Use of an occupational therapy motor performance checklist by a school health service: a pilot study

Psychometric properties of observational tools for identifying motor difficulties - a systematic review

BACKGROUND

Early identification of children with motor difficulties, such as developmental coordination disorder (DCD), is essential. At present only a fraction of children with DCD are identified. The purpose of the study was to systematically review the literature from 1994 to 2017 on observational screening tools and to evaluate the validity, reliability and usability of the questionnaires used.

METHODS

The review of the literature was conducted to synthesize the data from five electronic databases for children aged 6-12 years. The following databases were searched: Academic search Elite (EBSCO), ERIC (ProQuest), MEDLINE (Ovid), PsycINFO (ProQuest), and SPORTDiscus with Full Text (EBSCO). The studies meeting our inclusion criteria were analyzed to assess the psychometric properties and feasibility of the measures.

RESULTS

The literature search retrieved 1907 potentially relevant publications. The final number of studies that met the inclusion criteria of our systematic review was 45. There were 11 questionnaires for parents, teachers and children. None of the questionnaires was valid for population-based screening as the only measurement tool.

CONCLUSIONS

There are many challenges in using initial screening tools to identify children with motor difficulties. Nevertheless, many promising questionnaires are being developed that can provide information on functional skills and limitations across a variety of tasks and settings in the daily lives of children with DCD. The review provides much needed information about the current scales used in many clinical, educational and research settings. Implications for assessing psychometric properties of the developed questionnaires and further research are discussed.

TRIAL REGISTRATION

PROSPERO, CRD42018087532 .

Standardized tests of handwriting readiness: a systematic review of the literature

AIM

To establish if there are psychometrically sound standardized tests or test items to assess handwriting readiness in 5- and 6-year-old children on the levels of occupations activities/tasks and performance.

METHOD

Electronic databases were searched to identify measurement instruments. Tests were included in a systematic review if: (1) participants are 5 and 6 years old, (2) the focus was on handwriting readiness, and (3) the measurement was standardized. In the second step a further electronic search was undertaken for selected relevant measurement instruments to evaluate the content, psychometric properties, and feasibility of these instruments.

RESULTS

The search identified 1113 citations. In the final selection 39 articles with information about 12 tests were included. The content, feasibility, and psychometric properties of these 12 tests were evaluated and none of the instruments was satisfactory, according to the specific criteria.

INTERPRETATION

None of the instruments include all necessary components to evaluate writing readiness. Therefore, the development of an all encompassing assessment is necessary to test handwriting readiness and to make tailored interventions possible.

Use of the motor performance checklist to study motor outcomes in 5-year-olds

AIM

To report findings about the Motor Performance Checklist (MPC) for 5-year-olds, a simple 12-item instrument for assessing gross and fine motor skills, in a research study of neurodevelopmental outcomes after neonatal events.

METHODS

We trained 10 examiners to use the MPC in a study of the outcomes of neonatal jaundice and dehydration in 339 5-year-old children. We compared MPC scores with those on the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), the Beery-Buktenica Developmental Test of Visual-Motor Integration-Fourth Edition (VMI-4), and a standard neurological examination, and compared failure rates on each MPC item across examiners. Parent concerns about their child's development were addressed using the Parent Evaluation of Developmental Status (PEDS).

RESULTS

Children who 'failed' the MPC had 7-10 points lower mean scores on the WPPSI-R subscales (P = 0.001), 9-10 points lower mean scores on the VMI-4 subscales (P = 0.001), and were almost twice as likely to have a 'questionable' neurological examination score (adjusted OR 1.86, 95% CI 1.00-3.53, P = 0.005). On the PEDS, only the concern about the use of arms and hands was significantly associated with MPC failure. We found significant sex differences on four of the 12 MPC items. We also found differences in failure rates by different examiners.

CONCLUSIONS

MPC scores correlated with other measures of neurodevelopment. Because of different failure rates across examiners, examiner terms need to be included if it is used in research studies.

