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B. Saale1, D. Fell1, M. Lewis1
1University of South Alabama, Physical Therapy, Mobile, United States
Background: Loss of selective motor control is common in individuals with cerebral injury, and this loss tends to affect multiple joints in the body. Loss of motor control contributes to multiple functional limitations such as difficulty with gait, transfers, and ADLs. Measuring changes in motor control can help guide evaluation, goal setting, and intervention plans.
Current motor control scales tend to be extremity or joint-specific and insensitive to small changes. Unlike the Fugl-Meyer, Trost, and SCALE, the Boyd and Graham scale has a four-point scoring system allowing it to potentially be more sensitive to changes in motor control. This scale was only developed for application to ankle dorsiflexion.4 The Modified Boyd and Graham (mBG) scale was designed by the authors to be applicable to any joint and to more specifically measure the portion of available range with isolated or selective control. Such a measurement tool would capture small changes in motor control by using an expanded scoring system.
Current motor control scales tend to be extremity or joint-specific and insensitive to small changes. Unlike the Fugl-Meyer, Trost, and SCALE, the Boyd and Graham scale has a four-point scoring system allowing it to potentially be more sensitive to changes in motor control. This scale was only developed for application to ankle dorsiflexion.4 The Modified Boyd and Graham (mBG) scale was designed by the authors to be applicable to any joint and to more specifically measure the portion of available range with isolated or selective control. Such a measurement tool would capture small changes in motor control by using an expanded scoring system.
Purpose: The purpose of this study was to determine the intra-rater and inter-rater reliability of the Modified Boyd and Graham Scale.
Methods: Twenty-one raters participated in this study, including two licensed physical therapists with experience in pediatrics, and nineteen third-year physical therapy students. On average, the licensed physical therapists had 18.5 years of experience.
Reviewers were given five minutes to familiarize themselves with the mBG scale. Then, they were shown a video of a patient attempting isolated elbow flexion or isolated knee extension. Six videos of either elbow flexion or knee extension from four different patients were used for this study. Each video was shown for a total of 3 times consecutively.
After watching each video, the therapists scored the patient’s motor control using the mBG scale. Raters viewed each video again one week after the initial scoring to test intra-rater reliability.
Reviewers were given five minutes to familiarize themselves with the mBG scale. Then, they were shown a video of a patient attempting isolated elbow flexion or isolated knee extension. Six videos of either elbow flexion or knee extension from four different patients were used for this study. Each video was shown for a total of 3 times consecutively.
After watching each video, the therapists scored the patient’s motor control using the mBG scale. Raters viewed each video again one week after the initial scoring to test intra-rater reliability.
Results: The intraclass correlation coefficient (ICC) was calculated using SPSS version 25. The inter-rater reliability was calculated using two-way, mixed effects with absolute agreement. For the initial scoring, the inter-rater reliability ICC was 0.50. For scores determined one week later, the inter-rater reliability ICC was 0.60. The intra-rater reliability was determined using two-way, random effects with absolute agreement. The intra-rater reliability ICC was calculated to be 0.98.
Conclusion(s): The inter-rater reliability for the initial scores demonstrated fair reliability, but increased to good reliability after a week. By this time, therapists were more familiar with the scale and had already seen the videos, indicating a possible training effect which could contribute to the increase in inter-rater reliability. The intra-rater reliability was excellent implying that it may be possible for a single rater to consistently use the mBG scale to monitor and document improvement in a patient’s motor control.
Implications: The intra-rater reliability of the mBG scale was excellent implying that it may be possible for a single rater to consistently use the mBG scale to monitor and document improvement in a patient’s motor control. Further research is warranted to determine validity and whether the measure is responsive to change.
Funding, acknowledgements: No funding was received for this research.
Keywords: Motor control, Isolated control, Reliability
Topic: Neurology
Did this work require ethics approval? Yes
Institution: Univerisity of South Alabama
Committee: Institutional Review Board
Ethics number: 18-087
All authors, affiliations and abstracts have been published as submitted.
