Evaluation and adaptation of an observation protocol to quantify and define physiotherapeutic actions for children with cerebral palsy
Date
2017
Authors
Dalton, Lindie
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Abstract
Aim: The aim of this study was to evaluate the applicability of an existing
behavioural observation tool and assess whether it could be used to quantify and
define physiotherapeutic actions (PA) as implemented during treatment sessions of
children between the ages of one and 16 years with a diagnosis of Cerebral Palsy
(CP). If the tool was found to be unsuitable a more appropriate measure would
need to be developed.
Method: This study consisted of three phases and was exploratory in nature with
one phase leading to the next.
Phase 1: A panel of experts evaluated the Original Observation Protocol (OOP) by
implementing it on treatment videos of children from different Gross Motor Function
Classification System (GMFCS) levels, thereby testing its usefulness in a different
context to its original intended purpose.
Phase 2: The OOP’s content validity was evaluated with the help of the same panel
of experts. The recommended adaptations were based on the feedback collected
during a series of modified Nominal Group Technique (NGT) sessions.
Phase 3: The Adapted Observation Protocol (AOP) was piloted on five treatment
videos, each with different GMFCS levels, by a sample group of six experienced
physiotherapists (PT’s). Inter-rater and intra-rater reliability were determined to start
unpacking some of the psychometric properties of the AOP.
Results: Phase 1: The mutual exclusivity of the OOP was found to be
unsatisfactory and hence unsuitable for use with older children within the South
African context where adaptation was deemed necessary.
Phase 2: Content validity for an adapted version was established by achieving 80%
agreement between the experts for the inclusion and adaptation of items from the
OOP. The AOP consisting out of three sections was developed as the end result of
this phase.
Phase 3: Some of the preliminary results of the psychometric properties of the AOP
looked promising. In Section 3 a high to very high positive correlation were found
when looking at both inter- and intra-rater reliability for relative duration of the
therapeutic activities across all videos. The ICC values ranged from α= 0.68 to
α=0.94 for the inter-rater reliability and α=0.65 to α=0.99 for the intra-rater reliability
with a confidence level of 95%. In contrast, the incidence of therapeutic activities
scored in Section 3 had slightly lower correlation, ICC ranging from α=0.43 to 0.76.
In Sections 1 and 2 a negligible to moderately positive level of correlation was
predominantly observed. This might be ascribed to a lack of training amongst other
reasons.
Conclusion: Further research is needed to develop the psychometric properties of
the AOP. However, it does have the potential to be a tool that defines and quantifies
therapeutic input in children with CP and an invaluable free resource that can be
implemented across a variety of practice settings within South Africa.
Description
A Dissertation submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of
Master of Science (Physiotherapy).
Johannesburg 2017