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van Maren-Suir I1, Boonzaaijer M1, Wester P2, Nuysink J1
1HU University of Applied Sciences, Research Group Lifestyle and Health, Institute of Human Movement Studies, Utrecht, Netherlands, 2University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
Background: The Alberta Infant Motor Scale (AIMS) is an elegant, psychometrically strong and widely used observation instrument. Pediatric physical therapists use the instrument to assess gross motor development of infants from birth until independent walking. It is well known that child rearing practices and beliefs differ between societies and cultures, which in turn possibly influence infant motor development. This raises the question whether the (original) Canadian normative values of the AIMS are applicable to infants living in other countries.
Purpose: The AIMS-NL study examined whether the currently used original Canadian normative values of the AIMS are appropriate for infants in The Netherlands.
Methods: This cross-sectional cohort study included 499 Dutch infants in the age of 14 days to 19 month representative of the current Dutch population. Infants with known neuromotor impairments were excluded. Infants were divided in monthly age-groups. A validated eHealth method, the AIMS home-video method, was used for data-collection. The recordings were assessed with the AIMS by four trained researchers/pediatric physical therapists. AIMS scores of the Dutch infants were compared to infants included in the original Canadian norm study (n=2202) matched on age. Data analysis was comparable to the scaling method used in a recent re-evaluation of the Canadian norms (2014). Using the scaling method, 45/58 items met the criterion for stable regression in the original Canadian as well as the Dutch dataset. Standard logistic regression of probability of ´passing´ an item as a function of age (item location) was calculated for each item of the AIMS and compared between the two samples.
Results: 499 home-videos were assessed with the AIMS. 5.8% of the infants had a non-Western ethnic background and 7.6% of the infants were born prematurely. The sequence of AIMS items, i.e. the order of the emergence of milestones was similar between Canadian and Dutch infants. Dutch infants pass 42/45 items at a later age compared to the Canadian infants. The biggest difference was 15.71 weeks for early stepping (item Stand 12): Canadian infants passed this item at a mean age of 50.99 weeks (11.8 months), and Dutch infants at a mean age of 66.70 weeks (15.4 months).
Almost all monthly age groups of Dutch infants show significant lower mean AIMS scores.
Conclusion(s): The Canadian norms are not appropriate for the Dutch population. Dutch infants appear to develop in a similar sequence, but in a slower rate. This raises the question: Which factors are associated to infant motor development and the considerable differences in gross motor development rate of infants?
Implications: The results affect research as well as clinical decisions based on AIMS data, with over-referral and perhaps even unnecessary parental concern and treatment of infants with gross motor developmental delay as a consequence. The advice for paediatric physical therapists is to use the Dutch norms from now on. But still considering the infant as part of its environment and its influences on the motor development, one should use the Dutch norms next to other available diagnostics as family concerns, medical history and clinical tests.
Keywords: normative values, motor development, infants
Funding acknowledgements: This study was supported by The Netherlands Organisation for Scientific Research (NWO) and the Scientific Organisation for Physiotherapy (WCF).
Purpose: The AIMS-NL study examined whether the currently used original Canadian normative values of the AIMS are appropriate for infants in The Netherlands.
Methods: This cross-sectional cohort study included 499 Dutch infants in the age of 14 days to 19 month representative of the current Dutch population. Infants with known neuromotor impairments were excluded. Infants were divided in monthly age-groups. A validated eHealth method, the AIMS home-video method, was used for data-collection. The recordings were assessed with the AIMS by four trained researchers/pediatric physical therapists. AIMS scores of the Dutch infants were compared to infants included in the original Canadian norm study (n=2202) matched on age. Data analysis was comparable to the scaling method used in a recent re-evaluation of the Canadian norms (2014). Using the scaling method, 45/58 items met the criterion for stable regression in the original Canadian as well as the Dutch dataset. Standard logistic regression of probability of ´passing´ an item as a function of age (item location) was calculated for each item of the AIMS and compared between the two samples.
Results: 499 home-videos were assessed with the AIMS. 5.8% of the infants had a non-Western ethnic background and 7.6% of the infants were born prematurely. The sequence of AIMS items, i.e. the order of the emergence of milestones was similar between Canadian and Dutch infants. Dutch infants pass 42/45 items at a later age compared to the Canadian infants. The biggest difference was 15.71 weeks for early stepping (item Stand 12): Canadian infants passed this item at a mean age of 50.99 weeks (11.8 months), and Dutch infants at a mean age of 66.70 weeks (15.4 months).
Almost all monthly age groups of Dutch infants show significant lower mean AIMS scores.
Conclusion(s): The Canadian norms are not appropriate for the Dutch population. Dutch infants appear to develop in a similar sequence, but in a slower rate. This raises the question: Which factors are associated to infant motor development and the considerable differences in gross motor development rate of infants?
Implications: The results affect research as well as clinical decisions based on AIMS data, with over-referral and perhaps even unnecessary parental concern and treatment of infants with gross motor developmental delay as a consequence. The advice for paediatric physical therapists is to use the Dutch norms from now on. But still considering the infant as part of its environment and its influences on the motor development, one should use the Dutch norms next to other available diagnostics as family concerns, medical history and clinical tests.
Keywords: normative values, motor development, infants
Funding acknowledgements: This study was supported by The Netherlands Organisation for Scientific Research (NWO) and the Scientific Organisation for Physiotherapy (WCF).
Topic: Paediatrics; Outcome measurement; Professional practice: other
Ethics approval required: Yes
Institution: University Medical Center Utrecht
Ethics committee: Medical Research Ethics Committee
Ethics number: 17-186/C
All authors, affiliations and abstracts have been published as submitted.
