Observer reliability of the Gross Motor Performance Measure and the Quality of Upper Extremity Skills Test, based on video recordings

Abstract

The aim of this study was to examine observer reliability of the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremity Skills Test (QUEST) based on video clips. The tests were administered to 26 children with cerebral palsy (CP; 14 males, 12 females; range 2-13y, mean 7y 6mo), 24 with spastic CP, and two with dyskinesia. Respectively, five, six, five, four, and six children were classified in Gross Motor Function Classification System Levels I to V; and four, nine, five, five, and three children were classified in Manual Ability Classification System levels I to V. The children's performances were recorded and edited. Two experienced paediatric physical therapists assessed the children from watching the video clips. Intraobserver and interobserver reliability values of the total scores were mostly high, intraclass correlation coefficient (ICC) 1,1 varying from 0.69 to 0.97 with only one coefficient below 0.89. The ICCs of subscores varied from 0.36 to 0.95, finding 'Alignment' and 'Weight shift' in GMPM and 'Protective extension' in QUEST highly reliable. The subscores 'Dissociated movements' in GMPM and QUEST, and 'Grasp' in QUEST were the least reliable, and recommendations are made to increase reliability of these subscores. Video scoring was time consuming, but was found to offer many advantages; the possibility to review performance, to use special trained observers for scoring and less demanding assessment for the children.Quality of movement refers to how well a movement is performed. Due to an early disorder in the brain, children with cerebral palsy (CP) often have problems with accomplishment of tasks, as well as impaired quality of movements. Increased quality of movements such as faster speed, improved stability, and a more coordinated movement pattern are considered important in order to improve functional ability and safety, as well as to decrease effort. Better alignment may also prevent secondary muscle and joint problems. A two-dimensional model of therapy based on motor learning principles to promote accomplishment of tasks and activities to prevent secondary problems, has recently been proposed. 1 This is in line with parents' concerns about their children's ability to carry out everyday activities, as well as their movement quality. 2,3 Two complementary measurement tools are available to assess quality of movements in children with CP; the Gross Motor Performance Measure (GMPM) 4 and the Quality of Upper Extremity Skills Test (QUEST). 5 The GMPM was developed to evaluate change in performance over time in gross motor activities such as walking, sitting, and crawling. The QUEST was developed to evaluate change in quality of upper extremity activities such as grasp, weight bearing, and protective extension. The tests are observational and criterion referenced, and the children are compared with themselves over repeated measurements. Both tests have been used as outcome measures in intervention studies. [6][7][8][9][10] Previous studies, primarily performed by the test devel...

The Quality Function Measure: reliability and discriminant validity of a new measure of quality of gross motor movement in ambulatory children with cerebral palsy

“…intraclass correlation coefficients [ICCs] >0.80) with in-person rating by GMPM-experienced raters. [7][8][9] It discriminated among children with 'mild', 'moderate', and 'severe' CP 10 and those judged to be stable versus those showing quality changes; 10 and it detected change with interventions (orthopaedic surgery, rhizotomy, and ankle orthoses). 11,12 The GMPM remains the only published measure that addresses multiple components of quality of gross motor skills for children with CP.…”

“…The format and wording of these new response options were tested with several local physiotherapists after which the revised options were reviewed by 10 physiotherapists from the original consensus group. Given the detail in these item-specific response options and the challenges observed when physiotherapists simultaneously scored the three GMPM attributes/items during in-person GMFM test sessions, 9,14,15 we decided that the QFM would be scored from a video recording of each child's GMFM-66 assessment.…”

“…22 Samples in GMPM reliability studies varied from 25 to 36 participants. [7][8][9] The discriminant validity sample size plan was to work with the responsiveness study sample (i.e. targeting at least 25 children in each GMFCS level).…”

“…24 ICC estimates generally exceeded those from GMPM reliability work with similar samples of children with CP. [7][8][9] This is an important outcome of the redevelopment of QFMs, as we had hoped that by following the recommendations of the GMPM developers, particularly with respect to operationalization All seven assessors had opportunity to do these repeat ratings with three to eight participants. b Two assessors (pair); all seven assessors were involved in an assessment pair with three to six participants.…”

Assessment Tools and Classification Systems Used For the Upper Extremity in Children With Cerebral Palsy

“…The QUEST is administered in a play context. The QUEST has been validated and established as reliable [9,10,16,58]. Publications include evidence of content, construct, and criterion validity; intrarater and interrater reliability; and test-retest reliability.…”