DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE CLINICAL ASSESSMENT OF BODY ALIGNMENT FOR POSTURE MANAGEMENT APPROACHES IN CHILDREN WITH CEREBRAL PALSY

F.K. George¹, D.A. Benham², P.L. Gabriel³, D.J. Purton¹

Background: Posture management programs typically utilize positioning equipment to support body alignment in order to prevent musculoskeletal deformity and promote function. Available standardized clinical assessments of body segment alignment for children with CP are limited. To be useful to clinicians and researchers, assessment measures should demonstrate adequate psychometric properties to have clinical meaning.

Purpose: To report the development, and psychometric evaluation of the Clinical Assessment of Body Alignment (CABA) as a measure of body alignment in children with cerebral palsy (CP).

Methods: Tool developed by the primary researcher and evaluated by expert opinion of 283 pediatric physiotherapists.  Participants reviewed items as matching or not to the domain of body alignment. Items with >70% agreement were included. Fleiss’ Kappa examined inter-rater reliability of expert responses. Reliability and construct validity ascertained through thirteen physiotherapists scored the CABA in 5 Children with CP GMFCS I – V from photographs. Eleven therapists rescored the same photos one month later. Intra-class correlation coefficients (ICCs) with 95% confidence intervals examined inter-rater and intra-rater reliability. One-way between subject ANOVA and Tukey HSD test examined constructed validity. Responsiveness evaluated through one physiotherapist scored the CABA in 10 children with CP GMFCS IV (n=5) and V (n=5) examined correlation with and without equipment. Paired sample t-test examined positional criteria. Independent sample t-test compared between GMFCS IV and V.

Results: Tool development resulted in the CABA; a 20 item assessment scoring deviations in alignment 0-3 across lying, sitting and standing. Percentage agreement (>70%) was high for 19 items and good for 1 item (>40%). Clinician's ratings showed overall fair to good agreement (k=.422).  Intra-class correlation coefficients reflecting inter-rater and intra-rater reliability of the CABA were all above 0.90. Construct validity was supported by a significant difference in mean values between GMFCS Levels (F(4,350)=30.03, p< 0.001). Post-hoc tests indicated significant difference between GMFCS levels except levels I-II (p=0.663) and II-III (p=0.770). Responsiveness: Strong significant correlations (r=0.769, p=0.002) were found between score with and without equipment at GMFCS levels. Paired t-test indicated significant differences in measures with equipment between positional criteria (t(9)=20.1, p<0.001). Independent t-tests indicated significant differences in measure with equipment at GMFCS level IV (t(4)=20, p<0.001) and V (t(4)=44, p<0.001).

Conclusion(s): The CABA has been carefully and extensively developed and shown to have excellent validity, reliability and responsiveness properties. This preliminary analysis suggests it is a useful tool for measuring postural alignment in clinical and research settings. The CABA has been shown to be responsive to immediate change in body alignment when posture management equipment is used in children with CP GMFCS IV and V.

Implications: The CABA is a standardized clinical assessment demonstrating excellent validity, reliability and responsiveness to measure body alignment in children with CP.  The CABA offers clinicians and researchers a rigorously developed clinical tool to practically measure body alignment in children with CP.

Funding, acknowledgements: None

Keywords: Measurement, Posture, Cerebral palsy

Topic: Paediatrics: cerebral palsy

Did this work require ethics approval? Yes

Institution: York St John University

Committee: Faculty of Health & Life Sciences Research Ethics Committee

Ethics number: 069011429_George_04032017 and 069011429_George_22092017