Reliability of Movakic; An Instrument to Evaluate Motor Abilities in Children with Severe Multiple Disabilities (Part-II)

Special Article - Pediatric Rehabilitation

Phys Med Rehabil Int. 2015; 2(9): 1069.

Reliability of Movakic; An Instrument to Evaluate Motor Abilities in Children with Severe Multiple Disabilities (Part-II)

Mensch SM1,2,5*, Rameckers EAA3,4,5, Echteld MA1,6,7 and Evenhuis HM¹

¹Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Centre, The Netherlands

²Ipse de Bruggen, Centre of Expertise in Intellectual Disabilities, The Netherlands

³Department of Rehabilitation Medicine, School for Public Health and Primary care (CAPHRI), Maastricht University, The Netherlands

4Adelante Centre of Expertise in Rehabilitation and Audiology, The Netherlands

5University for Professionals for Paediatric Physical Therapy, AVANSplus, The Netherlands

6Stichting Wetenschap Balans, The Netherlands

7Prisma, Centre of Expertise in Intellectual Disabilities, The Netherlands

*Corresponding author: Sonja M Mensch, Erasmus Medical Centre, Intellectual Disability Medicine, Department of General Practice, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Received: October 16, 2015; Accepted: November 17, 2015; Published: November 20, 2015

Abstract

Aim: ‘MOtor eVAluation of KIds with multiple and Complex disabilities’ (Movakic) is a newly developed Dutch instrument for evaluating motor abilities in children with severe multiple disabilities. We have previously shown that its feasibility and content validity are satisfactory. The aim of this study is to investigate test-retest and inter-rater reliability.

Methods: Children with severe multiple disabilities were scored six times by their own physical therapists at a three month interval, and at baseline by a second therapist familiar with the child in a subset of children. For the purposes of this study, the three-month period in which no event involving the child took place was selected.

Results: Sixty children were recruited. The mean age of the children was 7.7 years (range 2-16), 45% had a cognitive development level <6 months (N=27) and 52% had Gross Motor Function Classification System level V (N=31). Test-retest reliability could be evaluated in 50 children and inter-rater reliability in 19 children. Intraclass correlations were all excellent or good (range .72-.98). Adequate absolute reliability is reflected in a small mean distance of Movakic scores and most respondents’ distances for test and retest were between one standard deviation and zero. Distribution is not related to the score level, although a ceiling effect might be present in score range 90-100.

Conclusion: Movakic is a reliable instrument for measuring motor abilities in children with severe multiple disabilities.

Keywords: Severe multiple disabilities; Motor abilities; Cerebral Palsy GMFCS V; Evaluative instrument; Movakic; Reliability

Abbreviations

Movakic: MOtor eVAluation of KIds with multiple and Complex disabilities; SMD: Severe Multiple Disabilities; GMFCS: Gross Motor Function Classification System; COSMIN: COnsensus-based Standards for the selection of health Measurement Instruments; IQ: Intelligent Quotient; ICF-CY: International Classification of Functioning, Disability and Health for Children and Youth; ICC: intraclass correlation coefficients.

Introduction

Motor abilities are of paramount importance to independent functioning, but are often severely compromised in children with severe multiple disabilities (SMD). Children with SMD suffer from profound intellectual disabilities (IQ <25) and have a level of motor abilities that is comparable to level IV/V on the Gross Motor Function Classification System (GMFCS) for children with cerebral palsy [1,2]. In addition, children with SMD may have multiple sensory disorders and other comorbidities. Usually, physiotherapists are closely involved with stimulation and training of such children, because even subtle improvement of motor abilities can aid these children in developing some degree of control over their environment and may as such improve their quality of life. As in any healthcare profession, physical therapists desire to evaluate the effectiveness of their treatment methods, for which reliable instruments are needed.

However, commonly used instruments for measuring motor abilities in children with disabilities [3] are considered unsuitable for children with SMD. They are unsuitable because of their inclusion of higher GMFCS levels, the requirement of perfect execution of the motor ability, the need for verbal instruction, the use of large-step grading, and the design of items without the application of manual support or use of devices in mind. Therefore, an instrument was needed that fulfills specific suitability criteria [4].

A new instrument named Movakic (MOtor eVAluation of KIds with multiple and Complex disabilities) for measuring and evaluating motor abilities in children with SMD was developed by a Dutch expert focus group and was found to be feasible with good content validity [4]. Before an instrument can be used in clinical or research settings, stability across time and raters should be assessed [5]. Therefore, in this study the test-retest reliability and inter-rater reliability of Movakic were evaluated.

Methods

Participants, selection

Children younger than 18 years with SMD who received care in specialized day-care centers were included. Severe multiple disabilities were defined as profound intellectual disability (IQ<25) in combination with severely impaired motor abilities GMFCS level IV and V [1].

Each of 37 experienced therapists working in the centers, who all had more than 10 years experience with the target population, selected one or two of their own clients. Informed consent by parents or legal representatives was obtained from all participants.

Movakic

Movakic is a questionnaire consisting of items on motor abilities; the complete questionnaire is shown in the appendix of the design article [4]. All terminology used is based on the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) terminology [6]. Motor abilities are distributed over 13 ‘situations’ (Table 1), each representing a client’s body position with or without the use of a device. Within each situation, a cluster of items addresses four groups of motor abilities: maintaining position, activities, changing body position, and moving around. Questions are asked about the extent in which manual support or support from a device was needed, the own activity of the child, and the extent of aiding the child manually i.e. ‘provocation’ of the child with your hands.