Triaging Patients for Allied Health Services: A Systematic Review of the Literature

Occupational therapists and other allied health clinicians often need to make decisions about the relative urgency of referrals, which patients should be seen first and, in some cases, whether patients require services at all. A systematic review of the literature was conducted to investigate the properties and outcomes of triage systems applied to patients referred to allied health services. Literature was searched through the CINAHL, EMBASE and MEDLINE databases (until March 2008), combining the key elements of ‘allied health’ and ‘triage’. Seven articles were identified that met the inclusion and exclusion criteria, and these were assessed against quality criteria and a process of descriptive synthesis applied for the purpose of analysis and comparison.

The findings indicate that there has been little investigation of the outcomes of allied health triage systems. Studies that have assessed triage systems have focused largely on measurement properties and the majority of these have indicated poor to fair reliability. A first step in introducing allied health triage systems is to establish reliability, involving the patient directly in the assessment process. There is not yet sufficient evidence to recommend any particular triage system for application to allied health services.

Motor performance checklist for 5-year-olds: a tool for identifying children at risk of developmental co-ordination disorder

OBJECTIVE

The aim of this study was to further evaluate the 'Motor Performance Checklist for 5-year-olds', an instrument which had been piloted with some success and reported via this journal in 1996.

METHOD

Both validity and reliability in identifying children in most need of paediatric occupational therapy services was assessed. The Motor Performance Checklist was compared against a chosen 'gold standard' test, The Bruininks-Oseretsky test of Motor Proficiency, in a group of 141 5-year-old children.

RESULTS

Correlations of 0.72 and 0.85 were found between the tests. The checklist was found to have a sensitivity of 83% and a specificity of 98%. Positive predictive validity was found to be 72% and negative predictive validity 99%. Interrater reliability ranged between 0.79 and 0.99 and intrarater reliability was 0.77.

CONCLUSIONS

These results indicate that the Motor Performance Checklist has the potential to assist in identifying children in most need of referral to community occupational therapy services.

Infants with bilirubin levels of 30 mg/dL or more in a large managed care organization

OBJECTIVE

To describe the incidence, etiology, treatment, and outcome of newborns with total serum bilirubin (TSB) levels >or=30 mg/dL (513 micro mol/L).

DESIGN

Population-based case series.

SETTING

Eleven Northern California Kaiser Permanente Medical Care Program hospitals and 1 affiliated hospital.

PATIENTS

Eleven infants with TSB levels of >or=30 mg/dL in the first 30 days after birth, identified using computer databases from a cohort of 111,009 infants born 1995-1998.

OUTCOME MEASURES

Clinical data from the birth hospitalization, rehospitalization, and outpatient visits in all infants; psychometric testing at age 5 (N = 3), neurologic examinations by child neurologists at age 5 (N = 3), or primary care providers (N = 7; mean age: 2.2 years); Parent Evaluation of Developmental Status (N = 8; mean age: 4.2 years).

RESULTS

Maximum TSB levels of the 11 infants ranged from 30.7 to 45.5 mg/dL (525 micro mol/L to 778 micro mol/L; mean: 34.9 mg/dL [597 micro mol/L]). Four were born at 35 to 36 weeks gestation, and 7 were exclusively breastfed. Two had apparent isoimmunization; the etiology for the other 9 remained obscure, although only 4 were tested for glucose-6-phosphate dehydrogenase deficiency and 1 was bacteremic. None had acute neurologic symptoms. All received phototherapy and 5 received exchange transfusions. One infant died of sudden infant death syndrome; there was no kernicterus at autopsy. Two were lost to follow-up but were neurologically normal when last seen for checkups at 18 and 43 months. One child was receiving speech therapy at age 3. There were no significant parental concerns or abnormalities in the other children.

CONCLUSIONS

In this setting, TSB levels >or=30 mg/dL were rare and generally unaccompanied by acute symptoms. Although we did not observe serious neurodevelopmental sequelae in this small sample, additional studies are required to quantify the known, significant risk of kernicterus in infants with very high TSB levels.