.…”