Psychometric properties of the English language version of the C-BiLLT evaluated in typically developing Canadian children

PURPOSE

This study aimed to 1) investigate the convergent and discriminant validity, internal consistency, and test-retest reliability of the Canadian English version of the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), and 2) explore feasibility of the C-BiLLT assessment for children with cerebral palsy (CP) and complex communication needs in the Canadian health care context.

METHODS

Eighty typically developing children between 1.5 and 8.5 years of age completed the C-BiLLT-CAN, the Peabody Picture Vocabulary Test-IV (PPVT-4), the receptive language sub-test of the New Reynell Developmental Language Scales (NRDLS), and/or the Raven's 2. Correlations between raw scores were calculated for estimates of convergent and discriminant validity. Internal consistency was calculated for all items and separately for items pertaining to vocabulary and grammar. To calculate the standard error of measurement (SEM) and intraclass correlation coefficient (ICC), 33 participants were re-tested with the C-BiLLT within three weeks. Feasibility was explored with nine participants with CP.

RESULTS

C-BiLLT-CAN's convergent validity was good to excellent (Spearman's rho >  0.78) and discriminant validity was higher than hypothesized (Spearman's rho >  0.8). Internal consistency (Cronbach's alpha = 0.96), test-retest reliability (ICC >  0.9), and measurement error (SEM <  5%) were excellent. The feasibility study could not be fully completed due to the COVID-19 pandemic. Preliminary data demonstrated some technical and practical barriers for using the C-BiLLT in children with CP in Canada.

CONCLUSION

The C-BiLLT-CAN demonstrates good to excellent psychometric properties in a sample of typically developing children, indicating that it is an adequate test for measuring language comprehension in English-speaking Canadian children. Further research is needed to investigate the feasibility of the C-BiLLT-CAN in children with CP.

Implementing the language comprehension test C-BiLLT: a qualitative description study using the COM-B model of behaviour change

Background

It is challenging to reliably assess the language comprehension of children with severe motor and speech impairments using traditional assessment tools. The Computer Based instrument for Low motor Language Testing (C-BiLLT) aims to reduce barriers to evidence-based assessment for this population by allowing children to access the test using non-traditional methods such as eye gaze so they can independently respond to test items. The purpose of this study is to develop a contextualized understanding of the factors that influenced clinicians’ implementation of the C-BILLT in practice in the Netherlands and Norway.

Materials and methods

A qualitative approach including semi-structured individual interviews with 15 clinicians (speech-language pathologists, neuropsychologists, and one teacher, counsellor, and vision specialist) was used. Data analysis was conducted in two rounds. First, a deductive approach including a codebook was used to code data within the COM-B components describing clinicians’ capability, opportunity, and motivation for behaviour change. Then, an abductive approach applying thematic analysis was used to identify meaningful patterns within the COM-B components.

Results

Several meaningful barriers and facilitators were identified across the data. Clinicians used the C-BiLLT with two distinct groups of clients: (1) the population it was originally developed for, and (2) clients that could have also been assessed using a traditional language test. Clinicians working with the first group experienced more, and more complex barriers across all COM-B components, to successful C-BiLLT use than the latter.

Conclusion

This study provides timely insights into the capability, opportunity, and motivation factors important for creating and sustaining assessment behaviour change in clinicians who used or attempted to use the C-BiLLT. Potential tailored intervention strategies aimed at improving implementation of novel assessment tools are discussed and may be helpful for others working to improve service delivery for children with complex needs.

Virtual grand rounds: a new educational approach in social work that benefits long-term care providers and patients in rural Idaho

INTRODUCTION

Nationwide, rural USA is experiencing a shortage of social workers. In rural Idaho, three state-wide non-profit organizations worked together to develop Virtual Grand Rounds (VGRs), a new approach to delivering continuing education to social workers and residential care coordinators, in order to promote their retention in the workforce. This study examined participant satisfaction and the potential for the delivery system to be replicated in other states.

METHODS

Between July 2002 and December 2006, 740 person-hours (359 attendees x 2.06 hours) of continuing education were delivered to resident care coordinators and social workers in 9 sessions of VGRs. In total, 287 evaluation forms (79% return rate) were collected on the quality of the presentation, the presenter's expertise and delivery, the relevance and value of the presentation to the attendee, and the quality of the technology. The questionnaire consisted of 10 questions that aimed to measure participant satisfaction level, using a five-point Likert scale with a comments section.

RESULTS

Programs and presenters received positive scores. Participants approved of the delivery method and the overall satisfaction rating was 4.1. As to whether the information presented would lead to changes in practice, participants responded positively with a score of 3.25.

CONCLUSION

The Telehealth Idaho program contributed to a thorough training for new healthcare employees and for those in rural Idaho unable to attend the annual conference for essential training. Initial successes led to an expansion of the program to include other facility staff, and other topics which provided a new training system and infrastructure. This represents one unique contribution to addressing the rural social workers shortage.

An evaluation of the use of retrospectively acquired preoperative AOFAS clinical rating scores to assess surgical outcome after elective foot and ankle surgery

The use of retrospectively acquired preoperative AOFAS rating scores in clinical research to assess the outcomes of elective foot and ankle surgery has not been validated. The data obtained utilizing this methodology may misrepresent the results and lead to spurious conclusions. This investigation compared preoperative AOFAS Ankle-Hindfoot scores obtained before and after surgery from patients who had undergone elective surgery to determine if retrospectively acquired scores match those collected prospectively. Only two out of 47 patients (4%) recalled identical AOFAS scores. The mean difference between the preoperative scores (preoperative score obtained after surgery minus preoperative score obtained before surgery) was -5.3 points. Fifteen patients (32%) had preoperative scores that differed by 20 points or more. Kappa statistics found little agreement among the five elements that comprised the two preoperative scores when responses obtained before and after surgery were compared to one another. The results suggest that preoperative clinical rating scores obtained after elective surgery are a poor predictor of the patient's preoperative condition and that studies which employ retrospectively acquired preoperative AOFAS clinical rating scores may overestimate the benefit of surgery.